bluuebunny/crossref_metadata_2025 huggingface dataset:
Indolent nonprogressive multifocal choroidal lymphoid lesions with late development of systemic lymphoma
Authors: Roya Zandi , Ivy Zhu , Lee M Jampol
Published: May 2024

Purpose:

To report a case of indolent nonprogressive multifocal choroidal lymphoid lesions with late development of pulmonary low-grade B-cell lymphoma after lymphoid lesion regression.

Methods:

Case report.

Results:

A 79-year-old male was followed with ocular and systemic surveillance over a sixteen-year period for unilateral nonprogressive choroidal lesions presumed to be a benign lymphocytic disease of the choroid. Workups for systemic lymphoma and birdshot chorioretinopathy were negative. After sixteen years of observation, the choroidal lesions had largely regressed. Recent diagnosis of atrial fibrillation led to an incidental discovery of a right lower lobe lung lesion measuring 4.5 cm. Computerized tomography-guided biopsy showed low-grade B-cell lymphoma. There was no additional systemic disease detected. The patient underwent right lower lobectomy revealing extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue.

Conclusion:

Patients with indolent nonprogressive multifocal choroidal lymphoid lesions should be monitored regularly for late systemic disease, which although rare, can develop even after years of follow-up.
Dysfunctional intestinal microvascular endothelial cells: Insights and therapeutic implications in gastrointestinal inflammation
Authors: Park Ji Seok , Cresci Gail A. M.
Published: May 2024

The intestinal microvascular endothelium plays a crucial role in orchestrating host responses to inflammation within the gastrointestinal tract. This review delves into the unique aspects of intestinal microvascular endothelial cells, distinct from those of larger vessels, in mediating leukocyte recruitment, maintaining barrier integrity, and regulating angiogenesis during inflammation. Specifically, their role in the pathogenesis of inflammatory bowel diseases, where dysregulated endothelial functions contribute to the disease progression, is reviewed. Furthermore, this review discusses the isolation technique for these cells and commonly used adhesion molecules for in vitro and in vivo experiments. In addition, we reviewed the development and therapeutic implications of a biologic agent targeting the interaction between α4β7 integrin on T lymphocytes and mucosal addressin cellular adhesion molecule-1 on gut endothelium. Notably, vedolizumab, a humanized monoclonal antibody against α4β7 integrin, has shown promising outcomes in inflammatory bowel diseases and other gastrointestinal inflammatory conditions, including chronic pouchitis, immune checkpoint inhibitor-induced colitis, and acute cellular rejection post-intestinal transplantation.
A Multidisciplinary Approach: Management and Rehabilitation of Children With Pediatric Post-COVID-19 Condition
Authors: Noij Lieke , Terheggen-Lagro Suzanne , Muselaers Eefje , Whittaker Elizabeth , Gosling Justine , Brackel Caroline , Oostrom Kim , Alsem Mattijs
Published: May 2024

Post-COVID-19 condition in children is a still largely unknown syndrome with a diverse pattern of symptoms, which can have a major impact on daily life. Currently, there are no evidence-based proven treatments, and the focus is on symptom management and recovery of daily functioning. A multidisciplinary, tailored approach is recommended, with attention to energy management and activity building, where the main goal should be a return to baseline levels of cognitive, physical and social activity.
A Case-Based Review of LVAD Infection by MABC
Authors: Khardori Nancy , Ripley Kathryn , Talt Irene , Pine Carly , Ingemi Amanda , Tin Htwe , Sciortino Christopher
Published: May 2024

We present a review of literature and report a case of left ventricular assist device (LVAD) infection and postsurgical wound infection withMycobacterium abscessuscomplex (MABC) following exposure to sewage and tap water, respectively. The initial infectious process involved the driveline and the deep pocket and progressed to involve LVAD. Prior to availability of culture results, the patient was started on linezolid followed by surgical debridement of driveline site and change of exit site. The debrided tissue grew a smooth and a rough colony variant of MABC. After 2 weeks of imipenem intravenous (IV), tigecycline IV, azithromycin oral (PO), and tedizolid PO, the patient presented to us with worsening of wound status. Antimicrobial therapy was changed to amikacin IV, imipenem IV, and cefoxitin IV along with bedside debridement, removal of 3 sutures, and placement of wound vacuum device. Amikacin IV, imipenem IV, and cefoxitin IV were then replaced with Recarbio (imipenem/cilastatin/relebactam) IV plus amoxicillin PO with significant improvement. The patient underwent LVAD removal and heart transplantation after 5 weeks and was discharged 15 days later. Following showering at home, the patient developed signs of extensive infection involving the surgical wound (chest and abdominal walls). Tigecycline IV and azithromycin IV were started. Imipenem/cilastatin/ relebactam IV plus amoxicillin PO were replaced by bedaquiline PO because of the continued financial burden to the patient. The patent was discharged on bedaquiline PO and azithromycin PO to complete 18 months of antimicrobial therapy at which time he was enjoying a very active lifestyle as he did prior to the diagnosis of advanced heart failure. He continues to do well 2 years 9 months after heart transplantation and more than a year after stopping all antimycobacterial therapy.
The bidirectional relationship between sleep problems and chronic musculoskeletal pain: a systematic review with meta-analysis
Authors: Runge Nils , Ahmed Ishtiaq , Saueressig Tobias , Perea Julya , Labie Celine , Mairesse Olivier , Nijs Jo , Malfliet Anneleen , Verschueren Sabine , Van Assche Dieter , de Vlam Kurt , Van Waeyenberg Tybo , Van Haute Jelle , De Baets Liesbet
Published: May 2024

