bluuebunny/crossref_metadata_2025 huggingface dataset:
Long‐term patient‐reported outcome measures (PROMs) after primary ventral or small midline incisional hernia repair
Authors: Mills Joanna M. Z. , Luscombe Georgina M. , Hugh Thomas J.
Published: July 2024

Background

Ventral hernia repair is a common elective surgical procedure lacking strong evidence for specific operative approaches. This study aimed to evaluate the outcomes of primary suture repair or polypropylene sandwich mesh repair for ventral hernias. The main outcome measures were the rate of hernia recurrence, and evaluation of long‐term complications and patient‐reported outcomes.

Methods

This retrospective cohort study evaluated patient perceived recurrence and pain in patients who had undergone a primary ventral hernia (epigastric, supraumbilical, or umbilical) repair or small (≤20 mm) midline incisional hernia repair 10 years after the procedure. Short‐term follow‐up occurred up to 6 weeks after the initial operation, while long‐term follow‐up included patients who were reviewed clinically or interviewed via telephone at or beyond 3 years after the procedure.

Results

Most (75/100, 75.0%) patients had an extra‐peritoneal sandwich mesh repair. Short‐term follow‐up showed minimal pain and normal activities for all patients (97/97, 100%). Long‐term follow‐up (median 12 years [IQR 11–13]) was achieved in 95.9% (93/97) of patients with only a small number reporting a slight bulge (5/93, 5.4%) and intermittent mild discomfort (8/93, 8.6%). Nine patients (9/97, 9.3%) experienced hernia recurrence, diagnosed at a median of 26 months [interquartile range, IQR, 7–58] post‐operatively.

Conclusions

These findings suggest that an open sandwich mesh technique is a safe and effective method for repairing primary ventral hernias and small midline incisional hernias and is associated with favourable long‐term patient‐reported outcomes.
Oxygenated versus non‐oxygenated flush out during deceased donor liver procurement: The first proof‐of‐concept study in humans
Authors: Fernandes Eduardo de Souza Martins , Corrêa Raphael Rodrigues , Furtado Rodrigo Lopes Leite , Brüggenwirth Isabel M. A. , Yang Cindy , de Mello Felipe Pedreira Tavares , de Oliveira Andrade Ronaldo , Pimentel Leandro Moreira Savattone , Girão Camila Liberato , César Camilla , Siqueira Munique Ana Pimentel , Braga Eduardo Pinho , Carvalho Angela Cristina Gouvea , Porte Robert J. , Bouskela Eliete
Published: July 2024

Background

Liver transplantation is used for treating end‐stage liver disease, fulminant hepatitis, and oncological malignancies and organ shortage is a major limiting factor worldwide. The use of grafts based on extended donor criteria have become internationally accepted. Oxygenated machine perfusion technologies are the most recent advances in organ transplantation; however, it is only applied after a period of cold ischemia. Due to its high cost, we aimed to use a novel device, OxyFlush®, based on oxygenation of the preservation solution, applied during liver procurement targeting the maintenance of ATP during static cold storage (SCS).

Methods

Twenty patients were randomly assigned to the OxyFlush or control group based on a 1:1 ratio. In the OxyFlush group, the perfusion solution was oxygenated with OxyFlush® device while the control group received a non‐oxygenated solution. Liver and the common bile duct (CBD) biopsies were obtained at three different time points. The first was at the beginning of the procedure, the second during organ preparation, and the third after total liver reperfusion. Biopsies were analyzed, and adenosine triphosphate (ATP) levels and histological scores of the liver parenchyma and CBD were assessed. Postoperative laboratory tests were performed.

Results

OxyFlush® was able to maintain ATP levels during SCS and improved the damage caused by the lack of oxygen in the CBD. However, OxyFlush® did not affect laboratory test results and histological findings of the parenchyma.

Conclusion

We present a novel low‐cost device that is feasible and could represent a valuable tool in organ preservation during SCS.
Rethinking ‘family’: A call for conceptual amelioration
Authors: Lam Ryan Xia‐Hui
Published: July 2024

The modern concept of ‘family’ in the United States recognizes many types of social groups as families, a conceptual shift which was largely helped along by advancements in assisted reproductive technologies enabling those formerly unable to biologically reproduce to have children, as well as by social movements aimed at garnering recognition for these emergent nonbiologically related social groups spearheaded by LGBTQ+ and adoption activists. That these social groups are now recognized as types of families is unquestionably an improvement to the concept, though there are still defects in the concept that preclude these nonnuclear families from achieving the same social–ontological status as nuclear families. Drawing from the nascent philosophical field of conceptual engineering, I analyze our current conception of ‘family’ and argue that it is tacitly exclusionary of nonnuclear families, which can be attributed to a combination of widespread genetic essentialism and linguistic practices that unduly cast the nuclear family as a more desirable type of family by emphasizing genetic relatedness as a valuable quality. I then offer proposals to ameliorate these defects, such as educational interventions to reduce genetic essentialism and the introduction of new terminology that does not connote one type of family as being superior to another. In doing so, my hope is to reveal and begin to resolve an overlooked defect in the concept of ‘family’ in order to bolster the movement to view all families as equal.
Intracerebellar administration of the chemokine Cxcl3 reduces the volume of medulloblastoma lesions at an advanced stage by promoting the migration and differentiation of preneoplastic precursor cells
Authors: Ceccarelli Manuela , Rossi Sabrina , Bonaventura Fabrizio , Massari Roberto , D'Elia Annunziata , Soluri Andrea , Micheli Laura , D'Andrea Giorgio , Mancini Barbara , Raspa Marcello , Scavizzi Ferdinando , Alaggio Rita , Del Bufalo Francesca , Miele Evelina , Carai Andrea , Mastronuzzi Angela , Tirone Felice
Published: July 2024

