bluuebunny/crossref_metadata_2025 huggingface dataset:
Tapencarium (RZL-012) for Flank Fat Reduction: A Proof-of-Concept Study
Authors: Shridharani Sachin M , Kennedy MacKenzie L , Gueta Racheli , Walker Patricia
Published: October 2023

Background

RZL-012 is a novel cytolytic drug that has shown promise in reducing localized fat deposits in a single treatment session.

Objectives

To assess the safety and efficacy of injecting RZL-012 to the flanks.

Methods

A double-blind, placebo-controlled, proof of concept study randomized 12 patients to receive RZL-012 injections in 1 flank and placebo injections in the contralateral flank. After 12 weeks of follow-up, patients could receive RZL-012 in the placebo-treated flank and undergo follow-up for 12 weeks in the open-label phase.

Results

At 12 weeks, Investigator Global Aesthetic Improvement Scale assessments showed improvement for 90.9% of RZL-012-treated flanks and 0% of placebo-treated flanks (P < .0001), 81.8% of patients were satisfied with the RZL-012-treated flanks, and 9.1% were satisfied with the placebo-treated flanks (P = .0019). Volume reduction measured on 3-dimensional images was a mean 37.27 mL, which was significantly greater than placebo (P = .0052). The product was well tolerated, with no clinically significant trends in laboratory values, electrocardiograms, or vital signs. Pharmacokinetic analyses demonstrated that RZL-012 is quickly absorbed, reaches maximum concentration in approximately 1.67 h, and has a half-life of 9.1 h. The mean maximal concentration of RZL-012 found in the blood was <1 µg/mL.

Conclusions

RZL-012 is a promising option for injectable fat reduction of the flanks in a single treatment session. The drug was well tolerated in this small patient population, with no concerning safety signals, and it had indications of efficacy. Further research is needed in large Phase 2 studies with robust efficacy measurements to confirm these early findings.

Level of Evidence: 2
Radicalisation
Authors: Carvalho Jean-Paul , Sacks Michael
Published: October 2023

This paper analyses the rise of radical movements and the design of counter-radicalisation policies. A group derives meaning from participation in identity-based activities and a forward-looking organisation provides a platform for these activities. The warning sign for radicalisation is cultural purification by the organisation, i.e., the screening out of moderates and exclusive recruitment of radicals. While this shrinks the club, it puts it on a growth path along which it becomes larger and more extreme over time. Conventional counter-radicalisation policies can backfire. The radicalisation mechanisms we identify can be disabled by mild anti-radical messaging and informational interventions that eliminate stereotypes.
Comparing the Experiences of Participants With Mild Cognitive Impairment and Mild Dementia During an Oral Health Intervention
Authors: Shieu Bianca , Teng Chiao-Hsin , Chan Ya-Ning , Cho Youngmin , Dictus Cassandra , Wang Jing , Beeber Anna S , Bryant Ashley , Wu Bei , Plassman Brenda L , Anderson Ruth A
Published: October 2023

Background and Objectives

Cognitive impairment is associated with poor oral health outcomes. Oral hygiene tasks are an essential target of interventions aiming to improve oral health for older adults with cognitive impairment. We aimed to examine whether experiences in an oral health intervention based on the Adaptive Leadership Framework for Chronic Illness differed between individuals with mild cognitive impairment (MCI) or mild dementia (MD) and their respective care partners.

Research Design and Methods

This was a secondary analysis using directed content analysis and then an interpretive-description approach to analyze the data from a theory-driven intervention study. We included 10 people with MCI and their care partners (n = 20) and 8 people with MD and their care partners (n = 16) in the treatment arm of the intervention. For each participant, we analyzed audio recordings of 4 intervention coaching sessions, each ranging between 30 and 45 min. We managed the data and coding using ATLAS.TI software.

Results

Participants in both the MCI and MD groups experienced similar challenges in adapting to changes in oral hygiene techniques, and both groups worked on learning new oral hygiene techniques taught by the dental hygienist and meeting individualized goals developed with their care partner, interventionist, and hygienist. On the other hand, there were subtle differences in technical challenges between participants in MCI and MD groups; participants in the MCI group reacted more actively to dental hygienist suggestions than the MD group.

Discussion and Implications

Study findings provide information about how researchers and clinicians might tailor interventions to meet the learning needs of individuals and care partners in each group.
Trends in antimicrobial resistance of Shigella species in Peru, 2011–2020
Authors: Quino Willi , Bellido Gustavo , Flores-León Diana , Caro-Castro Junior , Mestanza Orson , Lucero Jorge , Gavilan Ronnie G
Published: October 2023

Objective

To describe the frequency of antimicrobial resistance rates and spatial-temporal distribution of Shigella species from the last 10 years in Peru.

Methods

A cross-sectional descriptive study was carried out. A total of 1668 Shigella strains, remitted as part of the national enteric pathogen surveillance from 2011 to 2020, were analysed. The strains were confirmed by conventional tests and serotyped with polyvalent and monovalent antibodies. Also, antimicrobial susceptibility was performed according to the Kirby–Bauer method.