Chronic musculoskeletal pain and sleep problems/disorders exhibit a recognized bidirectional relationship; yet, systematic investigations of this claim, particularly in a prospective context, are lacking. This systematic review with meta-analysis aimed to synthesize the literature on the prospective associations between sleep problems/disorders and chronic musculoskeletal pain. A comprehensive search across 6 databases identified prospective longitudinal cohort studies in adults examining the relationship between sleep problems/disorders and chronic musculoskeletal pain. Random-effects meta-analyses, using the Hartung–Knapp adjustment for 95% confidence intervals (CIs), were conducted, and all results were presented as odds ratios (ORs). Certainty of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Including 16 articles from 11 study populations (116,746 participants), meta-analyses indicated that sleep problems at baseline may heighten the risk of chronic musculoskeletal pain in both short term (OR 1.64, 95% CI 1.01-2.65) and long term (OR 1.39, 95% CI 1.21-1.59). The evidence for different sleep problem categories was very uncertain. Chronic musculoskeletal pain at baseline may increase the risk of short-term sleep problems (OR 1.56, 95% CI 1.02-2.38), but long-term evidence was very uncertain. The impact of only local or only widespread pain on short-term sleep problems was very uncertain, whereas widespread pain may elevate the risk of long-term sleep problems (OR 2.0, 95% CI 1.81-2.21). In conclusion, this systematic review with meta-analysis suggests that sleep problems are associated with an increased risk of chronic musculoskeletal pain, but the bidirectional nature of this relationship requires further investigation.
The effect of statin treatment on glucose homeostasis in prediabetic individuals: A prospective, randomized, controlled trial
Authors: Cheng Wan-Yin , Chang Li-Hsin , Chen Harn-Shen
Published: May 2024

Background:

This study aimed to evaluate the effects of rosuvastatin and pravastatin on glucose homeostasis and other biomarkers in individuals at high risk of developing diabetes.

Methods:

This prospective, randomized, open-labeled, and controlled trial included prediabetic individuals with impaired fasting glucose and impaired glucose tolerance. The participants were randomized into three groups: rosuvastatin (10 mg), pravastatin (40 mg), or control. Biomarkers of diabetes and glucose and insulin responses to oral glucose tolerance tests were assessed at baseline and after 6 months of treatment. The primary outcomes were comparisons of glucose homeostasis and biomarkers of diabetes among groups at baseline and after 6 months of treatment.

Results:

A total of 141 subjects with impaired fasting glucose (IFG) were screened and 41 participants were recruited. Twenty-two subjects were randomized to either the rosuvastatin or pravastatin group and 19 subjects were assigned to the control group. After 6 months of treatment, all groups had similar cholesterol and triglyceride levels. Likewise, HbA1c levels, glucose, and insulin excursions during oral glucose tolerance test, were similar among the three groups. However, compared to the other groups, the rosuvastatin group had higher homeostasis model assessment for insulin resistance (HOMA-IR) (insulin resistance) and a lower Matsuda index (insulin sensitivity).

Conclusion:

Among prediabetic individuals with IFG, rosuvastatin treatment was associated with increased insulin resistance and decreased insulin sensitivity compared to pravastatin and control groups. Further research is needed to elucidate the underlying mechanisms and clinical implications of these findings.
Clinical Outcomes With Extracorporeal Membrane Oxygenation for Interstitial Lung Disease: Systematic Review and Meta-Analysis
Authors: Balasubramanian Prasanth , Ghimire Manoj , Pattnaik Harsha , Saunders Hollie , Franco Pablo Moreno , Sanghavi Devang , Patel Neal M. , Baig Hassan , Bhattacharyya Anirban , Chaudhary Sanjay , Guru Pramod K.
Published: May 2024

The evidence on indications, outcomes, and complications with the use of extracorporeal membrane oxygenation (ECMO) in the setting of interstitial lung disease (ILD) is limited in the existing literature. We performed a systematic review and meta-analysis for the use of ECMO in the setting of ILD to study the prognostic factors associated with in-hospital mortality. Eighteen unique studies with a total of 1,356 patients on ECMO for ILD were identified out of which 76.5% were on ECMO as a bridge to transplant (BTT) and the rest as a bridge to recovery (BTR). The overall in-hospital mortality was 45.76%, with 71.3% and 37.8% for BTR and BTT, respectively. Among the various prognostic factors, mortality was lower with younger age (mean difference = 3.15, 95% confidence interval [CI] = 0.82–5.49), use of awake veno-arterial (VA)-ECMO compared to veno-venous (VV)-ECMO (unadjusted odds ratio [OR] = 0.22, 95% CI = 0.13–0.37) in the overall cohort. In the setting of BTT, the use of VA-ECMO had a decreased hazard ratio (HR) compared to VV-ECMO (adjusted HR = 0.34, 95% CI = 0.15–0.81, p = 0.015). The findings of our meta-analysis are critical but are derived from retrospective studies with small sample sizes and thus are of low to very low-GRADE certainty.
Outcomes of Adult Patients With COVID-19 Transitioning From Venovenous to Venoarterial or Hybrid Extracorporeal Membrane Oxygenation in the Extracorporeal Life Support Organization Registry
Authors: Nguyen Khoa , Altibi Ahmed , Prasad Pooja , Mukundan Srini , Shekar Kiran , Ramanathan Kollengode , Zakhary Bishoy
Published: May 2024