The prognosis for many pediatric brain tumors, including cerebellar medulloblastoma (MB), remains dismal but there is promise in new therapies. We have previously generated a mouse model developing spontaneous MB at high frequency, Ptch1+/−/Tis21−/−. In this model, reproducing human tumorigenesis, we identified the decline of the Cxcl3 chemokine in cerebellar granule cell precursors (GCPs) as responsible for a migration defect, which causes GCPs to stay longer in the proliferative area rather than differentiate and migrate internally, making them targets of transforming insults. We demonstrated that 4‐week Cxcl3 infusion in cerebella of 1‐month‐old mice, at the initial stage of MB formation, forces preneoplastic GCPs (pGCPs) to leave lesions and differentiate, with a complete suppression of MB development. In this study, we sought to verify the effect of 4‐week Cxcl3 treatment in 3‐month‐old Ptch1+/−/Tis21−/− mice, when MB lesions are at an advanced, irreversible stage. We found that Cxcl3 treatment reduces tumor volumes by sevenfold and stimulates the migration and differentiation of pGCPs from the lesion to the internal cerebellar layers. We also tested whether the pro‐migratory action of Cxcl3 favors metastases formation, by xenografting DAOY human MB cells in the cerebellum of immunosuppressed mice. We showed that DAOY cells express the Cxcl3 receptor, Cxcr2, and that Cxcl3 triggers their migration. However, Cxcl3 did not significantly affect the frequency of metastases or the growth of DAOY‐generated MBs. Finally, we mapped the expression of the Cxcr2 receptor in human MBs, by evaluating a well‐characterized series of 52 human MBs belonging to different MB molecular subgroups. We found that Cxcr2 was variably expressed in all MB subgroups, suggesting that Cxcl3 could be used for therapy of different MBs.
Neuroimaging and clinical features of bilateral Wallerian degeneration of middle cerebellar peduncles subsequent to pontine infarction
Authors: Zhang Yao , Wei Ting , Yu Hui , Li Wenli , Luo Wenqian , Liu Bin
Published: July 2024

Objective

Wallerian degeneration (WD) of the middle cerebellar peduncles (MCPs) following pontine infarction is a rare secondary degenerative neurological condition. Due to its infrequency, there is limited research on its characteristics.

Methods

This study aims to present three cases of WD of MCPs following pontine infarction and to analyze the prognosis, clinical manifestations, and neuroimaging features by amalgamating our cases with previously reported ones.

Results

The cohort consisted of 25 cases, comprising 18 men and 7 women aged 29 to 77 years (mean age: 66.2 years). The majority of patients (94%) exhibit risk factors for cerebrovascular disease, with hypertension being the primary risk factor. Magnetic resonance imaging (MRI) can detect WD of MCPs within a range of 21 days to 12 months following pontine infarction. This degeneration is characterized by bilateral symmetric hyperintensities on T2/FLAIR‐weighted images (WI) lesions in the MCPs. Moreover, restricted diffusion, with hyperintensity on diffusion‐weighted imaging (DWI) and low apparent diffusion coefficient (ADC) signal intensity may be observed as early as 21 days after the infarction. Upon detection of WD, it was observed that 20 patients (80%) remained asymptomatic during subsequent clinic visits, while four (16%) experienced a worsening of pre‐existing symptoms.

Conclusions

These findings underscore the importance of neurologists enhancing their understanding of this condition by gaining fresh insights into the neuroimaging characteristics, clinical manifestations, and prognosis of individuals with WD of bilateral MCPs.
Divine presence in Human world: The place of the Communicatio Idiomatum in Lundensian theology
Authors: Park Yong
Published: July 2024

The classic concept of the communicatio idiomatum, “communication of attributes,” is as indispensable as it is central to Lutheran theology. The councils of Nicaea (325 CE) and Chalcedon (451 CE) affirmed that Jesus Christ is one person with two natures: human and divine. The divine attributes and the human attributes communicate with one another while remaining distinct. “In, with, and under” the historical Jesus with his human attributes, Lutherans exclaim, the eternal Christ with his divine attributes is present. Martin Luther (1483–1546) adds a comparable role for the communicatio idiomatum within soteriology. The attributes of Christ communicate with the human attributes of the person of faith. Theologians have tried to find answers about how Christ's divine and human natures exist in the person of Christ for forgiveness of our sin. Lundensian theology argues that God abandoned Himself to the death on the cross through Christ spontaneously. Its emphasis offers innovation while remaining within classic orthodox parameters.
Healthcare professional perspectives on improving inter‐pregnancy care after a baby loss for women with type 1 and type 2 diabetes
Authors: Dyer Eleanor , Bell Ruth , Graham Ruth , Rankin Judith
Published: July 2024

Aims

Women with diabetes (WWD) (type 1 and type 2) are around four times more likely to experience baby loss: miscarriage, stillbirth, neonatal death or termination of pregnancy for medical reasons. Many WWD become pregnant again soon after loss. This study aimed to explore healthcare professional perspectives on improving inter‐pregnancy care for WWD after baby loss, as they play a crucial role in facilitating access to support for WWD to prepare for subsequent pregnancy.