Results

The most frequent Shigella species was S. sonnei (49.2%), followed by S. flexneri (42.2%), S. boydii (7.9%) and S. dysenteriae (0.7%). Phase II (46.29%) was the most frequent serotype in S. sonnei, serotype 2a (43.61%) in S. flexneri, serotype 2 in S. boydii and serotype 4 in S. dysenteriae. High rates of resistance were detected for trimethoprim/sulfamethoxazole (91.0%), tetracycline (88.4%), ampicillin (73.9%) and chloramphenicol (64.9%), moderate rates for amoxicillin/clavulanic acid (25.1%), ciprofloxacin (16.7%) and nalidixic acid (14.8%), and low rates for cefotaxime (1.74%), nitrofurantoin (0.7%) and ceftazidime (0.6%). Moreover, antimicrobial resistance to fluoroquinolones increased considerably from 2017 to 2020.

Conclusion

S. sonnei was the most frequent species, which have a large proportion of strains resistant to trimethoprim/sulfamethoxazole, and a growing trend of resistance to ciprofloxacin and nalidixic acid. This increase in resistance to commonly used antibiotics in treatments is alarming, threatening the control and management of these currently treatable infections.
Nasal hemophilic pseudotumor in a 2-year-old with recurrent epistaxis: a case report and review of the literature
Authors: Farag Nouran , Alwasiyah Bashair , Marglani Osama
Published: October 2023

Hemophilic pseudotumor is a rare, yet dangerous complication of hemophilia. It has been reported previously at sites prone to recurrent trauma like long bones and pelvis. However, in the field of otorhinolaryngology, few cases are reported and therefore there is no established protocol for management. We hereby report a case of a 2-year-old boy, a known case of hemophilia A (factor VIII deficiency), who presented with recurrent epistaxis not responding to medical management. Imaging was done and revealed a heterogenous nasal mass compressing the left orbital wall, extending to the sphenoid sinus, and causing skull base erosion. The patient was successfully managed by evacuation and drainage of the pseudotumor via endoscopic endonasal approach and replacement of factor VII pre-and post-operatively. To our knowledge, this is the first case of nasal hemophilic pseudotumor managed by evacuation and drainage through an endoscopic endonasal approach, which was deemed successful.
General dental practice, health education, and health promotion: a critical reappraisal
Authors: Croucher Ray
Published: October 2023

This chapter will discuss factors influencing the value of health education and health promotion in general dental practice. Four key areas are reviewed, namely:

the role that general dental practice could play in health education and health promotion; criticisms of the current practice of health education in general dental practice; the role of chairside health education and health education materials in general dental practice; developing an oral health promotion strategy for general dental practice.
Attenuation of binuclear hepatocytes in the paracancerous liver tissue is associated with short‐term recurrence of hepatocellular carcinoma post‐radical surgery
Authors: Zhang Yifan , Wang Nan , Hao Fengjie , Chen Yongjun , Fei Xiaochun , Wang Junqing
Published: October 2023

Short‐term recurrence of hepatocellular carcinoma (HCC) after radical resection leads to dismal outcomes. To screen high‐recurrence risk patients to provide adjuvant treatment is necessary. Herein, based on our previous research, we further focused on the changes in the abundance of binuclear hepatocytes (ABH) in the paracancerous liver tissue to discuss the relationship between the attenuation of binuclear hepatocytes and postoperative short‐term recurrence, by combining with the assessment of the value of a reported independent early recurrence risk factor in HCC, protein induced by vitamin K absence or antagonist‐II (PIVKA‐II). A cohort of 142 paracancerous liver tissues from HCC patients who received radical resection was collected. Binuclear hepatocytes were reduced in the paracancerous liver tissues, compared with the liver tissues from normal donors. ABH was negatively correlated with clinical features such as tumor size, TNM stages, tumor microsatellite formation, venous invasion, and Alpha‐fetoprotein (AFP) level, as well as the expression of E2F7 and Anillin, which are two critical regulators concerning the hepatocyte polyploidization. According to the short‐term recurrence information, ABH value was laminated, and univariate and multivariate logistic regression was performed to analyze the relationship between paracancerous ABH and short‐term tumor relapse. Simultaneously, the predictive effectiveness of the ABH value was compared with the preoperative PIVKA‐II value. As observed, the paracancerous ABH value below 1.5% was found to be an independent risk factor for recurrence. In conclusion, the paracancerous ABH is a credible indicator of short‐term recurrence of HCC patients after radical resection, and regular assessment of ABH might help to prevent short‐term HCC recurrence.
Integrating Lawyers Into Perinatal Care Teams to Address Unmet, Health-Harming Legal Needs
Authors: Patchen Loral , Richardson Roxana , McCullers Asli , Girard Vicki
Published: October 2023

Across the United States, historically imposed structural, social, and environmental variables are intimately connected to poor obstetric outcomes and high maternal and infant mortality rates among Black pregnancy-capable people. Efforts to diminish the effect of these variables include integrating screening for social determinants of health during the perinatal period and treating them with social services, mental health support, and other referrals, including connections to community-based resources. Although helpful, some of these social determinants cannot be overcome without legal advocacy. Medical–legal partnerships, which integrate lawyers into health care, fill this gap. This commentary by an interprofessional team of authors relies on the experience of an established MLP. We posit that unmet legal needs of perinatal patients merit ongoing monitoring and intervention. We explain the rationale for perinatal practice medical–legal partnerships and share implementation suggestions from a high-intensity safety-net urban hospital.
Eruptive Papules as a Cutaneous Manifestation of Metastatic Prostate Adenocarcinoma
Authors: Onalaja-Underwood Amanda A. , Sokumbi Olayemi
Published: October 2023