This retrospective analysis of the Extracorporeal Life Support Organization (ELSO) registry evaluates the outcomes and identifies risk factors associated with conversion from initial venovenous extracorporeal membrane oxygenation (ECMO) support to venoarterial or hybrid ECMO in patients with coronavirus disease 2019 (COVID-19). We collected deidentified data on all adult patients (≥18 years old) diagnosed with COVID who received venovenous extracorporeal membrane oxygenation between March 2020 and November 2022. Patients initially placed on an ECMO configuration other than venovenous (VV) ECMO were excluded from the analysis. Our analysis included data from 12,850 patients, of which 393 (3.1%) transitioned from VV ECMO to an alternative mode. The primary outcome measure was in-hospital mortality, and the conversion group exhibited a higher in-hospital mortality rate. We also examined baseline variables, including demographic information, biochemical labs, and inotrope requirements. Univariate analysis revealed that pre-ECMO arrest, the need for renal replacement therapy, and the use of inotropic agents, particularly milrinone, were strongly associated with the risk of conversion. Notably, even after implementing a 3:1 propensity score matching, the impact of conversion on both mortality and complications remained substantial. Our study underscores an elevated risk of mortality for COVID-19 patients initially treated with VV ECMO who subsequently require conversion to VA-ECMO or hybrid ECMO.
Effect of hyperbilirubinemia and phototherapy on apoptotic microparticle levels in neonates
Authors: Yücesoy Ebru , Demir Yenigürbüz Fatma , Ateş Halil , Tüzün Funda , Duman Nuray , Özkan Hasan , Ören Hale
Published: May 2024

Objective

We aimed to evaluate the effect of hyperbilirubinemia and phototherapy on total apoptotic, platelet-derived, endothelial-derived, and tissue factor (TF)-positive apoptotic microparticle (MP) levels in neonates with nonhemolytic pathologic hyperbilirubinemia.

Methods

Thirty-three term neonates with nonhemolytic pathologic hyperbilirubinemia and 25 healthy term neonates were included. MP levels were analyzed by flow cytometry using peripheral blood samples only once for the neonates in the control group and twice for the neonates in the study group (before and after phototherapy). Annexin V-positive MPs were defined as apoptotic MPs. Platelet-derived MPs were defined as those containing CD31. MPs containing CD144 were defined as endothelial-derived MPs, and MPs expressing TF were identified as those containing CD142.

Results

The rates of total apoptotic and endothelial-derived apoptotic MPs were significantly higher in the study group than the control group before phototherapy (P = 0.012 and P = 0.003, respectively) and after phototherapy (P = 0.046 and P = 0.001, respectively). Total apoptotic, platelet-derived, endothelial-derived, and TF-positive apoptotic MPs did not show any significant differences before and after phototherapy in the study group (P = 0.908, P = 0.823, P = 0.748, and P = 0.437, respectively).

Conclusions

Our study demonstrated that total apoptotic and endothelial-derived apoptotic MPs are increased in cases of nonhemolytic pathologic hyperbilirubinemia. We showed that phototherapy does not have a significant effect on apoptotic MP levels. Further studies are needed to evaluate the risk of elevated apoptotic MPs on the development of thromboembolism in neonates with nonhemolytic pathologic hyperbilirubinemia.
Poisoning by butylated hydroxytoluene quinone methide acting as a superwarfarin: first reported case in humans
Authors: Hindilerden Fehmi , Aksoy Elif , Öztürkmen Asli Yüksel , Türker Gamze , Gültürk Emine , Hançer Veysel Sabri , Mercan Selda
Published: May 2024

Superwarfarins are anticoagulant rodenticides nearly 100-fold potent than the parent compound. Since their development, accidental and intentional cases of superwarfarin poisoning have been reported. We report the first human case of poisoning by butylated hydroxytoluene (BHT) quinone methide acting as a superwarfarin otherwise reported to be a well tolerated food additive and preservative and used as an antioxidant, stabilizer, anti-skinning agent in various industries. We aim to highlight the possible underlying cause of this previously unreported and potentially lethal BHT-related complication in the human.
Acquired factor XIII deficiency and its unprecedented association with multiple myeloma: case report and literature review
Authors: Trabelsi Balkis , Baccouche Hela , Eddhib Jannet , Chakroun Aya , Sonia Mahjoub
Published: May 2024

This case involves a 58-year-old patient, with no personal or family history of bleeding, diagnosed with stage III-A IgG Kappa multiple myeloma in 2016 and underwent autografting in 2017. In March 2022, he suffered a myeloma relapse. In October 2022, the patient presented with a large spontaneous compressive hematoma in the left shoulder and hemithorax, requiring two surgical procedures. The platelet count and hemostasis parameters were within normal range. Further diagnostic testing revealed acquired factor XIII deficiency and acquired thrombopathy. Diagnostic challenges arose from the absence of specific assays for the B subunit of Factor XIII. Treatment involved transfusions and corticosteroids, but efficacity was limited. The patient's response to chemotherapy raised questions about the involvement of the monoclonal component. Subsequent follow-ups showed factor XIII levels fluctuating, even without symptoms. The patient was deemed ineligible for autograft due to a significant risk of hemorrhage.
Impact of serum iron levels on in-hospital mortality and clinical outcomes in patients with ST segment elevation myocardial infarction undergoing emergency percutaneous coronary intervention: a retrospective analysis
Authors: Wang Zuoyan , Peng Jianjun
Published: May 2024

Background

Despite advances in percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI), in-hospital mortality remains a concern, highlighting the need for the identification of additional risk factors such as serum iron levels.