Methods

Eighteen healthcare professionals recruited through social media and professional networks between November 2020 and July 2021 participated in a semi‐structured remote interview. Data were analysed using thematic analysis.

Results

Three main themes were identified: (1) supporting WWD who want to become pregnant again after baby loss; (2) recognising multiple hidden burdens in the inter‐pregnancy interval after loss; (3) discontinuities and constraints in inter‐pregnancy care. Most participants tended to assume WWD wanted time and space before thinking about pregnancy after loss, so they did not routinely broach the subject. Participants reported receiving little or no training on managing sensitive conversations. Care provision varied across providers, and unclear referral pathways were challenging to navigate. Participants reported concerns that not all healthcare professionals knew how to mitigate pregnancy risks.

Conclusions

It is unclear who is responsible for supporting WWDs preconception health between baby loss and subsequent pregnancy. Healthcare professionals may be reticent to initiate conversations about pregnancy for fear of causing upset or distress. Future research is required to scope out ways to raise awareness among healthcare professionals and practical tips on sensitively raising the topic of subsequent pregnancy.
Which is the best glomerular filtration marker: Creatinine, cystatin C or both?
Authors: Stehlé Thomas , Delanaye Pierre
Published: July 2024

Background

The glomerular filtration rate (GFR) is estimated by the serum or plasma concentration of creatinine and/or cystatin C using equations that include demographic data. The equations worldwide most widely used are those of the Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) consortium and updated in 2021 to remove the Afro‐American racial correction factor. In 2021 and then in 2023, the European Kidney Function Consortium also developed equations based on creatinine and cystatin C, usable across the full age spectrum, and constructed by including the Q value (i.e. the median creatinine or cystatin C in healthy men and women, which is customizable for specific populations).

Methods

The aim of this narrative review is to examine the strengths and weaknesses of each biomarker.

Results

Both biomarkers have non‐GFR determinants, namely muscle mass, protein intake and tubular secretion for creatinine; dysthyroidism and systemic corticosteroids for cystatin C, as well as other more debated determinants (diabetes, obesity, proteinuria, inflammatory syndrome). These non‐GFR determinants are the reason why no equation based on a single endogenous biomarker has an accuracy within 30% greater than 90% over the entire age spectrum (in at least one patient in 10, estimated GFR is at least 30% higher or at least 30% lower than the measured GFR).

Conclusion

Equations combining the two biomarkers provide a better estimate of GFR, particularly in the subgroup of patients whose estimates based on each of the biomarkers are highly discordant. These patients must also be identified as being at increased risk of morbidity, particularly cardiovascular, and mortality.
A knowledge synthesis of health research reporting standards relevant to epilepsy surgery
Authors: Kwon Churl‐Su , Chua Melissa M. J. , Jetté Nathalie , Rolston John D.
Published: July 2024

Objective

Numerous studies have examined epilepsy surgery outcomes, yet the variability in the level of detail reported hampers our ability to apply these findings broadly across patient groups. Established reporting standards in other clinical research fields enhance the quality and generalizability of results, ensuring that the insights gained from studying these surgeries can benefit future patients effectively. This study aims to assess current reporting standards for epilepsy surgery research and identify potential gaps and areas for enhancement.

Methods

The Enhancing the Quality and Transparency of Health Research (EQUATOR) repository was accessed from inception to April 27, 2023, yielding 561 available reporting standards. Reporting standards were manually reviewed in duplicate independently for applicability to epilepsy and/or neurosurgery research. The reporting standards had to cover the following aspects in human studies: (1) reporting standards for epilepsy/epilepsy surgery and (2) reporting standards for neurosurgery. Disagreements were resolved by a third author. The top five neurosurgery, neurology, and medicine journals were also identified through Google Scholar's citation index and examined to determine the relevant reporting standards they recommended and whether those were registered with EQUATOR.

Results

Of the 561 EQUATOR reporting standards, 181 were pertinent to epilepsy surgery. One was related to epilepsy, six were specific to surgical research, and nine were related to neurological/neurosurgical research. The remaining 165 reporting standards were applicable to research across various disciplines and included but were not limited to CONSORT (Consolidated Standards of Reporting Trails), STROBE (Strengthening the Reporting of Observational Studies in Epidemiology), and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‐Analyses). None of these required reporting factors associated with epilepsy surgery outcomes, such as duration of epilepsy or magnetic resonance imaging findings.

Significance

Reporting standards specific to epilepsy surgery are lacking, reflecting a gap in standards that may affect the quality of publications. Improving this gap with a set of specific reporting standards would ensure that epilepsy surgery studies are more transparent and rigorous in their design.
Strain distribution of a fir‐tree tenon/mortise structure under combined high and low cycle fatigue loads
Authors: Yan Han , Ding Xin , Huang Dawei , Yan Xiaojun , Yang Xingyu , Liu Haohao
Published: July 2024

The fir‐tree tenon/mortise structure in areo‐engine suffers from the combined high and low cycle fatigue (CCF) loads during service. The structural integrity of the tenon/mortise structure is significantly affected by the local strain distribution, while the strain value under the CCF loads is difficult to acquire. In this study, a simulated specimen of tenon/mortise structure is designed, and the CCF test is carried out using a divided‐path loading fixture to avoid interference between the high cycle fatigue (HCF) loads and the low cycle fatigue (LCF) loads. The high speed digital image correlation (DIC) method is adopted to acquire the real‐time strain distribution during CCF test. According to the strain results, the critical position of the mortise and its strain variation are determined. The high cycle strain of the mortise is proportional to the vibration amplitude of the tenon. The experimental results can provide basis for strength and life assessment.
A rare presentation of isolated candidal hepatic abscess in a maintenance hemodialysis patient
Authors: Asokan Arunkumar , Maiti Judhajit , Mathew Gerry George , Jayaprakash Varadharajan
Published: July 2024