Cutaneous metastasis from prostate cancer is a rare manifestation, occurring in less than 1% of all cases of prostate cancer. Prostate cancer metastasis occurs most often in lymph nodes and bones. In this study, we present the case of a 55-year-old man with prostate adenocarcinoma and progressive papules on his left chest that developed shortly after androgen deprivation therapy was initiated. This case emphasizes the significance of considering cutaneous metastasis in the diagnostic differential when assessing patients with a history of cancer and the need to thoroughly evaluate these cases.
A Case of Biphenotypic Adnexal Carcinoma With Bowenoid and Basaloid Features: Focus on the Expression of SOX9 and Wnt Signaling Pathway Molecules, Including CDX2
Authors: Sugimoto Akihiko , Fujimoto Masakazu , Masuo Yumi , Nakagawa Yujin , Yamada Yosuke , Kono Fumihiko , Haga Hironori
Published: October 2023

An 87-year-old woman presented with a pedunculated nodule of 1.2 × 1.2 × 0.6 cm on her left cheek. Microscopic examination of the lesion revealed bowenoid and rosette-like basaloid components, resembling Bowen disease and neuroendocrine carcinoma, respectively. Immunohistochemically, both components were positive for Wnt signaling pathway molecules—nuclear/cytoplasmic beta-catenin, lymphoid enhancer binding factor 1 (LEF1), and caudal type homeobox 2 (CDX2)—and the adnexal marker SRY-box transcription factor 9 (SOX9). Unlike neuroendocrine tumors and basal cell carcinomas, the basaloid component in the present case was negative for chromogranin A, INSM1, synaptophysin, and p40. Previously reported cases of similar CDX2-positive lesions were diagnosed as squamous cell carcinoma with enteric adenocarcinomatous differentiation and basaloid cutaneous carcinoma with a primitive cytomorphology. However, the lesion in the present case was simultaneously positive for SOX9, indicating adnexal differentiation. In particular, the expression of multiple Wnt signaling pathway molecules indicates follicular differentiation despite the absence of morphological follicular features, such as shadow cells. Moreover, shared immunopositivity for SOX9, CDX2, nuclear/cytoplasmic beta-catenin, and LEF1 by both bowenoid and basaloid components indicated that the bowenoid component did not represent Bowen disease but a part of the adnexal tumor, and that the basaloid component was not a tumor-to-tumor metastasis. After complete excision, no recurrence has been observed for 5 months. The findings of the present case expand the histological spectrum of cutaneous adnexal tumors with follicular immunophenotypic differentiation.
Evaluation of Dry Eye Disease Characteristics of Children With Type 1 and Type 2 Diabetes Mellitus and MODY
Authors: Yetkin Esat , Aksoy Aydemir Gözde , Bilen Abdurrahman , Pehlivanoglu Burcin , Asik Abdulvahit , Kocaay Funda , Ozkoyuncu Dilara , Aydemir Emre
Published: October 2023

Purpose:

To assess dry eye disease characteristics of pediatric patients with diabetes.

Methods:

Twenty-one patients with type-1 diabetes mellitus (DM), 20 with type-2 DM, 19 with maturity-onset diabetes of the young (MODY), and 20 control participants were included in the study. Ocular Surface Disease Index (OSDI) questionnaire, tear film break-up time (TBUT) analysis, Schirmer test with anesthesia, and conjunctival impression cytologic analysis were performed.

Results:

In Group 1, the Schirmer test and TBUT values were lower than the control group. In groups 1 to 3, OSDI scores were higher than the control group. In Groups 1 and 2, the goblet cell density was lower than the control group.

Conclusion:

Dry eye parameters of all three diabetic groups were adversely affected in favor of dry eye disease. Children with MODY have increased OSDI scores. Alterations in the conjunctival impression cytology were observed more prominently in patients with type-1 DM.
Echocardiographic function evaluation in adolescents following BNT162b2 Pfizer-BioNTech mRNA vaccination: A preliminary prospective study
Authors: Hsu Wan-Fu , Hsu Chih-Hsiung , Jeng Mei-Jy
Published: October 2023

Background:

Vaccination against coronavirus disease 2019 (COVID-19) is crucial for preventing and minimizing illness. Myocarditis and pericarditis after messenger RNA (mRNA) COVID-19 vaccination in adolescents and young adult males have been reported. Most of the studies in this area rely on retrospective symptom reporting, especially for adolescents experiencing myocarditis as a potential side effect. However, prospective postvaccination echocardiographic evaluation is rare.

Methods:

The study enrolled adolescents aged 12 to 15 years who received the second dose of the BNT162b2 Pfizer-BioNTech mRNA (BNT) vaccine. Serial echocardiographic examinations were conducted at baseline before vaccination, followed by subsequent assessments on days 2, 7, 14, and 28 to identify any notable differences or abnormal changes in cardiac function. Clinical symptom assessments were also recorded during each follow-up.

Results:

The study included 25 adolescents, comprising 14 males and 11 females, who completed the four follow-ups. Their mean age was 14 ± 1 years. The average interval between the first and second BNT vaccine doses was 90 ± 7 days. Ejection fraction values were 73.8% ± 5.2% at baseline, followed by 75.7% ± 5.3%, 75.5% ± 4.6%, 75.7% ± 4.5%, and 77.8% ± 5.8% at day 2, 7, 14, and 28, respectively. The cardiac function remained stable across all time points, with no significant differences observed between male and female participants. Within postvaccination 48 hours, 18 (72%) of the enrolled adolescents experienced temporary discomfort symptoms, which completely resolved by the final follow-up on the 28th day after vaccination.

