bluuebunny/crossref_metadata_2025 huggingface dataset:
Transfusion‐transmitted HBV infection with isolated anti‐HBs‐positive blood
Authors: Satake Masahiro , Yamagishi Naoji , Tanaka Ami , Goto Naoko , Sakamoto Tomohiko , Yanagino Yusuke , Furuta Rika A. , Matsubayashi Keiji
Published: May 2023

Background

Hepatitis B virus (HBV)‐positive individuals with isolated anti‐HBs are found among HBV vaccine recipients and healthy blood donors with no vaccination history. HBV infectivity from blood transfusions derived from such individuals remains unclear.

Case Presentation

A male patient who received transfusion with blood negative for individual donation‐NAT, HBsAg and anti‐HBc but weakly positive for anti‐HBs developed typical transfusion‐transmitted (TT)‐HBV with anti‐HBc response. The responsible blood donor was a frequent repeat donor showing a marked increase in anti‐HBs titer without anti‐HBc response 84 days after index donation. Test results for his past donations showed transient viremia with very low viral load and fluctuating low‐level anti‐HBs. The HBV vaccination history of this donor was unknown.

Discussion

Anti‐HBs and anti‐HBc kinetics of the donor suggest a second antibody response to new HBV challenge, representing a vaccine breakthrough case. On the other hand, transient low‐level viremia and fluctuating anti‐HBs in the test results of past donations suggested chronic occult HBV infection with isolated anti‐HBs.

Conclusion

Whatever the basic infection state, blood donors with isolated weak anti‐HBs may include a small population with a risk of causing TT‐HBV. Identifying individuals harboring such TT‐HBV risk among individuals positive only for anti‐HBs is difficult under current screening strategies. Active surveillance for the occurrence of TT‐HBV with blood positive only for anti‐HBs is necessary.
Embodying Place
Authors: NESVADERANI NAT
Published: May 2023

This article explores the implications of the Making Home Project, a participatory audio‐visual media project with migrant and refugee youth in Iran. This project does not picture the faces of youth as they express caring relationships and attachments to the people and places within the migrant neighborhoods where they reside—places locally characterized as poor, dangerous, and transient. I examine the audio, the visual and the off‐screen encounters of this participatory production to demonstrate how media outcomes are shaped by Afghan youth's differently situated refugee experiences in Iran. Ultimately, I argue that space and place are actualized through the embodied act of youth expressing and producing audio‐visual media about their homeplace.
HUMAN UNIQUENESS FROM A BIOLOGICAL POINT OF VIEW
Authors: Reich David
Published: May 2023

This article seeks to provide some genetic perspectives on the question “Just How Special Are Humans—Really?” It begins with an introduction to how genetic variation can provide information about the past. It continues by discussing two ways in which genetic analyses has, on multiple occasions, shown that humans are less unique than we thought we are. We have a cognitive bias to toward thinking we are special. Our species has colonized an ecological niche not exploited by any other species on our earth, but how much of our adaptation to that niche is cultural rather than genetic?
Enhancing Vietnamese Students’ Entrepreneurial Mindset and Creativity by Design Thinking Application
Authors: Phan Quốc Nguyên  , Lê Thị Hồng Duyên  , Đào Thị Diệu Linh  , Nguyễn Thị Thư  , Lư Thị Thanh Lê  , Lê Thanh Huyền
Published: May 2023

In recent years, more and more attention and concerns are paid on how students should be educated as global citizens with required characteristics of the unforeseen future society. Among the most crucial competencies that future workforce should acquire, it is necessary to focus on developing students’ creativity and entrepreneurial mindset. In this paper, authors-lecturers from different universities in Vietnam National University (VNU) have piloted the model of Design Thinking in different disciplines at different member universities of Vietnam National University, Hanoi with the purpose to foster such essential skills for Vietnamese students in the 21st century. With the illustration of applying Design Thinking in different scenarios such as psychology, education, physical training, folklore and information technology, this paper reports the initial and positive results of Design Thinking application at Vietnam National University context. It is recommended from the paper that if lecturers introduce and encourage students to apply Design Thinking process in their learning, it will help to foster their creativity and entrepreneurial mindset, which are essential for students to succeed in the 21st century.
Implementing an Integrated First-Year Engineering Curriculum with Mixed Teaching Approaches
Authors: Simon Howell  , Wayne Hall  , Nicholas Emerson
Published: May 2023

Griffith University offers Engineering programmes over two campuses in South East Queensland, Australia. A large proportion of students are the first in their families to attend university, with many from low socio-economic backgrounds. In 2017, Griffith moved to a trimester system, and the School of Engineering and Built Environment restructured the first-year engineering curriculum to provide an improved engineering experience focusing on key educational outcomes for its diverse student population.This article describes and evaluates the new integrated first-year curriculum, which includes a mix of traditionally taught, partially experiential, and fully experiential courses. The curriculum structure is discussed, and the outcomes evaluated in terms of student achievement, progression, and satisfaction. Findings of this evaluation indicate that teaching staff have a crucial role in ensuring courses are well received, traditionally taught mathematics courses do not appear to be meeting the needs of the students, and that ‘C’ is unlikely to be a good choice for a first programming language for engineering students. However, the restructuring shows some preliminary success in terms of increased retention when coupled with proactive outreach. Further research into student perceptions and performance across courses with different teaching approaches is recommended.
Career Education for First Year Students of Science and Technology to Improve Awareness of Working in Society
Authors: Matsumoto Hiroyuki , Amagai, K.  , Yasushi Yuminaka  , Sampson, R.
Published: May 2023

The Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) proposed the concept of “Bachelor’s abilities” and started a support program known as “university students’ employability” in 2010. In this article, we introduce the contents of this program. In addition, we mention the relationship between this program and the conventional concept of “employability skill”. We also introduce two courses, “career planning” and “career design”, related to this support program for first-year students in the field of science and technology. The aim of these courses is to improve students’ awareness for working in society. A questionnaire survey was conducted in order to understand first-year students’ characteristics. The survey was carried out with more than 2600 students over a period of five years. Survey results revealed that many students had no image of their future at the time of admission to the University. It seems that the obtained data shows the degree of consciousness of the average Japanese student in their first year at university. Through the introduced courses, students were able to consider their own future and discover their own goals and the significance of studying at University.
Heights on curves and limits of Hodge structures
Authors: Bloch Spencer , de Jong Robin , Sertöz Emre Can
Published: May 2023

We exhibit a precise connection between Néron–Tate heights on smooth curves and biextension heights of limit mixed Hodge structures associated to smoothing deformations of singular quotient curves. Our approach suggests a new way to compute Beilinson–Bloch heights in higher dimensions.
Exploring the role of TRPM4 in calcium‐dependent triggered activity and cardiac arrhythmias
Authors: Pironet Andy , Vandewiele Frone , Vennekens Rudi
Published: May 2023

Cardiac arrhythmias pose a major threat to a patient's health, yet prove to be often difficult to predict, prevent and treat. A key mechanism in the occurrence of arrhythmias is disturbed Ca2+ homeostasis in cardiac muscle cells. As a Ca2+‐activated non‐selective cation channel, TRPM4 has been linked to Ca2+‐induced arrhythmias, potentially contributing to translating an increase in intracellular Ca2+ concentration into membrane depolarisation and an increase in cellular excitability. Indeed, evidence from genetically modified mice, analysis of mutations in human patients and the identification of a TRPM4 blocking compound that can be applied in vivo further underscore this hypothesis. Here, we provide an overview of these data in the context of our current understanding of Ca2+‐dependent arrhythmias.

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Low-Cost and Rapid Shaping of Nitinol for Medical Device Prototyping
Authors: Yip Mighten C. , Alaie Seyedhamidreza , Romito Eva A. , Doshi Tejas , Amiri Moghadam Amir Ali , Mosadegh Bobak , Dunham Simon
Published: May 2023

This paper describes the methodology for rapid prototyping of nitinol structures by heat setting. Nitinol is a shape memory alloy commonly used in implantable medical devices. The proposed technique, based on 3D printing, can be used to effectively iterate multiple nitinol designs for different types of medical devices. We describe a rapid and low-cost process of ceramic replica molding of standard 3D printed parts to create high-temperature resistant fixtures, suitable for heat setting of nitinol. The technique represents a low cost (<$20 materials per fixture) and rapid (as quickly as 16 h for a volume less than 1.25 × 105 mm3) method for shaping nitinol, a technique that typically is costly, labor intensive, and requires specialized equipment. Our method satisfies a need for cost-effective, rapid prototyping of nitinol for implantable medical devices, and we show an example set of shaped nitinol wires, clips, and stents. This method is straightforward and can be easily applied by researchers to rapidly iterate medical device designs.
Serious Physics on a Playground Swing—With Toys, Your Own Body, and a
Smartphone
Authors: Pendrill Ann-Marie
Published: May 2023

10.1119_5.0074171.1 10.1119_5.0074171.1
Narrow-Band Invisibility Cloaking: The Vanishing Test Tube Revisited
Authors: Barretto Jerry
Published: May 2023

Invisibility has long been a staple in science fiction. The idea of not being seen has enchanted people for centuries. Recent examples in popular literature include H. G. Wells’s The Invisible Man, Wonder Woman’s invisible plane, and the invisibility cloak featured in several Harry Potter books. While advances in optical cloaking have improved the likelihood of realizing invisibility, classroom demonstrations involving a vanishing object immersed in a liquid have been popular with students and teachers alike. In these demonstrations, the refractive indices of the materials and liquid are very close, and the invisibility effect is observed using white light or a broadband light source. However, since the index of refraction is a function of wavelength, any dependence of invisibility on wavelength would not be observed.
Investigating diffraction phenomena with low-cost material and augmented reality
Authors: Wagner Thorsten , Hoyer Christoph , Ringl Christian , Kuhn Jochen
Published: May 2023

So far, there have only been a few articles in this column that discussed diffraction or augmented reality (AR) enhancements. In this article, we want to bring both aspects together and describe an experiment that can be used to investigate diffraction phenomena with low-cost materials and augmented reality in the classroom. Diffraction experiments in schools often have (at least) two difficulties:
Mechanosensation to inflammation: Roles for YAP/TAZ in innate immune cells
Authors: Meli Vijaykumar S. , Veerasubramanian Praveen Krishna , Downing Timothy L. , Wang Wenqi , Liu Wendy F.
Published: May 2023