A 61‐year‐old female with diabetes and stage 5 chronic kidney disease on hemodialysis since 3 years via left brachiocephalic arteriovenous fistula presented with uncontrolled sugars, weight loss, and dysphagia. On evaluation, she was found to have an oral thrush with leucocytosis. Initial blood and urine cultures were sterile, and ultrasonography revealed hypoechoic lesions in the left lobe of the liver. She had high‐grade fever followed by seizures on postadmission Day 10. Brain imaging and serum electrolytes were normal. Cerebrospinal fluid analysis was noncontributory, and urine culture revealed Candida non‐albicans with elevated white blood cell counts. She was started on fluconazole; however, her clinical condition deteriorated, with hemodynamic instability. Repeat abdominal computerized tomography revealed increasing hypodense lesions in the left lobe of the liver with elevated beta D glucan levels. Percutaneous drainage of the abscess revealed no fungal elements. In view of clinical deterioration, amphotericin B was started, which resulted in clinical improvement. Clinician should have high index of suspicion for fungal etiology in hemodialysis patients presenting with liver abscess.
Nutritional management for acute liver failure
Authors: Sasaki Tokio , Kakisaka Keisuke , Kuroda Hidekatsu , Matsumoto Takayuki
Published: July 2024

Acute liver failure (ALF) induces increased energy expenditure and disrupts the metabolism of essential nutrients. Hepatic encephalopathy is a complication of ALF with a poor prognosis and mainly involves the metabolic disturbance of amino acids in its pathogenesis. In this review, we discuss the nutritional management for ALF in consideration of the pathophysiology of ALF with respect to the impairment of hepatocyte function. It is known that enteral nutrition is recommended for patients with ALF, while parenteral nutrition is recommended for patients who cannot tolerate enteral nutrition. As ALF leads to a hypermetabolic state, the energy intake is recommended to cover 1.3 times the resting energy expenditure. Because of the high risk of hypoglycemia associated with disturbances in glucose metabolism, substantial glucose intake is recommended. Along with the deterioration of glucose metabolism, protein metabolism is also disrupted. As patients with ALF have increased systemic protein catabolism together with decreased protein synthesis, appropriate amounts of amino acids or protein under monitoring serum ammonia levels are recommended. In conclusion, nutritional management based on the understanding of nutritional pathophysiology is a pivotal therapeutic approach for patients with ALF. The approach should be individualized in the acute phase, the recovery phase, and the pretransplant phase.
Afghan immigrants' perceptions of integration policies in Iran
Authors: Zandi‐Navgran Leila , Sadeghi Rasoul , Afrasiabi Hossein , Askari‐Nodoushan Abbas
Published: July 2024

In the contemporary global context, the challenge of integrating immigrants into host societies has gained prominence. This paper delves into the perceptions and experiences of Afghan immigrants in Iran regarding immigration policies and laws. Employing a constructivist grounded theory methodology, the study aims to uncover participants' interpretations and the meanings attributed to immigration policies and laws. Grounded theory analysis, involving initial, focused, and theoretical coding, was employed to collect data. The results reveal that current immigration laws and policies in Iran have led to economic disparities, limited educational opportunities, social isolation, and identity challenges for Afghan immigrants. Iran's integration policies lean towards exclusion. Consequently, Afghan immigrants experience a weakened sense of belonging in the country. Therefore, our study suggests the importance of implementing integration theories and policies instead of those promoting disintegration. Such policies not only hinder immigrants' assimilation but also impede the overall progress of the host nation, thus undermining social cohesion.
Exploring the effect of wound related pain on psychological stress, inflammatory response, and wound healing
Authors: Woo Kevin , González Carol Viviana Serna , Amdie Fisseha Zewdu , de Gouveia Santos Vera Lúcia Conceição
Published: July 2024

Aims and Objectives

The relationship between pain and poor healing is intricate, potentially mediated by psychological stress and aberrations in inflammatory response. The purpose of this study was to examine the biopsychosocial model of pain by assessing the relationships between pain, stress, inflammation and healing in people with chronic wounds.

Design

This was a 4‐week prospective observational study to explore the relationship of pain, stress, inflammation and wound healing in a convenience sample of patients with chronic wounds in a chronic care hospital in Canada.

Methods

Only subjects over 18 with chronic wounds were recruited into the study. Chronic wounds were defined by the duration of wounds for more than 4 weeks of various aetiologies including wounds caused by pressure injuries, venous disease, arterial insufficiency, surgery or trauma and diabetic neuropathy. Participants were evaluated for pain by responding to the Brief Pain Inventory‐Short Form, the McGill Pain Questionnaire‐Short Form and the Leeds Assessment of Neuropathic Symptoms and Signs scale. Stress was measured by the Perceived Stress Scale (PSS). All wounds were assessed with the Pressure Ulcer Scale for Healing tool. The levels of matrix metalloproteinases were analysis by obtaining wound fluid from all participants.

Results

A total of 32 individuals with chronic wounds participated in the study. Correlation analysis indicated pain severity was positively and significantly related to pain interference, McGill Pain Questionnaire scores, neuropathic pain and matrix metalloproteinase levels. Logistic regression was used to determine the predictors for high or low perceived stress. The only significant variable that contributed to the stress levels was BPI‐I. Results suggested that participants who experienced higher levels of pain interference also had an increased odds to report high level of stress by 1.6 times controlling for all other factor in the model.