Objective

This study aims to assess the relationship between serum iron levels and in-hospital mortality among patients with STEMI undergoing emergency PCI.

Methods

A total of 685 patients diagnosed with STEMI, treated with emergency PCI between January 2020 and June 2023, were included in this retrospective observational study. Participants were categorized based on serum iron levels into a low serum iron group (Fe <7.8 μmol/L) and a control group (Fe ≥7.8 μmol/L). Clinical and biochemical variables were compared between the groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors for in-hospital mortality.

Results

The low serum iron group demonstrated significantly higher in-hospital mortality rates (9.3 vs. 1.0%,P < 0.05) compared with the control group. Multivariate logistic regression revealed that a left ventricular ejection fraction less than 40% upon admission [odds ratio (OR), 8.01; 95% confidence interval (CI), 1.230–52.173;P = 0.029], the occurrence of no-reflow during PCI (OR, 7.13; 95% CI, 1.311–38.784;P = 0.023), and serum iron levels below 7.8 μmol/L (OR, 11.32; 95% CI, 2.345–54.640;P = 0.003) were independent risk factors for in-hospital mortality.

Conclusion

Low serum iron levels are associated with increased in-hospital mortality in patients with STEMI undergoing emergency PCI. Serum iron levels may serve as an independent prognostic marker and could inform risk stratification and therapeutic targeting in this patient population.
Update on fracture risk assessment in osteoporosis
Authors: McCloskey Eugene , Tan Andre T.H. , Schini Marian
Published: May 2024

Purpose of review

The assessment of fracture risk is playing an ever-increasing role in osteoporosis clinical management and informing international guidelines for osteoporosis. FRAX, a fracture risk calculator that provides individualized 10-year probabilities of hip and major osteoporotic fracture, has been widely used since 2008. In this review, we recap the development and limitations of intervention thresholds and the role of absolute fracture risk.

Recent findings

There is an increasing awareness of disparities and inequities in the setting of intervention thresholds in osteoporosis. The limitations of the simple use of prior fracture or the DXA-derived BMD T-score threshold are increasingly being discussed; one solution is to use fracture risk or probabilities in the setting of such thresholds. This approach also permits more objective assessment of high and very high fracture risk to enable physicians to make choices not just about the need to treat but what agents to use in individual patients.

Like all clinical tools, FRAX has limitations that need to be considered, but the use of fracture risk in deciding who to treat, when to treat and what agent to use is a mechanism to target treatment equitably to those at an increased risk of fracture.
Application of small bowel capsule endoscopy in children with Meckel’s diverticulum
Authors: Li Lin , Zhan Xue , Chen Yuxia , Li Jun , Wang Yuting
Published: May 2024

Background

Meckel diverticulum (MD) is an important cause of gastrointestinal bleeding in children. Small bowel capsule endoscopy (SBCE) is a first-line examination method applied to patients with obscure gastrointestinal bleeding, but there are few studies on its application in children with MD. This article aims to provide evidence in favor of the auxiliary diagnosis of MD in children by analyzing its characteristics using SBCE.

Methods

We retrospectively collected the clinical data of patients with suspected MD.

Results

A total of 58 children were included in this study. All 58 children presented overt gastrointestinal bleeding (bloody stool or melena). Capsule endoscopy identified protruding lesions in 2 cases, double-lumen changes in 30 cases (all considered as MD), vascular lesions in 7 cases, intestinal mucosal inflammatory lesions in 3 cases, ulcers or erosion in 3 cases, and no obvious abnormalities in SBCE in 12 cases. Both SBCE and technetium-99 scans were performed for 24 cases, 22 of which were diagnosed MD by their combined results, giving a diagnostic coincidence rate of 91.7%. Eight cases were highly suspected as MD but were negative for the technetium-99 scan and positive for SBCE.

Conclusion

SBCE has high accuracy in the diagnosis of MD in children, especially when performed in combination with a technetium-99 scan, which can greatly improve the diagnostic rate of MD in children.
Coexistence of metabolic-associated fatty liver disease and autoimmune or toxic liver disease
Authors: Danielsson Oscar , Vesterinen Tiina , Arola Johanna , Åberg Fredrik , Nissinen Markku J.
Published: May 2024