Innate immune cells are responsible for eliminating foreign infectious agents and cellular debris, and their ability to perceive, respond to, and integrate biochemical and mechanical cues from their microenvironment eventually determines their behavior. In response to tissue injury, pathogen invasion, or a biomaterial implant, immune cells activate many pathways to initiate inflammation in the tissue. In addition to common inflammatory pathways, studies have demonstrated the role of the mechanosensitive proteins and transcriptional coactivators YAP and TAZ (YAP/TAZ) in inflammation and immunity. We review our knowledge of YAP/TAZ in controlling inflammation and immunity in innate immune cells. Furthermore, we discuss the roles of YAP/TAZ in inflammatory diseases, wound healing, and tissue regeneration and how they integrate mechanical cues with biochemical signaling during disease progression. Last, we comment on possible approaches that can be exploited to harness the therapeutic potential of YAP/TAZ in inflammatory diseases.
Penile calciphylaxis in a patient with concurrent haemodialysis and Coumadin treatment
Authors: Jarrett Omar , Heydari Hamed , Elder Zachary , Casadesus Damian
Published: May 2023

A man in his 30s, with a medical history of end-stage renal disease on haemodialysis three times a week after kidney transplant rejection, anaemia of inflammatory disease, hypertension, atrial fibrillation, hyperlipidaemia, subtotal parathyroidectomy and aortic valve replacement on Coumadin treatment, presented to our institution with glans penis pain. Examination of the penis revealed a painful black eschar with ulceration on the glans penis with surrounding erythema. CT scan of the abdomen and pelvis and penile Doppler ultrasound revealed calcifications of the abdominal, pelvic and penile blood vessels. He was diagnosed with penile calciphylaxis, a very rare manifestation of calciphylaxis characterised by penile blood vessel calcification leading to occlusion, ischaemia and necrosis. Treatment with low calcium dialysate and sodium thiosulfate was initiated with haemodialysis. Five days after the treatment started, the patient’s symptoms improved.
Acute unilateral isolated ptosis as a complication of sinusitis in a post-COVID-19 patient
Authors: Mirza Mohammed Osman , Mathai Anup , Owens Alan , Massey Glenn
Published: May 2023

A fit and well young man presented to our emergency department in the UK. On examination, he had an isolated left-sided ptosis; he had a 3-day history of frontal headache which was worse on head movement. He lacked any clinical signs of cranial, orbital, or preseptal infection, and his eye movements were normal. Ten days before presentation, he tested positive for SARS-CoV-2. Inflammatory markers were moderately raised, and CT of the head did not reveal any vascular abnormality or intracranial lesion. Imaging revealed opacification, predominantly in the left facial sinuses, keeping with sinusitis. He was discharged the same evening with oral antibiotics and made a full recovery over the next few days. He remained well at 6-month follow-up. The authors convey their findings to raise awareness of a rare complication of sinusitis and to demonstrate the utility of CT imaging for diagnosing sinusitis and ruling out severe pathology.
Early identification of persistent somatic symptoms in primary care: data-driven and theory-driven predictive modelling based on electronic medical records of Dutch general practices
Authors: Kitselaar Willeke M , Büchner Frederike L , van der Vaart Rosalie , Sutch Stephen P , Bennis Frank C , Evers Andrea WM , Numans Mattijs E
Published: May 2023

Objective

The present study aimed to early identify patients with persistent somatic symptoms (PSS) in primary care by exploring routine care data-based approaches.

Design/setting

A cohort study based on routine primary care data from 76 general practices in the Netherlands was executed for predictive modelling.

Participants

Inclusion of 94 440 adult patients was based on: at least 7-year general practice enrolment, having more than one symptom/disease registration and >10 consultations.

Methods

Cases were selected based on the first PSS registration in 2017–2018. Candidate predictors were selected 2–5 years prior to PSS and categorised into data-driven approaches: symptoms/diseases, medications, referrals, sequential patterns and changing lab results; and theory-driven approaches: constructed factors based on literature and terminology in free text. Of these, 12 candidate predictor categories were formed and used to develop prediction models by cross-validated least absolute shrinkage and selection operator regression on 80% of the dataset. Derived models were internally validated on the remaining 20% of the dataset.

Results

All models had comparable predictive values (area under the receiver operating characteristic curves=0.70 to 0.72). Predictors are related to genital complaints, specific symptoms (eg, digestive, fatigue and mood), healthcare utilisation, and number of complaints. Most fruitful predictor categories are literature-based and medications. Predictors often had overlapping constructs, such as digestive symptoms (symptom/disease codes) and drugs for anti-constipation (medication codes), indicating that registration is inconsistent between general practitioners (GPs).

Conclusions

The findings indicate low to moderate diagnostic accuracy for early identification of PSS based on routine primary care data. Nonetheless, simple clinical decision rules based on structured symptom/disease or medication codes could possibly be an efficient way to support GPs in identifying patients at risk of PSS. A full data-based prediction currently appears to be hampered by inconsistent and missing registrations. Future research on predictive modelling of PSS using routine care data should focus on data enrichment or free-text mining to overcome inconsistent registrations and improve predictive accuracy.
Costs, consequences and value for money in non-medical prescribing: a scoping review
Authors: Babashahi Saeideh , Carey Nicola , Jani Yogini , Hart Kath , Hounsome Natalia
Published: May 2023

Objectives

Non-medical prescribing (NMP) is a key feature of the UK healthcare system that refers to the legal prescribing rights granted to nurses, pharmacists and other non-medical healthcare professionals who have completed an approved training programme. NMP is deemed to facilitate better patient care and timely access to medicine. The aim of this scoping review is to identify, synthesise and report the evidence on the costs, consequences and value for money of NMP provided by non-medical healthcare professionals.