Conclusion

Pain is a complex biopsychosocial phenomenon affecting quality of life in people with chronic wounds. Results of this study identified a significant relationship between pain, stress and wound healing.
Nanomaterial strategies in wound healing: A comprehensive review of nanoparticles, nanofibres and nanosheets
Authors: Afshar Mohammad , Rezaei Alireza , Eghbali Samira , Nasirizadeh Samira , Alemzadeh Effat , Alemzadeh Esmat , Shadi Mehri , Sedighi Mahsa
Published: July 2024

Wound healing is a complex process that orchestrates the coordinated action of various cells, cytokines and growth factors. Nanotechnology offers exciting new possibilities for enhancing the healing process by providing novel materials and approaches to deliver bioactive molecules to the wound site. This article elucidates recent advancements in utilizing nanoparticles, nanofibres and nanosheets for wound healing. It comprehensively discusses the advantages and limitations of each of these materials, as well as their potential applications in various types of wounds. Each of these materials, despite sharing common properties, can exhibit distinct practical characteristics that render them particularly valuable for healing various types of wounds. In this review, our primary focus is to provide a comprehensive overview of the current state‐of‐the‐art in applying nanoparticles, nanofibres, nanosheets and their combinations to wound healing, serving as a valuable resource to guide researchers in their appropriate utilization of these nanomaterials in wound‐healing research. Further studies are necessary to gain insight into the application of this type of nanomaterials in clinical settings.
Prognostic significance of dynamic changes in liver stiffness measurement in patients with chronic hepatitis B and compensated advanced chronic liver disease
Authors: Yu Hongsheng , Huang Yinan , Li Mingkai , Jiang Hao , Yang Bilan , Xi Xiaoli , Smayi Abdukyamu , Wu Bin , Yang Yidong
Published: July 2024

Background and Aim

Liver stiffness measurements (LSMs) are promising for monitoring disease progression or regression. We assessed the prognostic significance of dynamic changes in LSM over time on liver‐related events (LREs) and death in patients with chronic hepatitis B (CHB) and compensated advanced chronic liver disease (cACLD).

Methods

This retrospective study included 1272 patients with CHB and cACLD who underwent at least two measurements, including LSM and fibrosis score based on four factors (FIB‐4). ΔLSM was defined as [(follow‐up LSM − baseline LSM)/baseline LSM × 100]. We recorded LREs and all‐cause mortality during a median follow‐up time of 46 months. Hazard ratios (HRs) and confidence intervals (CIs) for outcomes were calculated using Cox regression.

Results

Baseline FIB‐4, baseline LSM, ΔFIB‐4, ΔLSM, and ΔLSM/year were independently and simultaneously associated with LREs (adjusted HR, 1.04, 95% CI, 1.00–1.07; 1.02, 95% CI, 1.01–1.03; 1.06, 95% CI, 1.03–1.09; 1.96, 95% CI, 1.63–2.35, 1.02, 95% CI, 1.01–1.04, respectively). The baseline LSM combined with the ΔLSM achieved the highest Harrell's C (0.751), integrated AUC (0.776), and time‐dependent AUC (0.737) for LREs. Using baseline LSM and ΔLSM, we proposed a risk stratification method to improve clinical applications. The risk proposed stratification based on LSM performed well in terms of prognosis: low risk (n = 390; reference), intermediate risk (n = 446; HR = 3.38), high risk (n = 272; HR = 5.64), and extremely high risk (n = 164; HR = 11.11).

Conclusions

Baseline and repeated noninvasive tests measurement allow risk stratification of patients with CHB and cACLD. Combining baseline and dynamic changes in the LSM improves prognostic prediction.
An exploratory deep learning approach to investigate tuberculosis pathogenesis in nonhuman primate model: Combining automated radiological analysis with clinical and biomarkers data
Authors: Yaseen Faisal , Taj Murtaza , Ravindran Resmi , Zaffar Fareed , Luciw Paul A. , Ikram Aamer , Zafar Saerah Iffat , Gill Tariq , Hogarth Michael , Khan Imran H.
Published: July 2024

Background

Tuberculosis (TB) kills approximately 1.6 million people yearly despite the fact anti‐TB drugs are generally curative. Therefore, TB‐case detection and monitoring of therapy, need a comprehensive approach. Automated radiological analysis, combined with clinical, microbiological, and immunological data, by machine learning (ML), can help achieve it.

Methods

Six rhesus macaques were experimentally inoculated with pathogenic Mycobacterium tuberculosis in the lung. Data, including Computed Tomography (CT), were collected at 0, 2, 4, 8, 12, 16, and 20 weeks.

Results

Our ML‐based CT analysis (TB‐Net) efficiently and accurately analyzed disease progression, performing better than standard deep learning model (LLM OpenAI's CLIP Vi4). TB‐Net based results were more consistent than, and confirmed independently by, blinded manual disease scoring by two radiologists and exhibited strong correlations with blood biomarkers, TB‐lesion volumes, and disease‐signs during disease pathogenesis.