Fatty liver disease (FLD) affects approximately 25% of global adult population. Metabolic-associated fatty liver disease (MAFLD) is a term used to emphasize components of metabolic syndrome in FLD. MAFLD does not exclude coexistence of other liver disease, but impact of coexisting MAFLD is unclear. We investigated prevalence and characteristics of MAFLD in patients with biopsy-proven autoimmune hepatitis (AIH), primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), or toxic liver disease. Liver histopathology and clinical data from Helsinki University Hospital district (1.7 million inhabitants) between 2009 and 2019 were collected from patients with AIH, PBC, PSC, or toxic liver disease at the time of diagnosis. MAFLD was diagnosed as macrovesicular steatosis ≥5% together with obesity, type-2 diabetes, or signs of metabolic dysregulation. Of 648 patients included, steatosis was observed in 15.6% (n = 101), of which 94.1% (n = 95) was due to MAFLD. Prevalence of coexisting MAFLD in the four liver diseases varied between 12.4 and 18.2% (P = 0.483). Fibrosis was more severe in MAFLD among patients with toxic liver disease (P = 0.01). Histopathological characteristics otherwise showed similar distribution among MAFLD and non-FLD controls. Alcohol consumption was higher in MAFLD group among patients with AIH or PBC (P < 0.05 for both). In AIH, smoking was more common in patients with coexisting MAFLD (P = 0.034). Prevalence of coexisting MAFLD in other primary liver diseases is lower than reported in general population. Histopathology of MAFLD patients did not clearly differ from non-FLD ones. Alcohol and smoking were associated with MAFLD in AIH.
Short-chain fatty acid levels in stools of patients with inflammatory bowel disease are lower than those in healthy subjects
Authors: Ozturk Ozlem , Celebi Gurkan , Duman Umut Goktan , Kupcuk Erhan , Uyanik Metin , Sertoglu Erdim
Published: May 2024

Objective

Short-chain fatty acids (SCFAs) are produced when the microbiota in the large intestine cause fermentation of dietary carbohydrates and fibers. These fatty acids constitute the primary energy source of colon mucosa cells and have a protective effect in patients suffering from inflammatory bowel disease (IBD). This study aimed to compare the SCFA levels in the stools of patients with IBD and healthy controls.

Method

Healthy controls and patients with IBD aged 18 and over were included in the study. Stool samples from all patients and healthy controls were collected, and stool acetic acid, propionic acid, and butyric acid levels were measured using a gas chromatography–mass spectrometry measurement method.

Results

In this study, 64 participants were divided into two groups: 34 were in IBD (Crohn disease and ulcerative colitis) and 30 were in healthy control group. When fecal SCFA concentrations of IBD and healthy control groups were compared, a statistically significant difference was observed between them. When the fecal SCFA concentrations of Crohn’s disease and ulcerative colitis patients in the IBD group were compared, however, no statistically significant difference was observed between them. Furthermore, when the participants’ diet type (carbohydrate-based, vegetable-protein-based and mixed diet) and the number of meals were compared with fecal SCFA concentrations, no statistically significant difference was observed between them.

Conclusion

In general, fecal SCFA levels in patients with IBD were lower than those in healthy controls. Moreover, diet type and the number of meals had no effect on stool SCFA levels in patients with IBD and healthy individuals.
Assessing seasonal variations of biomarkers in inflammatory bowel disease
Authors: Neamți Lidia , Drugan Tudor Catalin , Drugan Cristina , Silaghi Ciprian , Ciobanu Lidia , Ilyés Tamás , Crăciun Alexandra
Published: May 2024

Objective

Inflammatory bowel diseases are chronic pathologies characterized by a complex interplay of genetic and environmental factors, as well as aberrant immune responses. This study aimed to investigate inflammation markers’ seasonality and association with disease exacerbation episodes in patients with Crohn’s disease and ulcerative colitis.

Methods

284 patients were classified based on clinical, endoscopic, and histopathological criteria. Systemic inflammation was evaluated using C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and chitotriosidase, while fecal calprotectin was measured to assess intestinal inflammation. Serum vitamin D levels and the seasonality of an activity score that combines several clinical and biological parameters were also evaluated.

Results

The peak number of patients reporting endoscopic activity occurred in autumn for Crohn’s disease (82%) and spring for ulcerative colitis (95%). Regarding histological activity, spring saw the highest number of patients for both diseases (72% for Crohn’s disease; 87% for ulcerative colitis). Most of the inflammatory markers exhibited lower values during winter. Systemic inflammatory markers follow a slightly different trend than fecal calprotectin and differ in the two pathologies. The maximum values of intestinal inflammation were observed in autumn for Crohn’s disease (784 µg/g) and in spring for ulcerative colitis (1269 µg/g). Serum vitamin D concentrations were consistently low throughout the year. Statistical analysis revealed differences between the seasons for CRP and ESR (P < 0.05).

Conclusion

The evolution of flares and inflammatory markers in Crohn’s disease and ulcerative colitis displayed distinct seasonal patterns. Systemic inflammation did not consistently parallel intestinal inflammation.
Change in Defense Mechanisms During a Brief Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder
Authors: Porto Tabeleão Viviane , Coelho Scholl Carolina , Pereira Kammer Katharina , Bonati de Matos Mariana , Puchalski Trettim Jéssica , Stark Stigger Rafaelle , Jacondino Pires Andressa , de Avila Quevedo Luciana
Published: May 2024

Defense mechanisms (DMs) are strategies used by the individuals to protect the ego. Therefore, compulsive behaviors in obsessive-compulsive disorder (OCD) can be recognized as DMs. We analyzed how DMs changed in a brief cognitive behavioral therapy (CBT) for OCD. This was a quasi-experimental study with 92 OCD patients (aged 18–60 years). We used the Mini International Neuropsychiatric Interview to confirm OCD diagnosis, and we assessed the DMs with the Defense Style Questionnaire at three time points. Through a latent change score modeling, we found that the mature mechanism presented a constant change during the therapy. This mechanism increased in average 0.37 points at each measured moment of CBT, showing a linear trajectory. Neurotic and immature mechanisms showed no significant changes during therapy. The increased use of the mature mechanism can be an indicator of improvement in OCD treatment, showing that patients intensified their more adaptive responses to conflicts.
The Associations Among Observers' Openness to Experience and Agreeableness With Social Distance
Authors: Ohayon Shay , Goldzweig Gil , Vilchinsky Noa , Hasson-Ohayon Ilanit
Published: May 2024