Conclusion:

Although adolescents vaccinated with the second dose of BNT vaccine commonly experienced transient postvaccination discomfort, the serial echocardiographic examinations did not reveal any significant deterioration of cardiac function within 28 days. Further studies are required to investigate the incidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccination-associated myocarditis in adolescents and the related mechanisms.
68Ga-FAPI-04 Detected Hepatic Arteriovenous Malformation in a Patient With IgA Nephropathy
Authors: Zhang Zeyu , Ni Xiang , Guo Shiwei , Zuo Changjing , Cheng Chao
Published: October 2023

A 51-year-old woman with a history of IgA nephropathy was found to have a mass in the right lobe of the liver by abdominal ultrasound. The PET/CT scan revealed elevated 68Ga-FAPI-04 uptake in the aforementioned lesion, indicating the potential presence of liver cancer. However, subsequent histopathological analysis confirmed it to be an arteriovenous malformation. This case illustrates that 68Ga-FAPI-04 uptake can occur in arteriovenous malformation and is a benign cause of 68Ga-FAPI-04 uptake.
Hepatic Cavernous Hemangioma Mimicking Malignancy on 18F-FDG PET/CT Imaging
Authors: Zhang Yuwei , Wang Peipei , Shi Ximin , Jing Hongli
Published: October 2023

A 65-year-old woman was referred to our hospital because of a liver lesion revealed by ultrasound and CT in an outside institution. 18F-FDG PET/CT images revealed an FDG-avid lesion in the left lateral lobe of the liver. Malignancy cannot be excluded. A subsequent resection was performed to remove the lesion. Postoperative pathology was hepatic cavernous hemangioma. This case suggests that PET/CT findings of FDG-avid hepatic cavernous hemangioma could mimic malignancy.
Giant Fibrovascular Polyp Mimicking Esophageal Malignancy on 18F-FDG PET/CT
Authors: Kim MinJeong , Chae Kum Ju , Kim Jong-Hun , Han Yeon-Hee
Published: October 2023

A 52-year-old man presented with continuous dull pain from the throat to the epigastric region with dysphagia. Initial endoscopy misdiagnosed a subepithelial tumor causing external compression of the esophagus. A CT scan visualized a 14.0 × 4.0-cm pedunculated mass inside the esophagus. Subsequent 18F-FDG PET/CT identified an intense FDG-avid area in the mass, which strongly suggested esophageal cancer. Total mass excision was performed, and fibrovascular polyp with chronic ulcerative inflammation was finally confirmed on histologic examination.
Artificial Intelligence–Driven Single-Shot PET Image Artifact Detection and Disentanglement
Authors: Shiri Isaac , Salimi Yazdan , Hervier Elsa , Pezzoni Agathe , Sanaat Amirhossein , Mostafaei Shayan , Rahmim Arman , Mainta Ismini , Zaidi Habib
Published: October 2023

Purpose

Medical imaging artifacts compromise image quality and quantitative analysis and might confound interpretation and misguide clinical decision-making. The present work envisions and demonstrates a new paradigm PET image Quality Assurance NETwork (PET-QA-NET) in which various image artifacts are detected and disentangled from images without prior knowledge of a standard of reference or ground truth for routine PET image quality assurance.

Methods

The network was trained and evaluated using training/validation/testing data sets consisting of 669/100/100 artifact-free oncological 18F-FDG PET/CT images and subsequently fine-tuned and evaluated on 384 (20% for fine-tuning) scans from 8 different PET centers. The developed DL model was quantitatively assessed using various image quality metrics calculated for 22 volumes of interest defined on each scan. In addition, 200 additional 18F-FDG PET/CT scans (this time with artifacts), generated using both CT-based attenuation and scatter correction (routine PET) and PET-QA-NET, were blindly evaluated by 2 nuclear medicine physicians for the presence of artifacts, diagnostic confidence, image quality, and the number of lesions detected in different body regions.

Results

Across the volumes of interest of 100 patients, SUV MAE values of 0.13 ± 0.04, 0.24 ± 0.1, and 0.21 ± 0.06 were reached for SUVmean, SUVmax, and SUVpeak, respectively (no statistically significant difference). Qualitative assessment showed a general trend of improved image quality and diagnostic confidence and reduced image artifacts for PET-QA-NET compared with routine CT-based attenuation and scatter correction.

Conclusion

We developed a highly effective and reliable quality assurance tool that can be embedded routinely to detect and correct for 18F-FDG PET image artifacts in clinical setting with notably improved PET image quality and quantitative capabilities.
Simultaneous Uptake of 18F-NaF and 18F-FDG by Bladder and Prostate Calculi
Authors: Park Mia Mijung , Park Peter Sang Uk , Werner Thomas J. , Høilund-Carlsen Poul F. , Alavi Abass
Published: October 2023

Calcification and formation of calculi in the genitourinary system such as the bladder, kidney, and prostate are common processes of aging. Despite being in different parts of the body, these calculi can share risk factors; for instance, bladder and prostate calculi are seen in older men with benign prostatic hyperplasia. There have been increasing reports of detection of calculi using PET tracers such as 18F-NaF and 18F-FDG, suggesting their role for detection of extraosseous calcification. In this report, we present simultaneous detection of bladder and prostate calculi with both 18F-NaF and 18F-FDG avidity in a 74-year-old man with multiple myeloma.
Gender Equity in Academic Female Pelvic Medicine and Reconstructive Surgery Departments: A Cross-Sectional Observational Study
Authors: Qin Lei Alexander , Menhaji Kimia , Sifri Yara , Hardart Anne , Ascher-Walsh Charles J.
Published: October 2023

Importance

Gender equity in obstetrics and gynecology remains a barrier to career mobility and workplace satisfaction.