Conclusion

The proposed approach is valuable in early disease detection, monitoring efficacy of therapy, and clinical decision making.
Architectural dysplasia in surgical margins and the risk of local relapse in oral cancer
Authors: Nauta Irene H. , Peferoen Laura A. N. , Brakenhoff Ruud H. , Leemans C. René , Bloemena Elisabeth
Published: July 2024

Background

A major challenge in the clinical management of oral cavity squamous cell carcinoma is local relapse. Even when surgical margins are tumor‐free, local relapses occur frequently, and relapse prediction by histology remains suboptimal. In leukoplakia, an oral potentially malignant disorder, the presence of architectural dysplasia is a critical risk factor for malignant transformation. This study aimed to investigate whether the presence of architectural dysplasia in oral cavity squamous cell carcinoma surgical margins is a risk factor for local relapse.

Methods

Hematoxylin and eosin‐stained slides of resection margins from a consecutive cohort of surgically treated patients diagnosed with stage I–IV oral cavity squamous cell carcinoma between 2008 and 2014 were assessed for the presence of architectural dysplasia (N = 311). Five‐year local relapse‐free survival rates of oral cavity squamous cell carcinoma with architectural dysplasia were compared to those of oral cavity squamous cell carcinoma without architectural dysplasia.

Results

In total, 92 of 311 (29.6%) of oral cavity squamous cell carcinoma displayed architectural dysplasia in the margins. The presence of architectural dysplasia was associated with higher patient age, female sex, less pack years, lower cT‐stage, and a cohesive tumor growth pattern. In oral cavity squamous cell carcinomas with architectural dysplasia, postoperative (chemo)radiotherapy was less often indicated compared with oral cavity squamous cell carcinoma without architectural dysplasia (19.5% vs. 36.1%, p = 0.009). Five‐year local relapse‐free survival was significantly lower in oral cavity squamous cell carcinoma with architectural dysplasia than in oral cavity squamous cell carcinoma without architectural dysplasia (83.1% vs. 94.9%, p = 0.017).

Conclusions

Oral cavity squamous cell carcinoma arising in the background of architectural dysplasia displays relatively favorable clinical and histopathological characteristics. Nonetheless, the presence of architectural dysplasia in oral cavity squamous cell carcinoma surgical margins is associated with a higher risk of local relapse, indicating its clinical relevance.
Hypophosphataemia and late‐onset sepsis in extremely preterm neonates: A case–control study
Authors: Fisher Elizabeth , Staub Eveline
Published: July 2024

Aim

Late‐onset sepsis (LOS) is common in extreme prematurity. These infants are at risk of refeeding syndrome‐associated hypophosphataemia. Our objective was to investigate whether hypophosphataemia predisposes to LOS in extremely premature neonates.

Methods

A retrospective case–control study of neonates born before 29 weeks' gestation in an Australian NICU from 2016 to 2020. Cases developed LOS or localised infection. Two controls, matched within 2 gestational weeks and 90 calendar days, were selected per case.

Results

Amongst 48 cases and 93 controls, cases were smaller at birth (767 g vs. 901 g, P = 0.01), but were otherwise comparable. Hypophosphataemia was more common in cases (26% vs. 15%, P = 0.18). Increased intravenous protein intake in the first week was protective against LOS (OR = 0.9, 95% CI 0.76–1.00, P = 0.04); median 2.1 g/kg/day in cases, 2.3 g/kg/day in controls.

Conclusions

Hypophosphataemia as part of refeeding syndrome is prevalent and under‐recognised in extremely premature neonates. We did not find an association between hypophosphataemia and LOS. Low intravenous protein may be an independent risk factor for infection.
Pathogenicity of Lasiodiplodia theobromae isolated from cocoa dieback disease in South Sulawesi, Indonesia
Authors: Asman Asman , Rosmana Ade , Bailey Bryan A. , Ali Shahin S. , Iwanami Toru , Sjam Sylvia , Amin Nur , Kuswinanti Tutik
Published: July 2024

Dieback disease is one of the constraints to cocoa production in Indonesia. A newly identified dieback symptom has been observed in cocoa farms in East Luwu since 2015 and later observed in Luwu, Pinrang, Enrekang and Soppeng Regency, South Sulawesi. The potential causal agent identity was determined using morphological characteristics, DNA sequences, and phylogenetic analyses. A total of four fungal isolates out of seven isolates that were recovered from diseased stems morphologically resembled Lasiodiplodia species. ITS and EF1α sequencing confirmed that three of the Lasiodiplodia isolates were Lasiodiplodia theobromae, and one isolate was Lasiodiplodia pseudotheobromae. The aggresiveness of all fungal isolates and control was further determined by a leaf disk assay. Experiments showed that L. theobromae isolate CAS0321 was the most aggressive isolate in a leaf disk assay, while other Lasiodiplodia isolates, Fusarium isolates and Diaporthe isolate, were less aggressive. L. theobromae isolate CAS0321 was further used for a pathogenicity test on cocoa seedlings. Two months after inoculation, L. theobromae isolate CAS0321 caused elongated streaks on seedling stems with dark brown to black streaking of vascular tissues similar to that observed in natural infections. This is the first report of a virulent isolate of L. theobromae associated with cocoa dieback in Sulawesi.
The synergistic impact of type 2 diabetes and MASLD on cardiovascular, liver, diabetes‐related and cancer outcomes
Authors: Riley David R. , Hydes Theresa , Hernadez Gema , Zhao Sizheng S. , Alam Uazman , Cuthbertson Daniel J.
Published: July 2024

Background and Aims

We examined the impact of a co‐diagnosis of metabolic dysfunction‐associated steatotic liver disease (MASLD) and type 2 diabetes (T2D) on patient outcomes.