Despite abundant literature on personality and stigma, the role of disability type in this relationship has remained unaddressed. In the current study, we examined whether the relationship between observers' openness to experience and agreeableness on the one hand, and social distance on the other, was moderated by the target person's type of disability (psychiatric vs. physical). One hundred thirty-nine participants were randomly assigned to complete a social distance questionnaire referring to a vignette of a person in three conditions (physical disability, psychiatric disability, and control). A main effect of openness on social distance was found. Additionally, we found an interaction effect of agreeableness and the type of disability. Namely, the relationship between agreeableness and social distance was significant only in the physical disability condition but not in the other two conditions. To conclude, the current study emphasizes the role of personality traits in social distance toward individuals with disabilities.
COVID-19 Vaccination Uptake, Infection Rates, and Seropositivity Among Youth Experiencing Homelessness in the United States
Authors: Santa Maria Diane M. , Padhye Nikhil , Ostrosky-Zeichner Luis , Grimes Carolyn Z. , Nyamathi Adeline , Lightfoot Marguerita , Quadri Yasmeen , Paul Mary E. , Jones Jennifer Torres
Published: May 2024

Background

People experiencing homelessness are at greater risk of exposure and poor health outcomes from COVID-19. Yet, little data exists on the prevalence and correlates of COVID-19 among homeless populations. To mitigate the spread and severity, uptake of the COVID-19 vaccine is needed. This can be challenging among youth experiencing homelessness who are more likely to be unvaccinated when compared to stably housed youth.

Objective

We conducted this study to determine the prevalence and correlates of COVID-19 among youth experiencing homelessness.

Methods

We examined experiences of COVID-19 symptoms, self-report of infection, rates of COVID-19 antibodies and distinguished between natural and vaccinated immunity among youth experiencing homelessness (N = 265) recruited in one large metropolitan area in the South.

Results

Based on self-report, very few participants experienced any symptoms, and 80% had never been diagnosed with COVID-19. Of those with COVID-19 antibodies (68%), the proportion with antibodies resulting from natural infection was 44%. The vaccination rate was 42%. Younger and vaccinated participants and those in shelters were likelier to have COVID-19 antibodies. Black and Hispanic youth were more likely than White youth to have had COVID-19. Those who adopted only one or two prevention behaviors were more likely to acquire a natural infection than those who adopted three or more prevention behaviors.

Discussion

Youth experiencing homelessness report low vaccination rates, disrupted access to health care and social supports, and underlying chronic conditions, which may explain why they face poorer outcomes when infected with COVID-19. Vaccination and risk mitigation strategies to combat the high prevalence of COVID-19 are especially needed for sheltered youth who are at high risk yet are often asymptomatic.
Screening for Nephropathy in Pediatric Type 2 Diabetes: Quality Improvement to Increase Nephropathy Screening
Authors: Mann Elizabeth A. , Alexander Kelsi , Beaton Whitney , Roe Elizabeth B. , Grant Amy , Shadman Kristin A.
Published: May 2024

Background:

Screening for early detection of microalbuminuria signaling kidney disease should begin as early as the time of diagnosis of youth-onset type 2 diabetes. This quality improvement initiative aimed to standardize urine nephropathy screening in pediatric patients with type 2 diabetes at a tertiary academic medical center and increase a baseline screening rate of 56%–75% over 6 months (September 2022–February 2023) and sustain that increase for 6 months (March through August 2023).

Methods:

A multi-disciplinary team used quality improvement methods and iterative Plan-Do-Study-Act cycles. Targeted interventions included previsit planning workflow, education, and a new-onset triage protocol. The team collected data at baseline and prospectively by reviewing electronic medical records. The primary outcome measure was pediatric type 2 diabetes clinic visits in diabetes clinic with urine nephropathy screening before or on the visit date.

Results:

A total of 121 youth were scheduled for T2D clinic visits between September 2021 and August 2023. The mean age was 14.5 years, and 60% were women, 40% were non-Hispanic Black, 28% were Hispanic/Latino, and 15% reported Spanish as their preferred language. Following the interventions of this project, urine nephropathy screening increased from 56% to 75%, and this change was sustained for 6 months.