Design

Scoping review

Data sources

MEDLINE, Cochrane Library, Scopus, PubMed, ISI Web of Science and Google Scholar were systematically searched from 1999 to 2021.

Eligibility criteria

Peer-reviewed and grey literature written in English were included. The research was limited to original studies evaluating economic values only or both consequences and costs of NMP.

Data extraction and synthesis

The identified studies were screened independently by two reviewers for final inclusion. The results were reported in tabular form and descriptively.

Results

A total of 420 records were identified. Of these, nine studies evaluating and comparing NMP with patient group discussions, general practitioner-led usual care or services provided by non-prescribing colleagues were included. All studies evaluated the costs and economic values of prescribing services by non-medical prescribers, and eight assessed patient, health or clinical outcomes. Three studies showed pharmacist prescribing was superior in all outcomes and cost saving at a large scale. Others reported similar results in most health and patient outcomes across other non-medical prescribers and control groups. NMP was deemed resource intensive for both providers and other groups of non-medical prescribers (eg, nurses, physiotherapists, podiatrists).

Conclusions

The review demonstrated the need for quality evidence from more rigorous methodological studies examining all relevant costs and consequences to show value for money in NMP and inform the commissioning of NMP for different groups of healthcare professionals.
Faecal microbiota transplantation to prevent complications after allogeneic stem cell transplantation for haematological malignancies: a study protocol for a randomised controlled phase-II trial (the FMT-allo study)
Authors: Dougé Aurore , Ravinet Aurélie , Corriger Alexandrine , Cabrespine Aurélie , Wasiak Mathieu , Pereira Bruno , Sokol Harry , Nguyen Stéphanie , Bay Jacques-Olivier
Published: May 2023

Introduction

Allogeneic haematopoietic stem-cell transplantation (allo-HSCT) is a major treatment for many haematological malignancies. The procedure has a good success rate but high transplant-related toxicity (TRM). TRM is mostly related to graft-versus-host disease (GvHD) and infectious complications. Alterations of the intestinal microbiota plays a major role in the development of allo-HSCT complications. The gut microbiota could be restored by faecal microbiota transplantation (FMT). However, there are no published randomised studies assessing the efficacy of FMT for GvHD prophylaxis.

Methods and analysis

This prospective, open-label, multi-centre, parallel-group, randomised phase-II clinical trial has been designed to assess the effect of FMT on toxicity in patients treated with myeloablative allo-HSCT for haematological malignancy. Based on Fleming’s single-stage sample size estimation procedure, the design plans to include 60 male and female patients aged 18 or over per arm, to be randomly assigned to two groups, one with and one without (control group) FMT. The primary endpoint is GvHD-free relapse-free survival rate at 1 year after allo-HSCT. Secondary endpoints are outcome measures of the impact of FMT on allo-HSCT-related morbidity and mortality (overall survival and progression-free survival at 1 and 2 years, haematological parameters, infectious complications, tolerance and safety of FMT). The primary endpoint will be evaluated according to assumptions of the single-stage Fleming design, compared between groups by a log-rank test and further investigated in a multivariate marginal structural Cox model taking into account centre effect. The proportional-hazard hypothesis will be verified using Schoenfeld’s test and by plotting residuals.

Ethics and dissemination

The local institutional review board (CPP Sud-Est II, France) issued approval on 27 January 2021. The French national authorities issued approval on 15 April 2021. The outcome of the study will be disseminated via peer-reviewed publications and at congresses.

Trial registration number

NCT04935684.
Examining spousal and family support as predictors of long-term weight loss and remission of type 2 diabetes following bariatric surgery in Singapore: a retrospective cohort study
Authors: Tan Edina Yi-Qin , Lee Phong Ching , Tham Kwang Wei , Ganguly Sonali , Lim Chin Hong , Liu Jean C J
Published: May 2023

Objectives

Postoperative outcomes vary considerably across bariatric patients and may be related to psychosocial factors. In this study, we examined whether a patient’s family support predicts postsurgical weight loss and the remission of type 2 diabetes mellitus (T2DM).

Design

Retrospective cohort study in Singapore.

Setting

Participants were recruited from a public hospital in Singapore.

Participants

Between 2008 and 2018, 359 patients completed a presurgical questionnaire before undergoing gastric bypass or sleeve gastrectomy.

Outcome measures

As part of the questionnaire, patients described their family support in terms of structure (marital status, number of family members in the household) and function (marriage satisfaction, family emotional support, family practical support). Linear mixed-effects and Cox proportional-hazard models were used to examine whether these family support variables predicted percent total weight loss or T2DM remission up to 5 years postsurgery. T2DM remission was defined as glycated haemoglobin (HbA1c) <6.0% without medications.

Results

Participants had a mean preoperative body mass index of 42.6±7.7 kg/m2and HbA1c (%) of 6.82±1.67. Marital satisfaction was found to be a significant predictor of postsurgical weight trajectories. Namely, patients who reported higher marital satisfaction were more likely to sustain weight loss than patients who reported lower marital satisfaction (β=0.92, SE=0.37, p=0.02). Family support did not significantly predict T2DM remission.