Methods

Using TriNetX, a global federated research network (n = 114 million), we undertook two retrospective cohort studies, using time‐to‐event analysis. Analysis 1 compared MASLD with T2D to MASLD alone; analysis 2 compared T2D with MASLD to T2D alone. Propensity score matching using greedy nearest neighbour (calliper .1) balanced the cohorts (1:1) for significant covariates. Primary outcomes were cardiovascular, liver, diabetes‐related, and cancer events over 5 years.

Results

Analysis 1 (n = 95 275): a co‐diagnosis of T2D significantly increased the risk of ischaemic heart disease (IHD) (HR 1.39; CI: 1.34, 1.44), ischaemic stroke (HR 1.45; CI: 1.35, 1.56), heart failure (HR 1.42; CI: 1.36, 1.49), atrial fibrillation (HR 1.09; CI: 1.03, 1.16), hepatocellular carcinoma (HR 1.96; CI: 1.69, 2.27), pancreatic cancer (HR 1.25; CI: 1.06, 1.48) and liver‐related complications over 5 years from MASLD diagnosis. Analysis 2 (n = 15 208): a co‐diagnosis of MASLD significantly increased risk of all‐cause mortality (HR 1.11; CI: 1.02, 1.22), IHD (HR 1.181; CI: 1.08, 1.29), hepatocellular (HR 50.31; CI: 6.94, 364.72), pancreatic (HR 1.78; CI: 1.12, 2.84), breast (HR 1.43; CI: 1.09, 1.88) and renal cancer (HR 2.01; CI: 1.24, 3.26), and diabetic neuropathy (HR 1.17; CI: 1.09, 1.27) over 5 years from metformin initiation.

Conclusions

T2D significantly potentiates the risk of cardiovascular, malignancy and liver‐related outcomes in people with MASLD. The effect of MASLD on people with T2D, although less dramatic, still potentiated risk of death, IHD, malignancy and peripheral neuropathy.
A Novel Method to Assess Healing of Segmental Bone Defects using the Induced Membrane Technique
Authors: Wang Peng , Ma Yunhong , Wang Yapeng , Zhou Ming , Liu Jun , Rui Yongjun , Wu Yongwei , Zhou Tong
Published: July 2024

Objective

Clinical concerns exist regarding the quality of bony consolidation in the context of the induced membrane technique. This study evaluates the clinical process of bone grafting in the second stage of induced membrane bone union in patients with tibial bone defects to infer the possibility of non‐union and establish a reliable and effective evaluation method combined with computed tomography (CT) to assess fracture healing.

Methods

Patients with tibial bone defects who underwent the induced membrane technique at our hospital between February 2017 and February 2020 were retrospectively analyzed. The Hounsfield unit (HU) values of the patients were evaluated at different times during the second stage of bone grafting. Bone healing at the boundary value of the 120 HU output threshold (−1024 HU–3071 HU) was directionally selected, and the changes in the growth volume of union (new bone volume [selected according to HU value]/bone defect volume) were compared with analyzing individual class bone union. Method 1 involved X‐rays revealing that at least three of the four cortices were continuous and at least 2 mm thick, with the patient being pain free. For Method 2, new bone volume (selected according to HU value/bone defect volume) at the stage was compared with analyzing individual class healing. Receiver operating characteristic curve analysis was used for Methods 1 and 2.

Results

A total of 42 patients with a segmental bone defect with a mean age of 40.5 years (40.5 ± 8.3 years) were included. The relationship between bone graft volume and time variation was analyzed by single factor repeated variable analysis (F = 6.477, p = 0.016). Further, curve regression analysis showed that the change in bone graft volume over time presented a logarithmic curve pattern (Y = 0.563 + 0.086 × ln(X), Ra2 = 0.608, p = 0.041). ROC curve analysis showed that Method 2 is superior to Method 1 (AUC: 86.3% vs. 68.3%, p < 0.05).

Conclusion

The induced membrane technique could be used to treat traumatic long bone defects, with fewer complications and a higher healing rate. The proposed imaging grading of HU (new bone volume/bone defect volume) can be used as a reference for the quality of bony consolidation with the induced membrane technique.
A comprehensive review of the typical and atypical side effects of gabapentin
Authors: Nwankwo Angela , Koyyalagunta Dhanalakshmi , Huh Billy , D'Souza Ryan Steven , Javed Saba
Published: July 2024

Background

Gabapentin, a widely prescribed medication for various neuropathic pain conditions, has demonstrated efficacy in managing diverse neurological disorders. While conventional side effects are well‐documented, a growing body of evidence suggests the existence of atypical side effects, necessitating comprehensive exploration. This paper aims to systematically review and summarize the literature on the atypical side effects of gabapentin, shedding light on manifestations beyond the conventional spectrum.

Methods

A systematic review was conducted, encompassing peer‐reviewed articles published up to the knowledge cutoff date in November 2023. Databases, specifically PubMed, were searched for relevant studies, focusing on atypical side effects such as myoclonus, ataxia, pediatric aggression, respiratory depression, pneumonia, pregnancy complications, sleep interference, encephalopathy, peripheral edema, suicidal ideation, dyskinesia, anorgasmia, and myopathy. Inclusion criteria comprised studies with a focus on gabapentin‐related atypical side effects, published in recognized journals and involving human subjects.

Results

The review identified a spectrum of atypical side effects associated with gabapentin use, ranging from neurological manifestations like myoclonus and ataxia to behavioral changes such as pediatric aggression and suicidal ideation. Additionally, respiratory complications, pregnancy‐related issues, sleep disturbances, and rare complications like encephalopathy and myopathy were observed. Literature synthesis provided insights into the incidence, clinical presentation, and potential mechanisms underlying these atypical side effects.