Objective

This study aimed to evaluate gender equity for academic positions in female pelvic medicine and reconstructive surgery (FPMRS) divisions with an Accreditation Council for Graduate Medical Education–accredited fellowship in the United States.

Study Design

This was a cross-sectional observational study of all FPMRS divisions with an Accreditation Council for Graduate Medical Education–accredited fellowship program in the United States in July 2020 using publicly available demographic and academic data collected from online search engines. Gender equity in academic FPMRS was assessed by gender representation, academic appointment, and research productivity of each attending physician within the division. Research productivity was assessed using both the H-index with career length controlled for with the M-quotient.

Results

There were 348 attending physicians from 72 FPMRS divisions (198 female [56.9%], 150 male [43.1%]). A large percentage of female attending physicians were at the assistant professor level (75.8% [94 of 124]) when compared with their male counterparts (24.4% [30 of 124]; P < 0.001). Conversely, there were a larger percentage of male attending physicians (62.2% [56 of 90]) at the professor level when compared with their female counterparts (37.8% [34 of 90]; P < 0.001). There was no difference in research productivity between male and female attending physicians after controlling for career length with the M-quotient (P = 0.65). Only age (odds ratio, 1.14; 95% confidence interval, 1.05–1.24) and the M-quotient (odds ratio, 36.17, 95% confidence interval, 8.57–152.73) were significantly associated with professorship.

Conclusions

Our study found that there are more female attending physicians in FPMRS and that most are assistant professors. Male and female FPMRS attending physicians had similar research productivity with respect to their career lengths. Gender was not a determinant for achieving a “professor” appointment.
Management of Urinary Tract Infection Symptoms in Older Women: A Survey of Practitioners
Authors: Murillo Ashley , Su Selma , Zyczynski Halina , Bradley Megan
Published: October 2023

Importance

Urinary tract infection (UTI) is the most common bacterial infection for which empiric antibiotics are prescribed despite limited progression to urosepsis. More than half of antibiotics prescribed to older adults for a suspected UTI are considered unnecessary.

Objective

The aim of the study was to assess knowledge, attitudes, and practices regarding management of older women (>65 years) with symptoms attributed to UTIs among family and internal medicine providers.

Study Design

This cross-sectional study surveyed 330 primary care providers in November 2021 regarding management of UTI symptoms. The primary outcome was the proportion of primary care providers who felt safe waiting for urine culture results before prescribing antibiotics in older women.

Results

The response rate was 43.0% (n = 142) with the majority of primary care providers practicing medicine more than 15 years (56.3%). For the primary outcome, 26.1% (n = 37) of primary care providers felt safe waiting for a urine culture result before prescribing antibiotics, while 62.0% (n = 88) felt delaying antibiotics depended on multiple factors, and 9.2% (n = 13) felt it was never safe to delay antibiotics. Primary care providers that either never felt it was safe to delay antibiotics or felt that “it depends” on a variety of factors, attributed their antibiotics administration to concern for progression to sepsis (n = 50, 49.5%) or progression of symptoms (n = 28, 27.7%). A higher proportion of primary care providers practicing more than 15 years felt safe delaying antibiotics compared with primary care providers with less experience (33.8% vs 18.3%, P = 0.04), and 70.3% of those who felt safe delaying antibiotics had more than 15 years of experience.

Conclusion

Primary care providers with more clinical experience have more comfort delaying antibiotics in older women with UTI symptoms.
Prospective Study to Analyze the Concordance Between a Standardized Visual Method With Pathology to stratify Nonalcoholic Fatty Liver Disease in Cadaveric Liver Grafts Evaluated for Transplantation
Authors: Sampaio-Neto José , Nicoluzzi João E.L. , Luvison Gomes da Silva Larissa , Billó Leandro , de Pádua Peppe-Neto Antônio , Dall´ Asta Luíza , P. de Moraes Thyago , Fragoso Gabrielle R.
Published: October 2023

Background.

The main challenge of liver transplantation is the discrepancy in demand and availability. Marginal grafts or full organs from donors with expansion criteria have been considered to reduce the shortage and assist a greater number of patients. Nonalcoholic fatty liver disease (NAFLD) is one of the most important defining criteria for expanded criteria organs. The present study proposes that an organized visual analysis method could correctly identify and classify NAFLD and organ viability without the need for liver biopsy and its logistical concerns.

Methods.

Pictures from the grafts were taken at a standardized method (same distance, light conditions, and register device) before and after the perfusion. The visual liver score (VLS) was applied by transplant surgeons; biopsies of the grafts were analyzed by a pathologist in a double-blind design. Score performance and interobserver agreement for NAFLD detection and grading, as graft viability evaluation, were calculated.

Results.