Conclusions:

Interventions focused on efficient recognition of the population needing screening, coordinated internal processes around screening, a shared understanding between all stakeholders, and practical support in the healthcare system increased urine nephropathy screening with sustained improvement.
Brucella Prostatitis: A Rare Manifestation of Fever of Unknown Origin, Detected by FDG PET/CT
Authors: Mahdi Raza Abbas , Preet Komal , Mittal Bhagwant Rai , Kumar Rajender , Singh Harmandeep , Taneja Sunil
Published: May 2024

FDG PET/CT is a well-documented imaging investigation to evaluate fever of unknown origin (FUO). Brucellosis is one of the causes of FUO, which can be missed as it requires a longer incubation period for growth on culture media. Rarely, it can involve the prostate. Here, we present a case of FUO with initial negative blood and urine cultures and no localizing signs or symptoms. 18F-FDG PET/CT revealed hypermetabolism in the prostate and seminal vesicles. A repeat blood and urine culture showed the growth of Brucella species after 5 days of incubation, and the patient responded to Brucella-directed antibiotic therapy.
Prophylactic Anticoagulation Reduces the Risk of Kidney Graft Venous Thrombosis in Recipients From Uncontrolled Donation After Circulatory Death Donors With High Renal Resistive Index
Authors: Molina Maria , Fernández-Ruiz Mario , Gonzalez Esther , Cabrera Jimena , Praga Manuel , Rodriguez Alfredo , Tejido-Sánchez Angel , Medina-Polo Jose , Mateos Alonso , Rubio-Chacón Carlos , Sanchez Angel , Pla Ana , Andrés Amado
Published: May 2024

Background.

Uncontrolled donation after circulatory death (uDCD) increases organ availability for kidney transplantation (KT) at the expense of a higher risk of primary graft nonfunction (PNF). At least half of the cases of PNF are secondary to graft venous thrombosis. The potential benefit from prophylactic anticoagulation in this scenario remains unclear.

Methods.

In this single-center retrospective study we compared 2 consecutive cohorts of KT from uDCD with increased (≥0.8) renal resistive index (RRI) in the Doppler ultrasound examination performed within the first 24–72 h after transplantation: 36 patients did not receive anticoagulation (“nonanticoagulation group”) and 71 patients underwent prophylactic anticoagulation until normalization of RRI in follow-up Doppler examinations (“anticoagulation group”).

Results.

Anticoagulation was initiated at a median of 2 d (interquartile range, 2–3) after transplantation and maintained for a median of 12 d (interquartile range, 7–18). In 4 patients (5.6%), anticoagulation had to be prematurely stopped because of the development of a hemorrhagic complication. In comparison with the nonanticoagulation group, recipients in the anticoagulation group had a lower 2-wk cumulative incidence of graft venous thrombosis (19.4% versus 0.0%; P < 0.001) and PNF (19.4% versus 2.8%; P = 0.006). The competing risk analysis with nonthrombotic causes of PNF as the competitive event confirmed the higher risk of graft thrombosis in the nonanticoagulation group (P = 0.0001). The anticoagulation group had a higher incidence of macroscopic hematuria (21.1% versus 5.6%; P = 0.049) and blood transfusion requirements (39.4% versus 19.4%; P = 0.050) compared with the nonanticoagulation group. No graft losses or deaths were attributable to complications potentially associated with anticoagulation.

Conclusions.

Early initiation of prophylactic anticoagulation in selected KT recipients from uDCD with an early Doppler ultrasound RRI of ≥0.8 within the first 24–72 h may reduce the incidence of graft venous thrombosis as a cause of PNF.
Variation in DCD Liver Transplant Protocols Among Transplant Centers in the United States
Authors: Punjala Sai Rithin , Logan April , Han Jing , Obana Ayato , Limkemann Ashley J. , Schenk Austin D. , Washburn William K.
Published: May 2024

Background.

Variation in donation after circulatory death (DCD) organ recovery and liver transplant practices exist among transplant centers. This study aimed to evaluate these practices among centers in the United States.

Methods.

Scientific Registry of Transplant Recipients data were accessed to identify centers that performed liver transplantation in 2021 and 2022. Surveys were sent to transplant centers that consistently performed ≥5 DCD liver transplants per year.

Results.

DCD liver transplants were performed by 95 centers (65.1%) of the 146 liver transplant centers in the United States. Survey results were recorded from 42 centers that consistently performed ≥5 DCD liver transplants per year, with a 59.5% response rate. Withdrawal-to-asystole and agonal time were used to define donor warm ischemia time (WIT) in 16% and 84% centers, respectively. Fifty-six percent of the centers did not use oxygen saturation to define donor WIT. Systolic blood pressure cutoffs used to define agonal time varied between 50 and 80 mm Hg, donor age cutoffs ranged between 55 and 75 y, and cold ischemia times varied between 4 and 10 h. Seventy-six percent of centers used normothermic machine perfusion for DCD liver transplantation.

Conclusions.

This study highlights the wide variation in use, recovery, and definition of donor WIT. Using national data to rigorously define best practices will encourage greater utilization of this important donor resource.
Multiple-target Therapy for Posttransplant Focal Segmental Glomerulosclerosis
Authors: Mansur Juliana , Chang-Dávila Domingo , Simões Marcela Giraldes , Cristelli Marina Pontello , Stopa Martins Suelen Bianca , de Sousa Proença Henrique Machado , Viana Laila Almeida , Ferreira Alexandra Nicolau , Doher Marisa Petrucelli , Medina-Pestana José , Mastroianni Kirsztajn Gianna , Tedesco-Silva Helio
Published: May 2024

Background.

There is no consensus on the ideal strategy to treat posttransplant focal segmental glomerulosclerosis. The multiple-target therapy, which consisted of high-dose intravenous cyclosporine, prednisone, and plasmapheresis, showed favorable results.

Methods.

This single-center, prospective study sought to evaluate the multiple-target therapy in an independent cohort of patients.

Results.

