bluuebunny/crossref_metadata_2025 huggingface dataset:
The effectiveness of mindfulness-based stress reduction (MBSR) on depression, PTSD, and mindfulness among military veterans: A systematic review and meta-analysis
Authors: Li Wendy Wen , Nannestad Jaime , Leow Timothy , Heward Carolyn
Published: November 2024

Thirteen studies were included in the current systematic review and meta-analysis with 1131 participants. Both within- and between-group comparisons demonstrated reductions in depressive and PTSD symptoms with medium effect sizes post MBSR intervention. Additionally, MBSR demonstrated small effects in improving mindfulness in veterans at post-intervention. Maintenance of treatment effects were observed at follow-up for the three outcomes during within-group comparisons. Treatment effects were maintained at follow-up between-groups for depression and mindfulness, but not for PTSD symptoms. Furthermore, there were no significant differences between MBSR and cognitive behavioural therapy/person-centred group therapy intervention groups in the three outcomes.
Extended Donor Criteria Outcomes in Adult Congenital Heart Disease Patients Undergoing Heart Transplantation in the United States
Authors: Masha Luke , Aldweib Nael , Colaco Nalini , Bhamidipati Castigliano M.
Published: November 2024

Background: There are very few published outcomes for the use of extended criteria donor (ECD) organs in adult congenital heart disease (ACHD) patients undergoing cardiac transplantation. We investigated outcomes with the use of ECD organs in this population. We hypothesized that ECD organs may be safely used in this population in patients who are younger and carry less vascular and renal disease than the general cardiac transplant population. Methods: United Network of Organ Sharing data from all ACHD heart transplant recipients between October 18, 2018, and September 30, 2023, was analyzed. Patients were grouped by ECD transplantation. The primary outcome of interest was one-year survival. Secondary outcomes included length of stay, posttransplant stroke, retransplantation, kidney transplantation, dialysis, pacemaker implantation, and rejection. Results: Extended criteria donor organs were utilized in 39.1% (200/512) of ACHD heart transplantation cases. There was marked regional variation in the use of ECD organs. Extended criteria donor criteria in this population were solely met by ischemic time ≥4 h in 89.5% (179/200) of cases. Transplantation with ECD donors was associated with lower survival (one-year survival 82.76% vs 90.62%). A multivariate Cox regression analysis suggested a hazard ratio of 1.96 with the use of these organs. Conclusion: Compared with organs accepted under traditional donor criteria, ECD organs appear to compromise short- and long-term survival in ACHD transplant candidates.
Low Rate of Teriparatide Supplementation for the Treatment of Osteoporotic Pelvic Fractures in Elderly Females
Authors: Novikov David , Kelley Mary Grace , Kain Michael S. , Tornetta Paul
Published: November 2024

Background

Osteoporotic pelvic fractures in the elderly lead to pain and immobility resulting in decreased quality of life and worsening frailty. Teriparatide has been shown to shorten time to fracture union, diminish pain, and improve mobilization. At our hospital, this medication is prescribed by an outpatient endocrinologist or geriatrician. We hypothesize that elderly female patients sustaining low energy lateral compression (LC) pelvic fractures are not given Teriparatide. This study reports rates of successful Teriparatide initiation and looks for areas of improvement.

Materials and Methods

A retrospective chart review of stable LC pelvic fractures admitted to a single urban academic level 1 trauma center from January 2012 to February 2021 was conducted. Females over 60 years old with stable LC pelvic fractures were included. Males and those aged less than 60 were excluded.

Results

118 females with mean age of 79.1 ± 10.5 were included. Fourteen patients were not eligible for Teriparatide due to medical history, leaving 104 eligible patients. Twenty-eight patients (23.7%) had previous dual energy X-ray absorptiometry (DEXA) scans with mean T-scores of −3.14 ± 1.1 and 61% had Medicare insurance. Orthopaedic services recommended Teriparatide in 100% of cases. Geriatricians or endocrinologists documented evaluations for Teriparatide in 18 (17%), prescribed in 10 (9.6%), and initiated in 7 (6.7%) patients. Insurance type did not significantly differ among those that initiated Teriparatide and those that did not ( p-0.10). Insurance did not approve the medication in 2 instances and in 1 instance it was discontinued at follow-up.

Conclusion

Despite level 1 evidence of Teriparatide’s benefit for elderly osteoporotic women with low energy LC pelvic fractures, we failed to initiate treatment in 93% of eligible patients. Barriers to initiation included low rates of medical evaluation for its use and failure of insurance coverage. There are opportunities for multidisciplinary collaboration to increase evaluation for and initiation of Teriparatide.