Fifty-seven grafts were analyzed. At least 1 previous expansion criterion was presented by 59.64% of donors. The prevalence of NAFLD was 94.73%, with 31.57% borderline nonalcoholic steatohepatitis and 5.26% nonalcoholic steatohepatitis. Steatosis was identified with 48.68% (preperfusion) and 64.03% (postperfusion) accuracy. NAFLD stratification was performed with 49.53% (preperfusion) and 46.29% (postperfusion) accuracy. Viability related to NAFLD was identified with 51.96% (preperfusion) and 48.52% (postperfusion) accuracy. Interobserver agreement was moderate for total VLS and poor for individual components of VLS.

Conclusions.

Although a standardized method was not reliable enough for visual evaluation of NALFD compared with pathology, efforts should be made to expand access to biopsy. Further studies are needed to understand whether the VLS needs to be adapted or even excluded in the liver transplant scenario, to assess the importance of ectoscopy related to posttransplant clinical outcomes, and to determine its role in graft selection.
An Insight into Genes Responsible for Fosfomycin Resistance Among Uropathogens of Asymptomatic Bacteriuria during Pregnancy: A North Indian Study
Authors: Khatoon Sajda , Sultan Asfia , Khan Fatima , Khan Tamkin , Singh Anuradha
Published: October 2023

Purpose: Asymptomatic bacteriuria (ASB) is a common finding during pregnancy. Effective antibiotic treatment could reduce its adverse effects on both mother and fetus. However, emerging antimicrobial resistance limits the treatment options. Fosfomycin might be a promising drug in this regard, as its resistance is still low. The aim of the study was to determine the antimicrobial susceptibility pattern of fosfomycin in isolates causing ASB by disc diffusion and agar dilution (in selected isolates), determine minimum inhibitory concentration (MIC) by agar dilution in isolates resistant by disc diffusion and detect the genes responsible for fosfomycin resistance.
Material and Methods: This was a 2-year study carried in the Department of Microbiology, Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University (AMU), Aligarh. Total 10252 urine samples from asymptomatic pregnant females (18-45 years) attending the antenatal care (ANC) outpatient department (OPD) were submitted. Identification of pathogen and antimicrobial susceptibility testing (AST) done as per standard methods of CLSI. There was phenotypic detection of methicillin resistant Staphylococcus aureus (MRSA) and Other Staphylococcusspecies (MRSS), high level aminoglycoside resistance (HLAR), vancomycin resistant Enterococci (VRE) and S. aureus (VRSA), extended spectrum β-lactamase (ESBL) and carbapenem resistant Enterobacterales (CRE). All the fosfomycin resistant isolates (by disk diffusion) were tested by agar dilution. Conventional PCR was performed for murA, fosA, uhpT and glpT genes on all resistant isolates.
Result: In this study, the prevalence of ASB among pregnant females was 1173(11.4%), in which Escherichia coli 495(42%) being the predominant organism. The overall sensitivity of fosfomycin among Gram-positive cocci (GPC) and Gram-negative bacilli (GNB) was 99% and 97.6% respectively. MRSA and MRSS accounted for 50 (66.6%) and 71 (76%) respectively. Highest rate of MIC >2048 µg/ml were shown by most isolates (mainly E. coli) on agar dilution. PCR studies revealed four E. coli strains possessed both murA (also present in 1 K. pneumoniae strain) and glpT genes. While only one isolate (E. faecalis) was positive for fosA gene. But none of the strain possessed uhpT gene.
Conclusion: According to this study, murA and glpT genes were more frequent than fosA. We cannot comment on the prevalence and regional distribution of fosfomycin resistant genes based on this preliminary study. Therefore, more Indian studies should be carried out to create awareness about the presence of genes in a particular area.
A fatal case of Aeromonas jandaei necrotizing fasciitis
Authors: Anil Anjali , Kumar Mani Bhushan , Chauhan Sachin , Ray Pallab , Dahiya Divya , Angrup Archana
Published: October 2023

Introduction. Necrotizing soft tissue infections (NSTIs) are associated with a fulminating course because of their rapid destruction of tissue planes underlying the skin.

Aeromonas

-associated monomicrobial NSTIs are usually associated with exposure to fresh water, particularly among agricultural workers and fish handlers. Albeit uncommon in incidence, urgent medical and surgical intervention are required once a diagnosis has been made.

Case report. A 40-year-old male patient, a known case of alcoholic liver disease, presented to the emergency department with pain and diffuse swelling of bilateral lower limbs, which quickly progressed to form blackish discolouration and blebs. Blood for preliminary haematological and biochemical investigations, as well as fluid draining from blebs, were sent for microbiological investigation. The Gram stain revealed occasional neutrophils and Gram-negative bacilli, and pure growth in aerobic culture was identified as

Aeromonas jandaei

by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The patient was started on empirical antimicrobials, although lesions continued to progress and he ultimately succumbed within 12 h of hospital admission.