Thirteen patients with posttransplant focal segmental glomerulosclerosis received multiple-target therapy. Complete remission was achieved in 2 patients (15.4%), and partial remission in another 2 patients (15.4%). Four patients (30.7%) did not show remission, and 5 patients (38%) lost the graft because of posttransplant focal segmental glomerulosclerosis during the 12-mo follow-up. Premature discontinuation of treatment occurred in 10 patients (77%), all associated with infectious adverse events. Cytomegalovirus was the most common complication, and preemptive therapy was used instead of prophylaxis.

Conclusions.

In this cohort of patients, the efficacy of the multiple-target therapy was poor and limited by the high incidence of infectious adverse events.
Interhemispheric functional in age-related macular degeneration patient: a resting-state functional MRI study
Authors: Jiang Yi-Jing , Lai Ping-Hong , Huang Xin
Published: May 2024

Age-related macular degeneration (AMD) is a prevalent disease leading to severe visual impairment in the elderly population. Despite this, the pathogenesis of AMD remains largely unexplored. The application of resting-state functional MRI (rs-fMRI) allows for the detection of coherent intrinsic brain activities along with the interactions taking place between the two hemispheres. In the frame of our study, we utilize voxel-mirrored homotopic connectivity (VMHC) as an rs-fMRI method to carry out a comparative analysis of functional homotopy between the two hemispheres with the aim of further understanding the pathogenesis of AMD patients. In our study, we utilized the VMHC method to explore levels of brain activity in individuals diagnosed with AMD, planning to investigate potential links with their clinical characteristics. We extended our invitation to 20 AMD patients and 20 healthy controls from Jiangxi Provincial People’s Hospital to participate in this research. rs-fMRIs were captured for each participant, and associated neural activity levels were examined using the VMHC method. Remarkably, our comparative examination with the healthy control group revealed significantly reduced VMHC in the cuneus, superior occipital lobe, precentral gyrus, and superior parietal lobule in the patient cohort. Utilizing the VMHC method allows us to identify discrepancies in the visual pathways of AMD patients compared with standard controls, potentially explaining the common challenges among AMD patients with object recognition, face recognition, and reading.
The activation of AMPK/PGC-1α/GLUT4 signaling pathway through early exercise improves mitochondrial function and mitigates ischemic brain damage
Authors: Wu Xinyue , Li Chen , Ke Changkai , Huang Chuan , Pan Bingchen , Wan Chunxiao
Published: May 2024

Mitochondria play a crucial role in maintaining cellular energy supply and serve as a source of energy for repairing nerve damage following a stroke. Given that exercise has the potential to enhance energy metabolism, investigating the impact of exercise on mitochondrial function provides a plausible mechanism for stroke treatment. In our study, we established the middle cerebral artery occlusion (MCAO) model in Sprague–Dawley rats and implemented early exercise intervention. Neurological severity scores, beam-walking test score, and weight were used to evaluate neurological function. The volume of cerebral infarction was measured by MRI. Nerve cell apoptosis was detected by TUNEL staining. Mitochondrial morphology and structure were detected by mitochondrial electron microscopy. Mitochondrial function was assessed using membrane potential and ATP measurements. Western blotting was used to detect the protein expression of AMPK/PGC-1α/GLUT4. Through the above experiments, we found that early exercise improved neurological function in rats after MCAO, reduced cerebral infarction volume and neuronal apoptosis, promoted the recovery of mitochondrial morphology and function. We further examined the protein expression of AMPK/PGC-1α/GLUT4 signaling pathway and confirmed that early exercise was able to increase its expression. Therefore, we suggest that early exercise initiated the AMPK/PGC-1α/GLUT4 signaling pathway, restoring mitochondrial function and augmenting energy supply. This, in turn, effectively improved both nerve and body function in rats following ischemic stroke.
Melatonin mitigates cisplatin-induced cognitive impairment in rats and improves hippocampal dendritic spine density
Authors: Qutifan Shahd , Saleh Tareq , Abu Shahin Nisreen , ELBeltagy Maha , Obeidat Fatimah , Qattan Duaa , Kalbouneh Heba , Barakat Noor A. , Alsalem Mohammad
Published: May 2024

Cisplatin-induced cognitive impairment (chemobrain) affects a considerable percentage of cancer patients and has no established pharmacological treatment. Chemobrain can be associated with neuroinflammation and oxidative stress. Melatonin, a pineal hormone, is known to have antioxidant, anti-inflammatory and neuroprotective potential. In this study, we investigated cisplatin-induced cognitive impairment in rats and whether melatonin can improve or reverse this impairment. Behavioral testing involved measuring working memory using the novel location recognition test (NLRT) under conditions of cisplatin or cisplatin + melatonin treatment, followed by the collection of rats’ brains. The brains were subsequently stained with Golgi-Cox stain and then the hippocampus area CA3 of each one was examined, and dendritic spine density was calculated. Treatment with cisplatin resulted in deficits in the rats’ performance in the NLRT (P < 0.05). These deficits were prevented by the coadministration of melatonin (P < 0.05). Cisplatin also reduced the density of dendritic spines in the hippocampus (P < 0.0001), specifically CA3 area, while the coadministration of melatonin significantly reversed this reduction (P < 0.001). This study showed that melatonin can ameliorate cisplatin-induced spatial memory deficits and dendritic spines density abnormalities in rats. Given that melatonin is a safe and wildly used supplement, it is feasible to explore its use as a palliative intervention in cancer treatment.