Level of Evidence

Cohort Retrospective (level III evidence).
Identifying the Unidentified Race: A Study of Normative Features of Commonsense Knowledge of Racism in Asian Members’ Online Interaction
Authors: Zhang Tianhao
Published: November 2024

This article adopts an interactionist approach to examine the normative features and the everyday reproduction of commonsense knowledge regarding race and racism in social interaction among Asian members. Specifically, applying conversation analysis and membership categorization analysis to forum interactions in online Asian American communities, I focus on the interactional phenomenon where recipients of a racism report, in responding to the report, make relevant the perpetrator(s)’ race that is not identified in the report. I identify three sets of practices adopted by members: (1) directly assuming the perpetrator(s)’ race, (2) asking about the perpetrator(s)’ race, and (3) implicating the perpetrator(s)’ race through telling second stories. I show that members’ patterned practices point to their orientations toward a normative expectation that “Whites” are the perpetrators of anti-Asian racism and a common assumption that perpetrator(s)’ race matters when making sense of anti-Asian racism. However, such proposed racial common sense can be contested by coparticipants. I demonstrate that commonsense knowledge regarding race and racism is normatively and morally organized so that disagreements and contestations over the use of such knowledge are often treated by participants as arising from normative/moral breaches. Implications on studies on racism and relative positioning of racial groups in the contemporary U.S. context are also discussed.
Book review: Chanborey Cheunboran, Cambodia’s China Strategy: Security Dilemmas of Embracing the Dragon
Authors: Lim Chhay
Published: November 2024

Chanborey Cheunboran, Cambodia’s China Strategy: Security Dilemmas of Embracing the Dragon. New York: Routledge, 2021, 251 pp. £37.99 (paperback). ISBN 9780367762339.
Transcultural Adaptation and Psychometric Properties of the Persian Version of the Nursing Student Competence Scale (NSCS)
Authors: Jalali Amir , Chavoshani Fatemeh , Rasad Raheleh , Darvishi Niloufar , Fashi Fatemeh Merati , Khodamorovati Mahbod , Moradi Khalil
Published: November 2024

Introduction

The competency of a nurse in integrating knowledge, skills, attitudes, and values in various healthcare areas depends on their ability to apply these elements. It is a basic indicator of performance in nursing, and its assessment is a necessity among nursing students.

Objective

The present study was conducted to determine the psychometric properties of the Persian version of the nursing competence tool for Iranian nursing students in 2023.

Methods

This is a methodological study in which the Nursing Student Competence Scale (NSCS) was translated into Persian using the forward–backward translation method. A total of 321 nursing students were selected for construct validity by the exploratory factor analysis (EFA) (the first 190 nursing students) and confirmatory factor analysis (CFA) by convenience sampling method. Cronbach's alpha coefficient was used to evaluate the internal consistency, and the test–retest method was used to check the instrument's reliability.

Results

The results of EFA and CFA confirmed the instrument with six factors and 28 items. The results showed that the fit indices of the model in CFA included (CFI = .91, NNFI = .90, goodness of fit index = .83, root mean square error of approximation = .075, standardized root mean square residual = .047). Pearson's correlation coefficient between items and subscales showed a direct and significant relationship with the main scale. Also, Cronbach's alpha coefficient (0.9) and test–retest (0.88) confirmed the reliability of the Persian version of (NSCS).

Conclusion

Generally, the Persian version of the NSCS with 28 items and six factors is a valid and reliable scale. This instrument has good internal consistency, validity, and reliability, which can be used to evaluate nursing students’ competence in bachelor training.
Operative Times in Scleral Buckle Surgery: Influencing Factors and Cost Analysis
Authors: Blumenthal Jonah , Meshkin Ryan S. , Hoyek Sandra , Feng Yilin , Patel Nimesh A.
Published: November 2024