Conclusion

This comprehensive review highlights the diverse range of atypical side effects associated with gabapentin use, expanding beyond conventional knowledge. Healthcare practitioners must be cognizant of these manifestations, recognizing their potential impact on patient well‐being. As clinical decision‐making relies on a thorough understanding of a medication's side effect profile, this review contributes to enhancing awareness and fostering informed practices in the prescription and management of gabapentin. Further research is warranted to elucidate the mechanisms and risk factors associated with these atypical side effects, refining our understanding of gabapentin's safety profile.
A study of knowledge on Alzheimer's disease and attitudes of Chinese social residents toward Alzheimer's disease: A cross‐sectional survey in China
Authors: Rui Lu , Ning Qiao , Jin Song , Ziqiong Wang , Jiarui Zhao , Ruixia Yu , Qiucheng Wang , Jing Jiang
Published: July 2024

Objective

Social residents become increasingly concerned about Alzheimer's dementia (AD) as a global public health crisis. China's AD population is the largest and growing fastest. However, no study has examined Chinese social residents' knowledge and attitudes concerning Alzheimer's illness. This study examined Chinese social residents' AD knowledge and attitudes using the Alzheimer's Disease Knowledge Scale (ADKS) and dementia attitudes scale (DAS).

Design

Cross‐sectional survey.

Sample

338 social residents over 18 years old from various Chinese regions were recruited using convenient sampling.

Measurements

The ADKS (Chinese) and the Dementia Attitude Scale (Chinese) were used to assess their knowledge and attitude regarding AD.

Results

A total of 328 respondents (97.04%) completed the survey. ADKS = 19.44 ± 3.33; DAS = 86.98 ± 12.7. Age and education levels can have a substantial impact on ADKS scores, and education levels can have a substantial impact on DAS scores.

Conclusions

Low levels of awareness and acceptance of AD exist among Chinese residents. The results indicate that China must immediately implement comprehensive AD education for its social residents.
National charitable fundraising for the NHS, 1948–2023
Authors: Stewart Ellen , Cresswell Rosemary , Möller Christian
Published: July 2024

Whether charitable fundraising might play a part in funding Britain's ostensibly tax‐funded NHS has been a longstanding dilemma, which until recently has received only occasional scholarly attention. In 1946, Aneurin Bevan argued that one of the main goals of the reformed health care system was to liberate health care from the ‘caprice of private charity’. Seven decades later, NHS Charities Together's Urgent Covid‐19 Appeal became a powerful societal rallying cry in the health emergency of the pandemic and raised £150 million in the process. This paper draws together findings from new archival research, a witness seminar with key actors in the NHS charity sector, and qualitative research based on interviews with NHS charity staff and trustees (N = 13), all conducted between 2021 and 2023. We investigate the way in which national appeals have been proposed, debated and implemented at different times in the NHS's history. We trace the recurrence of conflicting ideas about the acceptability of national fundraising for the NHS, about whether public loyalties are to their local services or the national ‘brand’ and about the introduction of national appeals into a complex ecology of local NHS charities. The history of charitable fundraising for the NHS is, we argue, neither a simple story of spontaneous public generosity, nor often of formal policy reform, but is an artefact of more complex dynamics between a changing cast of local and national actors over the last 75 years.
Belatacept‐based immunosuppression does not confer increased risk of BK polyomavirus‐DNAemia relative to tacrolimus‐based immunosuppression
Authors: Eichenberger Emily M. , Magua Wairimu , Rickert Joseph B. , Karadkhele Geeta , Fallahzadeh Mohammad Kazem , Vasanth Payaswini , Larsen Christian
Published: July 2024

Background

The effect of belatacept on BK polyomavirus (BKPyV) control remains largely unknown.

Methods

This is a propensity matched retrospective cohort study in adult kidney transplant recipients (KTR) transplanted between 2016–2020 who received a belatacept‐ versus tacrolimus‐based immunosuppression regimen. A continuous time multi‐state Markov model was used to evaluate BKPyV replication dynamics (BKPyV‐dyn). Three BKPyV‐dyn states were defined: BKPyV‐dyn1 (viral load <3 log10), BKPyV‐dyn2 (viral load ≥ 3 log10 and ≤4 log10), and BKPyV‐dyn3 (viral load >4 log10).

Results

Two hundred eighty KTR on belatacept‐ and 280 KTR on tacrolimus‐based regimens were compared. The probability of transitioning between BKPyV‐dyn states and time spent in each state in both groups was comparable. Total duration in BKPyV‐dyn‐1 was 632.1 days (95% CI 612.1, 648.5) for belatacept versus 615.2 days (95% CI 592.5, 635.8) for tacrolimus, BKPyV‐dyn‐2 was 49.2 days (95% CI 41.3, 58.4) for belatacept versus 55.6 days (95% CI 46.5, 66.8) for tacrolimus, and BKPyV‐dyn‐3 was 48.7 days (95% CI 37.1, 363.1) for belatacept versus 59.2 days (95% CI 45.8, 73.5) for tacrolimus. BKPyV associated nephropathy (PyVAN) occurred in 3.9% in belatacept‐ and 3.9% tacrolimus‐treated KRT (P > .9).

Conclusions

Compared with tacrolimus‐based immunosuppression, belatacept based immunosuppression was not associated with increased risk of BKPyV‐DNAemia or nephropathy.

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