Conclusions

Given the link between marital support and long-term weight outcomes, providers could consider asking patients about their spousal relationships during presurgical counselling.

Trial registration number

NCT04303611.
Validation of a rapid SARS-CoV-2 antibody test in general practice
Authors: Domen Julie , Verbakel Jan Yvan Jos , Adriaenssens Niels , Scholtes Beatrice , Peeters Bart , Bruyndonckx Robin , De Sutter An , Heytens Stefan , Van den Bruel Ann , Desombere Isabelle , Van Damme Pierre , Goossens Herman , Buret Laetitia , Duysburgh Els , Coenen Samuel
Published: May 2023

Objectives

To validate a rapid serological test (RST) for SARS-CoV-2 antibodies used in seroprevalence studies in healthcare providers, including primary healthcare providers (PHCPs) in Belgium.

Design

A phase III validation study of the RST (OrientGene) within a prospective cohort study.

Setting

Primary care in Belgium.

Participants

Any general practitioner (GP) working in primary care in Belgium and any other PHCP from the same GP practice who physically manages patients were eligible in the seroprevalence study. For the validation study, all participants who tested positive (376) on the RST at the first testing timepoint (T1) and a random sample of those who tested negative (790) and unclear (24) were included.

Intervention

At T2, 4 weeks later, PHCPs performed the RST with fingerprick blood (index test) immediately after providing a serum sample to be analysed for the presence of SARS-CoV-2 immunoglobulin G antibodies using a two-out-of-three assay (reference test).

Primary and secondary outcome measures

The RST accuracy was estimated using inverse probability weighting to correct for missing reference test data, and considering unclear RST results as negative for the sensitivity and positive for the specificity. Using these conservative estimates, the true seroprevalence was estimated both for T2 and RST-based prevalence values found in a cohort study with PHCPs in Belgium.

Results

1073 paired tests (403 positive on the reference test) were included. A sensitivity of 73% (a specificity of 92%) was found considering unclear RST results as negative (positive). For an RST-based prevalence at T1 (13.9), T2 (24.9) and T7 (70.21), the true prevalence was estimated to be 9.1%, 25.9% and 95.7%, respectively.

Conclusion

The RST sensitivity (73%) and specificity (92%) make an RST-based seroprevalence below (above) 23% overestimate (underestimate) the true seroprevalence.

Trial registration number

NCT04779424.
Exploration of the unmet needs of patients diagnosed with idiopathic pulmonary fibrosis: a scoping review protocol
Authors: Bramhill Carita , Langan Donna , Mulryan Helen , Eustace-Cook Jessica , Russell Anne-Marie , Brady Anne-Marie
Published: May 2023

Introduction

Interstitial lung diseases consist of a range of lung disorders, the most prevalent being idiopathic pulmonary fibrosis (IPF). IPF is a chronic, progressive disease, resulting in loss of lung function and potentially significant impacts on quality of life. There is an increasing need to address unmet needs in this population as there is evidence that unmet needs may impact quality of life and health outcomes. The key objective of this scoping review is to define the unmet needs of patients living with a diagnosis of IPF and to identify gaps in the literature relating to unmet needs. Findings will inform the development of services and the introduction of patient-centred clinical care guidelines for IPF.

Methods and analysis

This scoping review is guided by the methodological framework for conducting scoping reviews developed by the Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist is used for guidance. The following databases will be searched: CINAHL, MEDLINE, PsycINFO, Web of Science, Embase and ASSIA and include a comprehensive grey literature search. The review will report on adult patients >18 with a diagnosis of IPF or pulmonary fibrosis and be limited to publications from 2011 onwards, with no language restrictions applied. Two independent reviewers will screen articles in consecutive stages for relevance against the inclusion and exclusion criteria. Data will be extracted using a predefined data extraction form and analysed using descriptive and thematic analysis. Findings will be presented in tabular form, coupled with a narrative summary of the evidence.

Ethics and dissemination

Ethics approval is not required for this scoping review protocol. We will disseminate our findings using traditional approaches that include open access peer-reviewed publications and scientific presentations.
Association of uric acid with the decline in estimated glomerular filtration rate in middle-aged and elderly populations: evidence based on the China Health and Retirement Longitudinal Study
Authors: Liu Peijia , Liang Ying , Cui Sini , Hu Kaiyuan , Lin Liu , Shao Xinning , Lei Ming
Published: May 2023

Objective

Whether uric acid (UA) has an effect on renal function remains controversial. We aimed to investigate the association between serum UA with the decline in estimated glomerular filtration rate (eGFR) in middle-aged and elderly populations in the China Health and Retirement Longitudinal Study (CHARLS).

Design

Longitudinal cohort study.

Setting

This was a second analysis of a public dataset (CHARLS).

Participants

In this study, 4538 middle-aged and elderly individuals were screened after removing individuals younger than 45 years old, with kidney disease, malignant tumour and missing values.

Outcome measures

Blood tests were performed both in 2011 and 2015. Decline in eGFR was defined as an eGFR decrease of more than 25% or deterioration of the eGFR stage during the 4-year follow-up period. Logistic models corrected for multiple covariables were used to analyse the association of UA with the decline in eGFR.