Purpose: To determine the various factors affecting the duration of scleral buckle surgery, the percentage of profitable scleral buckle cases, and the operational break-even point. Methods: This single-center retrospective consecutive series comprised patients diagnosed with primary rhegmatogenous retinal detachment (RD) repaired with scleral buckling between 2019 and 2021. The primary outcome was operative time. Factors associated with longer surgery time were identified using regression analysis. A time-driven activity-based cost analysis was performed. Results: Following are the mean values: duration of 108 primary RD scleral buckle repairs, 106 ± 35 minutes (range, 52-231; median, 98); number of breaks, 2.15 ± 1.5 (range, 0-10); extent of the RD, 4.3 ± 2.0 clock hours (range, 0-9); duration of follow-up with a retina physician, 489 ± 355 days (range, 0-1316). Twenty eyes (19%) required subsequent RD repair. A regression analysis showed the following main risk factors for prolonged duration of RD repair via scleral buckling: number of breaks (β = 5.98; P = .005), use of radial elements (β = 52.09; P = .001), and gas injection (β = 31.27; P < .001). The median cost per case was $7674.64, which was $2713.64 (55%) more than the maximum Medicare reimbursement of $4961.00. The break-even time was 54.43 minutes. Conclusions: Independent risk factors for a prolonged duration of primary scleral buckle surgery include multiple breaks, use of radial elements, and gas injection. These additive steps could justify a separate complex Current Procedural Terminology code. The large majority of cases were not profitable, with losses proportional to operative time. This study demonstrates the clear need for greater reimbursements and economic incentives for scleral buckle surgery.
Perpetual planning: Expertise, uncertainty, and the politics of delay in Colombia's Guayuriba river-basin
Authors: Rinaldi Parisa Nourani , Roa-García María Cecilia , Brown Sandra
Published: November 2024

Perpetually planning the Guayuriba River basin for nearly two decades has allowed mining companies to continue extracting gravel, amidst uncertain flooding dynamics; oil companies to continue discharging production waters, despite uncertain water quality; and palm oil plantations to continue large-scale irrigation, notwithstanding uncertainties in water use and availability. Drawing on ethnographic ﬁeldwork and semi-structured interviews in the Guayuriba River basin of the Eastern Foothills of Colombia, we discuss the temporality of planning, the rituals of expertise and public participation, and the accrual of uncertainties related to flooding, water quality, and water use and availability. Uncertainties have been perpetuated, accumulated, obscured, and met with a lack of will throughout the continual revision and adjustment of the river-basin planning document. While peoples and natures are made to wait, perpetual planning has in fact led to a tacit authorization of increased resource extraction despite concerns of environmental degradation. By embracing uncertainty as an inherent aspect of the system, we can envision a planning process that would prioritize local knowledge and experiential insights over detached expertise, reshaping the dynamics of knowledge dissemination in the region and mitigating the potential for corrupt practices, allowing our engagement with uncertainty to evolve as we interact with the world.
Could Extended Reality Visualization Decrease Blood Loss in Craniofacial Surgery?
Authors: Amm Christian El , Bowen Ira , Gernsback Joanna , Gross Naina
Published: November 2024

Background: Blood loss is a major concern in craniofacial surgery due to extensive skeletal remodeling. Various strategies and technologies have been employed to mitigate blood loss, but the impact of Extended Reality (XR) visualization has not been extensively studied. This study investigates the effect of XR visualization on blood loss in craniofacial surgery. Materials and Methods: This retrospective cohort study included patients undergoing major craniofacial procedures at a tertiary academic medical center from January 2018 to February 2022. An internally developed XR system displaying Virtual Surgical Planning (VSP) data overlaid on patient anatomy was introduced in 2019. The study compared blood loss between patients who had XR-assisted surgeries (n = 17) and those who did not (n = 62). Primary outcome measured was calculated blood loss (ERCV%), and secondary outcomes included the incidence of sinus proximity bleeding, dural injuries, surgery duration, and transfusion volumes. Results: The XR-assisted group had significantly lower blood loss (43.7% vs 61.9%, P < .05). Sinus proximity bleeding during craniotomy was also significantly reduced in the XR group. More patients in the XR-assisted group avoided transfusion altogether (35% vs 24%) and tended to have fewer donor-units exposure (0.88 vs 1.34), but those trends did not reach statistical significance in our small study sample. Conclusion: In this pilot study, XR visualization in craniofacial surgery is associated with reduced blood loss and sinus proximity bleeding during craniotomy. While the study suggests XR can enhance surgical safety, larger, well-designed investigations are needed to confirm these results and fully understand the implications of XR technology in craniofacial surgery.
Climate change policy uncertainty and challenges in carbon emission for east and southern African regions
Authors: Maumoh Immaculate , Onoja Anthony
Published: November 2024