Conclusion. As appropriate antimicrobial therapy and early surgical intervention are required for management of the same, occupational exposure and the fulminant course should raise suspicion of

Aeromonas

-associated infections.
Genotyping of Acinetobacter baumannii isolates from a tertiary care hospital in Cochin, South India
Authors: RAJAN VINEETH , Vijayan Ardhra , Puthiyottu Methal Ambili , Lancy Justus , Sivaraman Gopalan Krishnan
Published: October 2023

Acinetobacter baumannii poses a significant challenge in healthcare settings across the globe, with isolates exhibiting carbapenem resistance at unprecedented rates. Here, we characterized a collection of A. baumannii isolates (n=64) recovered during the period September 2020 – November 2021 at a teaching hospital in Cochin, South India. The identity of the isolates was confirmed with blaOXA-51-like PCR. The major carbapenemase determinants identified were blaOXA-23-like (45, 70.3%) and blaNDM-1 (31, 48.4%); co-occurrence of these genes was also observed in 27 (42.2%) isolates. Other resistance genes identified included blaPER (34, 53.1%), aac(6')-Ib-cr (42, 65.6%), qnrS (25, 39.1%), sul1 (32, 50%), sul2 (33, 51.6%), strA/strB (36, 56.3%), aphA1-Iab (35, 54.7%) and tetB (32, 50%). Mapping PCR revealed the insertion element, ISAbaI upstream of blaOXA-23-like in all isolates possessing this gene. Concerning disinfectant resistance, all isolates carried the quaternary ammonium compound (QAC) resistance gene, qacEΔ1. Minimal inhibitory concentration (MIC) of benzalkonium chloride was high among the isolates and ranged from 8 to 128 µg/ml. However, low MICs were observed for chlorhexidine and triclosan, with the majority (54, 80.6%) of isolates showing an MIC of 2 µg/ml for chlorhexidine and all isolates exhibiting MICs of ≤0.125 µg/ml for triclosan. Further, all isolates were strong biofilm-producers, as assessed by the crystal violet-based microtitre plate assay. The ApaI-pulsed-field gel electrophoresis (PFGE) revealed the multi-clonal nature of the isolates, with 16 clusters and 16 unique pulsotypes identified at a cut-off of 80%. In short, this study provides useful data on the molecular features of A. baumannii from this region, which could be helpful in assessing the local epidemiology of this pathogen and also to devise infection control strategies.
The Influence Of Covid-19 On Patient Mobilization And Injury Attributes In The ICU: A Retrospective Analysis Of A Level II Trauma Center
Authors: Navarro Yelissa , Huang Elizabeth , Johnson Chandler , Clark Forrest , Coppola Samuel , Modi Suraj , Warren Gordon L. , Call Jarrod A.
Published: October 2023

The objectives of this study were to determine the effect of COVID-19 on physical therapy (PT) mobilization of traumatically-injured patients and to determine if mobilization affected patient course in the ICU. This retrospective study included patients who were admitted to the ICU of a level II trauma center. The patients were divided into two groups, i.e., those admitted before (n=378) and after (n=499) April 1, 2020 when Georgia’s COVID-19 Shelter-in-place order was mandated. The two groups were contrasted on nominal and ratio variables using Chi-square and Student’s t-tests. A secondary analysis focused specifically on the after COVID patients examined the extent to which mobilization (n=328) or lack of mobilization (n=171) influenced ICU outcomes (e.g., mortality, readmission). The two groups were contrasted on nominal and ratio variables using Chi-square and Student’s -tests. The after COVID patients had higher injury severity as a greater proportion was classified as severely injured (i.e., >15 on Injury Severity Score) compared to the before COVID patients. After COVID patients also had greater cumulative number of comorbidities and experienced greater complications in the ICU. Despite this, there was no difference between patients in receiving a PT consultation or day-to-mobilization. Within the after COVID cohort, those that were mobilized were older, a higher proportion were female, they had greater Glasgow Coma Scale scores, had longer total hospital days, and a lesser mortality rate. Despite shifting patient injury attributes post-COVID-19, a communicable disease, mobilization care remained consistent and effective.

Level of Evidence

Level III
ASSOCIATION BETWEEN THE USE OF CANNABIS AND DEPRESSION IN UNITED STATES ADULTS
Authors: Ortiz K. , OLeary J. , Bhatt H. , Nadraga V.
Published: October 2023

Introduction

Recent studies show a growing body of evidence suggesting that users of cannabis have consistently higher prevalence rates of depressive disorders in comparison to non-users. Besides, it can be used as a highly effective treatment for depression and other mood disorders.

Methods

A study with a cross-sectional design was conducted with data from respondents aged 25-64 who participated in the 2018 Behavioral Risk Factor Surveillance System (BRFSS) survey. The population was assessed for the baseline characteristics, followed by a bivariate analysis, a multivariate logistic regression to control any confounders, and assess the association between the use of cannabis and depression.

Results

The sample included 57,757 individuals. The unadjusted binary logistic regression indicated that those who use cannabis are 93% more likely (OR: 1.93) to have a diagnosis of depression. On the other hand, the adjusted analysis indicated that those who use cannabis are 78% more likely (OR: 1.78) to have a diagnosis of depression. Other variables including participants under the age of 45 years were significantly associated with the diagnosis of depression (OR: 1.35). Moreover, participants with an education without a high school diploma (OR: 0.54), and those having a full-time commitment (OR: 0.37) were significantly less likely to have a diagnosis of depression.