Results

The median (IQR) concentrations of serum UA grouped by quartiles were 3.1 (0.6), 3.9 (0.3), 4.6 (0.4) and 5.7 (1.0) mg/dL, respectively. After multivariable adjustment, the OR of the decline in eGFR was higher for quartile 2 (3.5–<4.2 mg/dL: OR 1.44; 95% CI 1.07 to 1.64; p<0.01), quartile 3 (4.2–<5.0 mg/dL: OR 1.72; 95% CI 1.36 to 2.18; p<0.001) and quartile 4 (≥5.0 mg/dL: OR 2.04; 95% CI 1.58 to 2.63; p<0.001) when compared with quartile 1 (<3.5 mg/dL), and the p value for the trend was <0.001.

Conclusions

Over a 4-year follow-up period, we found that elevated UA was associated with a decline in eGFR in the middle-aged and elderly individuals with normal renal function.
Coronary artery calcium: from risk prediction to treatment allocation and clinical trials
Authors: Whelton Seamus P , Blaha Michael J
Published: May 2023

Coronary artery calcium (CAC) is a direct measure of an individual’s coronary atherosclerotic burden. Higher levels of CAC are strongly associated with an increased risk of cardiovascular disease (CVD) events and individuals with very high CAC levels have a CVD risk similar to stable persons with a prior CVD event. Conversely, the absence of CAC (CAC=0) is associated with a low long-term risk of CVD, even among groups classified as high risk based on traditional risk factors. Accordingly, the guideline-based role of CAC in allocation of CVD prevention therapies has expanded to include both statin and non-statin medications. Beyond prevention therapies, it is now widely recognised that the total burden of atherosclerosis is a stronger risk factor for CVD than a sole focus on coronary stenosis. Furthermore, evidence is accruing to support expanding the value of CAC=0 among low-risk symptomatic patients given its very high negative predictive value for ruling out obstructive coronary artery disease. There is now an appreciation of the value of routine assessment of CAC on all non-gated chest CTs and with the advent of artificial intelligence, automated interpretation is now possible. Additionally, CAC is now firmly established in randomised trials as a tool to identify high-risk patients most likely to benefit from pharmacotherapies. Future studies incorporating measures of atherosclerosis beyond the Agatston score will lead to continued refinement of CAC scoring, further improvements in personalisation of CVD risk prediction and more individualised allocation of prevention therapies to the patients at highest CVD risk.
Lowering the age limit of access to the identity of the gamete donor by donor offspring: the argument against
Authors: Pennings Guido
Published: May 2023

Countries that abolished donor anonymity have imposed age limits for access to certain types of information by donor offspring. In the UK and the Netherlands, a debate has started on whether these age limits should be lowered or abolished all together. This article presents some arguments against lowering the age limits as a general rule for all donor children. The focus is on whether one should give a child the right to obtain the identity of the donor at an earlier age than is presently stipulated. The first argument is that there is no evidence that a change in age will increase the total well-being of the donor offspring as a group. The second argument stresses that the rights language used for the donor-conceived child isolates the child from his or her family and this is unlikely to be in the best interest of the child. Finally, lowering the age limit reintroduces the genetic father in the family and expresses the bionormative ideology that contradicts gamete donation as a practice.
The VEBAS score: a practical scoring system for intracranial dural arteriovenous fistula obliteration
Authors: Becerril-Gaitan Andrea , Ding Dale , Ironside Natasha , Buell Thomas J , Kansagra Akash P , Lanzino Giuseppe , Brinjikji Waleed , Kim Louis , Levitt Michael R , Abecassis Isaac Josh , Bulters Diederik , Durnford Andrew , Fox W Christopher , Blackburn Spiros , Chen Peng Roc , Polifka Adam J , Laurent Dimitri , Gross Bradley , Hayakawa Minako , Derdeyn Colin , Amin-Hanjani Sepideh , Alaraj Ali , van Dijk J Marc C , Potgieser Adriaan R E , Starke Robert M , Peterson Eric C , Satomi Junichiro , Tada Yoshiteru , Abla Adib A , Winkler Ethan A , Du Rose , Lai Pui Man Rosalind , Zipfel Gregory J , Chen Ching-Jen , Sheehan Jason P
Published: May 2023

Background

Tools predicting intracranial dural arteriovenous fistulas (dAVFs) treatment outcomes remain scarce. This study aimed to use a multicenter database comprising more than 1000 dAVFs to develop a practical scoring system that predicts treatment outcomes.

Methods

Patients with angiographically confirmed dAVFs who underwent treatment within the Consortium for Dural Arteriovenous Fistula Outcomes Research-participating institutions were retrospectively reviewed. A subset comprising 80% of patients was randomly selected as training dataset, and the remaining 20% was used for validation. Univariable predictors of complete dAVF obliteration were entered into a stepwise multivariable regression model. The components of the proposed score (VEBAS) were weighted based on their ORs. Model performance was assessed using receiver operating curves (ROC) and areas under the ROC.

Results

A total of 880 dAVF patients were included. Venous stenosis (presence vs absence), elderly age (<75 vs ≥75 years), Borden classification (I vs II-III), arterial feeders (single vs multiple), and past cranial surgery (presence vs absence) were independent predictors of obliteration and used to derive the VEBAS score. A significant increase in the likelihood of complete obliteration (OR=1.37 (1.27–1.48)) with each additional point in the overall patient score (range 0–12) was demonstrated. Within the validation dataset, the predicted probability of complete dAVF obliteration increased from 0% with a 0–3 score to 72–89% for patients scoring ≥8.