With the growing threats of global warming, efforts towards climate justice globally and in Southern and Eastern African governments are gaining momentum in line with the UN Sustainable Development Goal 13 (take climate action). However, in Eastern and Southern Africa regions, there are some hurdles. This study therefore seeks to understand how relevant carbon pricing and markets are in the region’s economic growth and environmental outcomes. It documents regional progress made in carbon emission pricing and markets in line with the Paris Agreement 2015 and the Green Climate Fund (GCF) replenishment and reviews some climate policy designs and pitfalls against effective carbon pricing systems in Sub-Sahara Africa. The study used an in-depth review of relevant literature especially sourced from the NDC sub-sector 2021 database. Data were classified and quantified quantitatively for analysis. The results indicate reasonable progress in the regions to advance Carbon Pricing with magnitudes surpassing the West African regions. South Africa leads in terms of implementing initiatives that will establish carbon pricing. There was inverse negative significance in carbon trading in some West African sub-regions. However, political uncertainty persists and threatens reversals of gains from efforts to attain green economic growth. Carbon pricing and marketing in the region are indicated by carbon taxes, levies, and taxes, the establishment of trading platforms to sell carbon credits, and research funding to deepen knowledge and awareness of carbon trading status among others. However, carbon pricing and legislation progress in the region are threatened by unstable political certainty, lack of political goodwill and institutional frameworks on climate change mitigation; poor capacity of policymakers and countries experts to conceptualize and implement carbon pricing policies, and a general lack of financial systems and financial support to promote climate change mitigation. Five relevant recommendations were made based on the study findings.
The Contribution of the Monocyte-Macrophage Lineage to Immunotherapy Outcomes
Authors: Adams Rachael C , MacDonald Kelli PA , Hill Geoffrey R
Published: November 2024

Macrophages execute core functions in maintaining tissue homeostasis, where their extensive plasticity permits a spectrum of functions from tissue remodelling to immune defence. However, perturbations to tissue-resident macrophages during disease, and the subsequent emergence of monocyte-derived macrophages, can hinder tissue recovery and promote further damage through inflammatory and fibrotic programs. Gaining a fundamental understanding of the critical pathways defining pathogenic macrophage populations enables the development of targeted therapeutic approaches to improve disease outcomes. In the setting of chronic graft-versus-host disease (cGVHD), which remains the major complication of allogeneic haematopoietic stem cell transplantation, colony-stimulating factor 1 (CSF1)-dependent donor-derived macrophages have been identified as key pathogenic mediators of fibrotic skin and lung disease. Antibody blockade of the CSF1R to induce macrophage depletion showed remarkable capacity to prevent fibrosis in pre-clinical models and has subsequently demonstrated impressive efficacy for improving fibrotic cGVHD in ongoing clinical trials. Similarly, macrophage depletion approaches are currently under investigation for their potential to augment responses to immune checkpoint inhibition. Moreover, both monocyte and tissue-resident macrophage populations have recently been implicated as mediators of the numerous toxicities associated with CAR T-cell therapy, further highlighting potential avenues of macrophage-based interventions to improve clinical outcomes. Herein, we examine the current literature on basic macrophage biology and contextualise this in the setting of cellular and immunotherapy. Additionally, we highlight mechanisms by which macrophages can be targeted, largely by interfering with the CSF1/CSF1R signalling axis, for therapeutic benefit in the context of both cellular and immunotherapy.
PET/CT-derived coronary calcium score may predict cardiac complications in anthracycline-treated patients with lymphoma
Authors: Douglas Genevieve , Loh Zoe , Shum Evonne S.Y. , Lee Sze-Ting , Waters Niamh , Hamilton Garry , Chong Geoffrey , Murphy Alexandra C. , Hawkes Eliza A.
Published: November 2024