Conclusion

Findings suggest that selected U.S. participants who use cannabis have an increased risk to report depression. Furthermore, factors such as age, level of education, and a person’s time commitment status were found to have a significant influence on whether a diagnosis of depression is present.
Constructing a Finer-Grained Representation of Clinical Trial Results from ClinicalTrials.gov
Authors: Shi Xuanyu , Du Jian
Published: October 2023

Randomized controlled trials are essential for evaluating clinical interventions. ClinicalTrials.gov serves as a primary repository for such data, yet extracting and synthesizing information from it remains challenging. This study introduces a novel methodology for constructing a detailed arm-centered representation of clinical trial results, moving beyond the traditional PICO (Patient, Intervention, Comparison, Outcome) framework. The representation attentively uncovers both efficacy outcomes and adverse drug events in safety outcomes, promoting a dual-faceted understanding of intervention effects. Through a structured acquisition, extraction, and initialization process, we present a knowledge graph incorporating arm-level efficacy with safety results, categorizing outcomes into three distinct groups: biomarkers, patient-reported outcomes, and clinical endpoints. The goal is to bridge the gap between the generally described searchable design information and the specifically detailed reported results. This approach aims to offer a structured dataset towards better utilization and interpretation of ClinicalTrials.gov data, facilitating a more feasible and complete evidence synthesis practice to include both positive and negative results hidden in clinical trials registries.
Investigating “organizational maturity” in order to provide “blockchain banking service” based on “FinTech” (through “the CMMI” in “Parsian Bank”)
Authors: Ali Taghavi Komeil , Mashayekh Mohammadreza
Published: October 2023

Purpose

The description of “blockchain banking”, the determination of “the sub-processes” of “blockchain banking” as a “business process”, and the assessment of “maturity level” in Parsian Bank.

Design/methodology/approach

Theoretical sources on “blockchain banking” were initially investigated. Then the “sub-processes” of “blockchain banking” as a “business process” were extracted by Parsian Bank's experts through the “Delphi method”. Next, the “sequence” of the “sub-processes” was determined by means of the “AHP”. Eventually, Parsian Bank's maturity levels for all the sub-processes as well as the overall maturity level were specified on the basis of the “CMMI” V1.3 in order for Business Process Management (BPM).

Findings

Blockchain banking’ combines traditional banking with cryptocurrencies, which can be provided by merging “hybrid e-wallet” with “bank account” and “bank card” – all together as “crypto bank account”. Plus, “hybrid e-wallet” is a form of mobile e-wallet on blockchain that supports both cryptocurrencies and traditional currencies in the same platform by which the purchase and sale of cryptocurrencies are possible. Besides, “Blockchain banking service” can also be offered within the framework of “open banking” aligned with “open innovation” through a FinTech (or a beta bank) in collaboration with a licensed bank via “open API”, which is called “blockchain banking based on FinTech”. At last, the eight sub-processes of “blockchain banking” were determined and Parsian Bank's “maturity level” was specified.

Originality/value

This is the very first practical guide to “blockchain banking service”.
Gauging the level of time-varying interlinkages between environmental innovation and globalization in Vietnam
Authors: Thanh Ha Le
Published: October 2023

Purpose

This study aims to examine connections between five variables, including innovation in environment-related technology (EI), trade openness (TRADE), CO2 emissions (CO2) and foreign direct investment (FDI) from 1994 to 2019.

Design/methodology/approach

This study used an extended joint connectedness technique and the time-varying parameter vector autoregression (TVP-VAR) method. The analysis focuses on the variables of innovation in environment-related technology (EI), trade openness (TRADE), CO2 emissions (CO2) and foreign direct investment (FDI) using data from 1994 to 2019.

Findings

The results demonstrate that innovation in environment-related technology and an openness to the global network captured by FDI are identified as crucial net transmitters of shocks. In addition, an openness to the global trade network captured by TRADE turns from a transmitter to a receiver of shocks and vice versa. Moreover, it can be seen that the impact of EI was significant in the first five years of the observed period, and it transmitted the largest shock in 1997.

Practical implications

With regard to policy implications, the findings offer valuable insights for investors and policymakers. As the tradeoff between business efficiency and environmental sustainability diminishes, it is essential for Vietnam’s economy and enterprises to embrace green and sustainable growth in line with global trends. In a world characterized by uncertainties and risks, enterprises need to develop strategies to manage risks and shocks arising from geopolitical tensions, input material supply, financial–monetary instability and natural disasters.

Originality/value

This study contributes to the existing literature in two significant ways. First, as previously emphasized, this paper represents the first attempt to investigate the relationship between economic globalization and environmental innovation. Second, this study proposes a novel methodology that is better suited for analyzing volatility interlinkages across different market types.
Circular economy and carbon emissions: threshold effect of quality of governance
Authors: Mawutor John Kwaku Mensah , Sogah Ernest , Gborse Freeman Christian
Published: October 2023

Purpose

The main objective of the quantitative study is to ascertain the relationship between the circular economy (CE) and carbon emissions. And also, the study examines the threshold beyond which the quality of governance reduces carbon emissions.

Design/methodology/approach

The autoregressive distributed lag approach is employed for the econometrics analysis. The study employed quarterly data from 2006Q1 to 2017Q4 on Ghana.

Findings

The results indicated that, although the CE had a positive and significant effect on carbon emissions, the moderating term had an adverse and significant effect on carbon emissions. This result suggests that to mitigate carbon emissions, a robust and efficient quality of institutions should be sustained. Finally, the study also identified a quality of governance threshold of 1.155 beyond which a shift to a CE would result in a reduction in carbon emissions.

Research limitations/implications

The study recommends that policymakers should initiate policies that would enhance quality governance.

Originality/value

The main contributions of the study are that the paper ascertained the threshold beyond which quality of governance assists circular economic practices to mitigate carbon emissions. Also, the study revealed that quality of governance is a catalyst to promote circular economic practices in reducing carbon emissions. Finally, the study ascertains the long-run effect of the variables of interest on carbon emissions.