Conclusion

The VEBAS score is a practical grading system that can guide patient counseling when considering dAVF intervention by predicting the likelihood of treatment success, with higher scores portending a greater likelihood of complete obliteration.
Association of serum neurofilament light with microglial activation in multiple sclerosis
Authors: Saraste Maija , Matilainen Markus , Vuorimaa Anna , Laaksonen Sini , Sucksdorff Marcus , Leppert David , Kuhle Jens , Airas Laura
Published: May 2023

Background

Translocator protein (TSPO)-PET and neurofilament light (NfL) both report on brain pathology, but their potential association has not yet been studied in multiple sclerosis (MS) in vivo. We aimed to evaluate the association between serum NfL (sNfL) and TSPO-PET-measurable microglial activation in the brain of patients with MS.

Methods

Microglial activation was detected using PET and the TSPO-binding radioligand [11C]PK11195. Distribution volume ratio (DVR) was used to evaluate specific [11C]PK11195-binding. sNfL levels were measured using single molecule array (Simoa). The associations between [11C]PK11195 DVR and sNfL were evaluated using correlation analyses and false discovery rate (FDR) corrected linear regression modelling.

Results

44 patients with MS (40 relapsing-remitting and 4 secondary progressive) and 24 age-matched and sex-matched healthy controls were included. In the patient group with elevated brain [11C]PK11195 DVR (n=19), increased sNfL associated with higher DVR in the lesion rim (estimate (95% CI) 0.49 (0.15 to 0.83), p(FDR)=0.04) and perilesional normal appearing white matter (0.48 (0.14 to 0.83), p(FDR)=0.04), and with a higher number and larger volume of TSPO-PET-detectable rim-active lesions defined by microglial activation at the plaque edge (0.46 (0.10 to 0.81), p(FDR)=0.04 and 0.50 (0.17 to 0.84), p(FDR)=0.04, respectively). Based on the multivariate stepwise linear regression model, the volume of rim-active lesions was the most relevant factor affecting sNfL.

Conclusions

Our demonstration of an association between microglial activation as measured by increased TSPO-PET signal, and elevated sNfL emphasises the significance of smouldering inflammation for progression-promoting pathology in MS and highlights the role of rim-active lesions in promoting neuroaxonal damage.
Randomised trial of stable chest pain investigation: 3-year clinical and quality of life results from CE-MARC 2
Authors: Everett Colin C. , Berry Colin , McCann Gerry P. , Fernandez Catherine , Reynolds Catherine , Bucciarelli-Ducci Chiara , Dall’Armellina Erica , Prasad Abhiram , Foley James R. , Mangion Kenneth , Bijsterveld Petra , Brown Julia , Stocken Deborah , Walker Simon , Sculpher Mark , Plein Sven , Greenwood John P.
Published: May 2023

Aims

Guidelines for suspected cardiac chest pain have used historical risk stratification tools, advocating invasive coronary angiography (ICA) first-line in those at highest risk. We aimed to determine whether different strategies to manage suspected stable angina affected medium-term cardiovascular event rates and patient-reported quality of life (QoL) measures.

Methods

CE-MARC 2, a three-arm parallel group trial, randomised patients with suspected stable cardiac chest pain and a Duke Clinical pretest likelihood of coronary artery disease between 10% and 90%. Patients were randomised to either first-line cardiovascular magnetic resonance (CMR), single-photon emission computed tomography (SPECT) or the UK National Institute for Health and Care Excellence (NICE) CG95 (2010) guidelines-directed care. For the three arms, 1-year and 3-year first major adverse cardiovascular event (MACE) rates and QoL assessed by the Seattle Angina Questionnaire, Short Form 12 (V.12) Questionnaire and EuroQol-5 Dimension Questionnaire were recorded.

Results

1202 patients were randomised to CMR (n=481), SPECT (n=481) and NICE (n=240). Forty-two patients (18 CMR, 18 SPECT, 6 NICE) experienced one or more MACEs. The percentage rates (95% CIs) of MACE in the CMR, SPECT and NICE groups at 3 years were 3.7% (2.4%, 5.8%), 3.7% (2.4%, 5.8%) and 2.1% (0.9%, 4.8%), respectively. QoL scores did not significantly differ across domains.

Conclusion

Despite a fourfold increase in referrals for ICA, the NICE CG95 (2010) guidelines risk-stratified care strategy did not significantly reduce 3-year MACE or improve QoL, as compared with functional imaging with CMR or SPECT.

Trial registration number

ClinicalTrials.gov Registry (NCT01664858).
Systematic coronary physiology improves level of agreement in diagnostic coronary angiography
Authors: Bashar Hussein Ali Bashar , Saunders Alec , Alaour Bashir , Gerontitis Dimitrios , Hinton Jonathan , Karamanou Danai , Kechagioglou Georgios , Olsen Sally , Onwordi Eunice , Pope Michael , Zingale Anna , Nicholas Zoe , Golledge Peter , Escaned Javier , Ali Ziad , Curzen Nick
Published: May 2023

Objective

The training of interventional cardiologists (ICs), non-interventional cardiologists (NICs) and cardiac surgeons (CSs) differs, and this may be reflected in their interpretation of invasive coronary angiography (ICA) and management plan. Availability of systematic coronary physiology might result in more homogeneous interpretation and management strategy compared with ICA alone.