Anthracycline-mediated cardiotoxicity is a common concern after lymphoma therapy, particularly in patients with high cardiovascular risk (CVR). In noncancer populations, coronary artery calcium scoring (CACS) effectively identifies individuals who may benefit from aggressive CVR modification to lower the risk of cardiovascular events. Emerging evidence suggests that CACS can also predict cancer therapy-related cardiotoxicity, potentially identifying candidates for cardioprotective strategies. Our study aimed to evaluate whether CACS obtained from pretreatment positron emission tomography (PET)/computed tomography (CT) scans could stratify cardiac event risk in patients with lymphoma receiving anthracycline-based chemotherapy. We enrolled 358 consecutive patients with lymphoma treated between 2012 and 2022, calculating the CACS from their pretreatment PET/CT. We reviewed medical records to identify pre-existing cardiac conditions, CVR, and posttreatment cardiac events, including coronary events, heart failure (HF), and arrhythmias. Logistic and Cox regression models were used to assess associations between CVR, CACS categories (CACS = 0, CACS 1-400, CACS >400), and new cardiac events. At a median follow-up of 27 months (95% confidence interval [CI], 22.3-31.7) in patients without cardiac history, 10% experienced posttreatment cardiac events (HF, 14; arrhythmias, 9; coronary event, 1; combination, 8). Patients with a CACS >0 had more events (21 total, 20% vs 11 total, 5.4% for CACS = 0; P < .001). Elevated CACS was independently associated with HF (CACS 1-400: odds ratio [OR], 3.73; 95% CI, 1.21-11.43; P = .022; CACS >400: OR, 5.43; 95% CI, 1.47-20.03; P = .011) and any cardiac event (CACS 1-400: OR, 2.48; 95% CI, 1.02-6.04; P = .045; CACS >400: OR, 3.28; 95% CI, 0.91-10.68; P = .029). CACS may effectively stratify patients with lymphoma at risk of cardiac complications, thereby identifying a group poised to benefit from targeted preventive strategies.
MRD-driven phase 2 study of daratumumab, carfilzomib, lenalidomide, and dexamethasone in newly diagnosed multiple myeloma
Authors: Bhutani Manisha , Robinson Myra , Foureau David , Atrash Shebli , Paul Barry , Guo Fei , Grayson Jason M. , Ivanina-Foureau Anna , Pineda-Roman Mauricio , Varga Cindy , Friend Reed , Ferreri Christopher J. , Begic Xhevahire , Norek Sarah , Drennan Tiffany , Anderson Michelle B. , Symanowski James T. , Voorhees Peter M. , Usmani Saad Z.
Published: November 2024

In newly diagnosed multiple myeloma (NDMM), measurable residual disease (MRD) status is prognostically important, but its role in treatment decisions remains unclear. In a phase 2 trial, we assessed daratumumab, carfilzomib, lenalidomide, and dexamethasone (Dara-KRd) induction followed by a next-generation sequencing–based MRD-adapted strategy. The primary outcome was complete response (CR) and stringent CR (≥CR) after induction. Flow cytometry was used to profile T cells. Among 39 patients, 21 (54%) achieved ≥CR after induction (P = .375), with MRD-negative rates of 59% (10−5) and 41% (10−6). Patients who were MRD-negative (n = 24, group A) received lenalidomide maintenance, showing sustained MRD negativity in 14 of 18 (77.8%) for ≥12 cycles. MRD-positive transplant-eligible patients (n = 8, group B) underwent autologous stem cell transplantation, with 62.5% converting to MRD-negative at 10−5 (37.5% at 10−6) posttransplant. MRD-positive, transplant-ineligible patients (n = 4, group C) received KRd consolidation. Best MRD-negative rates improved to 77% (10−5) and 72% (10−6). No new safety concerns were identified for Dara-KRd. With a median follow-up of 30.1 months, 3, 2, and 1 patient(s) in groups A, B, and C, respectively, have progressed or died. We observed that Dara-KRd strongly activated memory T cells, which was associated with an MRD-negative state post induction. Although the primary outcome was not met, Dara-KRd induction in NDMM achieved high ≥CR and MRD-negative rates without new safety concerns. The post induction MRD-adapted strategy deepened responses in MRD-positive patients and maintained durable MRD control in MRD-negative patients. This trial was registered at www.clinicaltrials.gov as #NCT04113018.
Whole genome sequencing-based characterization and determination of quinolone resistance among methicillin-resistant and methicillin-susceptible S. Aureus isolates from patients attending regional referral hospitals in Tanzania
Authors: Juma Masoud A. , Kumburu Happiness , Wadugu Boaz , Kuchaka Davis , Shayo Mariana , Kimu Patrick , Kanje Livin E. , Beti Melkiory , van Zwetselaar Marco , Mmbaga Blandina , Sonda Tolbert
Published: November 2024

Background

The emergence of multidrug-resistant termed Methicillin-resistant Staphylococcus aureus (MRSA) strain, driven by the acquisition of resistance gene mecA imposes a substantial challenge in the treatment and control of their related infections. Although quinolones have historically been effective against both MRSA and methicillin-susceptible S. aureus (MSSA) strains, the rising resistance to quinolones among S. aureus isolates, particularly in MRSA, has severely curtailed their potency and further narrowed down the therapeutic options. This study aimed to determine the burden of MRSA among isolates, as well as their resistance profile, genotypic characterization, and molecular relatedness through the construction of a phylogenetic tree.