Methods

150 coronary angiograms from patients with stable chest pain were presented independently to three NICs, three ICs and three CSs. By consensus, each group graded (1) coronary disease severity and (2) management plan, using options: (a) optimal medical therapy alone, (b) percutaneous coronary intervention, (c) coronary artery bypass graft or (d) more investigation required. Each group was then provided with fractional flow reserve (FFR) from all major vessels and asked to repeat the analysis.

Results

There was only ‘fair’ level of agreement of management plan among ICs, NICs and CSs (kappa 0.351, 95% CI 0.295–0.408, p<0.001) based on ICA alone (complete agreement in 35% of cases), which almost doubled to ‘good’ level (kappa 0.635, 95% CI 0.572–0.697, p<0.001) when comprehensive FFR was available (complete agreement in 66% of cases). Overall, the consensus management plan changed in 36.7%, 52% and 37.3% of cases for ICs, NICs and CSs, respectively, when FFR data were available.

Conclusions

Compared with ICA alone, the availability of systematic FFR of all major coronary arteries produced a significantly more concordant interpretation and more homogeneous management plan among IC, NIC and CS specialists. Comprehensive physiological assessment may be of value in routine care for Heart Team decision-making.

Trial registration number

NCT01070771.
Awareness and use of short-fill e-liquids by youth in England in 2021: findings from the ITC Youth Tobacco and Vaping Survey
Authors: Taylor Eve , East Katherine , Reid Jessica L , Hammond David
Published: May 2023

Background

Refillable e-cigarettes were popular among youth in England in 2021. The UK Tobacco and Related Products Regulations (TRPR) limits e-liquids to 20 mg/mL of nicotine in a 10 mL bottle. Short-fill e-liquids, which are not covered by TRPR regulations, are typically nicotine-free and come in larger, underfilled bottles allowing customisation with the addition of ‘nicotine shots’. This paper investigates awareness, use, and reasons for use of short-fill e-liquids among youth in England.

Methods

Data are from the online 2021 International Tobacco Control Youth Survey, comprising 4224 youth (aged 16–19 years) in England. Weighted logistic regression models investigated associations between awareness and past 30-day use of short-fills by smoking status, vaping status, nicotine strength vaped and participant demographics. Reasons for use were also reported.

Results

Approximately one-quarter (23.0%) of youth in England reported awareness of short-fill e-liquids. Among youth who had vaped in the past 30 days, 22.1% had used short-fills in the past 30 days; use was most prevalent among those who were also smoking (43.2%) and those who reported usually vaping nicotine concentrations of 2.1% (21 mg/mL) or more (40.8%). ‘Convenience of a bigger bottle’ was the most selected reason for use (45.0%), followed by ‘less expensive than regular e-liquids’ (37.6%).

Conclusions

Awareness of short-fills was common among youth in 2021, including among those who had never vaped or smoked. Among youth who vaped in the past 30 days, short-fill use was more prevalent among those who also smoked and those who vaped nicotine-containing e-liquids. Integration of short-fill products into existing e-cigarette regulations should be considered.
Noise-aware Local Model Training Mechanism for Federated Learning
Authors: Zhang Jinghui , Lv Dingyang , Dai Qiangsheng , Xin Fa , Dong Fang
Published: May 2023

As a new paradigm in training intelligent models, federated learning is widely used to train a global model without requiring local data to be uploaded from end devices. However, there are often mislabeled samples (i.e., noisy samples) in the dataset, which will cause the model update to deviate from the correct direction during the training process, thus reducing the convergence accuracy of the global model. Existing works employ noisy label correction techniques to reduce the impact of noisy samples on model updates by correcting labels; however, such methods necessitate the use of prior knowledge and additional communication costs, which cannot be directly applied to federated learning due to data privacy concerns and limited communication resources. Therefore, this paper proposes a noise-aware local model training method that corrects the noisy labels directly at the end device under the constraints of federated learning. By constructing a label correction model, a joint optimization problem is formally defined for optimizing both the label correction model and the client-side local training model (e.g., classification model). As a solution to this optimization problem, we propose a robustness training algorithm using label correction, along with a cross-validation data sampling algorithm that updates both models simultaneously. It is verified through experiments that the mechanism can effectively improve the model convergence accuracy on noisy datasets in federated learning scenarios.
Contrastive Learning Models for Sentence Representations
Authors: Xu Lingling , Xie Haoran , Li Zongxi , Wang Fu Lee , Wang Weiming , Li Qing
Published: May 2023

Sentence representation learning is a crucial task in natural language processing, as the quality of learned representations directly influences downstream tasks, such as sentence classification and sentiment analysis. Transformer-based pretrained language models such as bidirectional encoder representations from transformers (BERT) have been extensively applied to various natural language processing tasks, and have exhibited moderately good performance. However, the anisotropy of the learned embedding space prevents BERT sentence embeddings from achieving good results in the semantic textual similarity tasks. It has been shown that contrastive learning can alleviate the anisotropy problem and significantly improve sentence representation performance. Therefore, there has been a surge in the development of models that utilize contrastive learning to fine-tune BERT-like pretrained language models to learn sentence representations. But no systematic review of contrastive learning models for sentence representations has been conducted. To fill this gap, this article summarizes and categorizes the contrastive learning based sentence representation models, common evaluation tasks for assessing the quality of learned representations, and future research directions. Furthermore, we select several representative models for exhaustive experiments to illustrate the quantitative improvement of various strategies on sentence representations.