Materials and methods

Archived clinical S. aureus isolates from a descriptive, cross-sectional study involving six regional referral hospitals in Dodoma, Songea, Kigoma, Kitete, and Morogoro in the mainland Tanzania and Mnazi Mmoja in Zanzibar were analyzed. Bacterial identification was performed using both classical microbiology and whole genome sequencing on Illumina Nextseq 550 Sequencer. Species identification was done using KmerFinder 3.2, Multilocus Sequence Typing using MLST 2.0, SCCmec typing using SCCmecFinder 1.2, resistance genes using ResFinder 4.1, and phylogenetic relatedness using CSI Phylogeny 1.4.

Results

Out of the 140 isolates analyzed, 69 (49.3%) were identified as MRSA, with 57 (82.6%) exhibiting quinolone resistance. Conversely, 71 isolates were identified as MSSA, and none of them exhibited resistance to quinolones. Spa-typing revealed six spa types, with t355, t1476, and t498 being the most common. Moreover, all (69) MRSA were found to carry SCCmec type IV. The isolates exhibited 14 different sequence types (STs). Notably, ST152 was prevalent among MSSA (50 isolates, 70%), while ST8 was the predominant sequence type among MRSA (58 isolates, 84%). The antimicrobial resistance profile revealed at least three horizontally acquired resistance genes, with blaZ, dfrG, tet(K), and aac (6’)-aph (2’’) genes being highly prevalent.

Conclusion

There is a high genetic diversity among the S. aureus isolates existing in Tanzania regional hospitals, with a concerning burden of quinolone resistance among MRSA isolates. The diversity in resistance genes among MRSA lineages emphasizes the necessity for the development of sustainable antimicrobial stewardship and surveillance to support evidence-based guidelines for managing and controlling MRSA infections in both community and hospital settings.
Associations between hand osteoarthritis, obesity and lipid metabolism: a cross-sectional study of the Halland County Osteoarthritis (HALLOA) cohort
Authors: Brogren Elisabeth , Andersson Maria , Westenius Melker , Wittrup Jenny , Zimmerman Malin
Published: November 2024

Background

To determine whether obesity and markers of lipid metabolism are associated with radiological hand osteoarthritis (OA) in the Halland County Osteoarthritis (HALLOA) cohort.

Methods

In this cross-sectional study, we included 231 participants aged 30–65 from the HALLOA cohort, which began in 2017 and is ongoing. Hand OA was defined as ≥ 2 joint groups (distal interphalangeal, proximal interphalangeal, and carpometacarpal I) with Kellgren-Lawrence grade ≥ 2. The severity of hand OA was classified in terms of the number of affected joint groups (moderate hand OA 2–4 joint groups, severe hand OA 5–6 joint groups). Metabolic profile, including body mass index (BMI), bioimpedance, waist circumference, blood pressure, serum leptin, total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides, were obtained. Multicollinearity was assessed with Pearson’s correlation and associations with logistic regression analyses adjusting for age, HDL-cholesterol, and central obesity.

Results

Two-thirds of the participants were women, and 91 (39%) had hand OA. We found a relationship between LDL-cholesterol and prevalent hand OA in women with an odds ratio of 1.7 (95% CI 1.1–2.6) and an association between LDL-cholesterol and severity of hand OA in women; odds ratio for no hand OA vs. moderate hand OA was 1.6 (95% CI 1.0-2.4) and for no hand OA vs. severe hand OA 2.5 (95% CI 1.2–4.9). There were no significant relationships between hand OA and obesity or serum leptin levels.

Conclusion

Circulating LDL-cholesterol levels were associated with the prevalence and severity of hand OA in women but not men.

Trial registration

ClinicalTrials. Gov (NCT04928170), Date of registration: 2017-12-20.
Insights into the virome of Hyalomma marginatum in the Danube Delta: a major vector of Crimean-Congo hemorrhagic fever virus in Eastern Europe
Authors: Bratuleanu Bianca Elena , Chretien Delphine , Bigot Thomas , Regnault Beatrice , Pérot Philippe , Savuta Gheorghe , Eloit Marc , Temmam Sarah
Published: November 2024

Background

Ticks are significant vectors of pathogens, including viruses, bacteria, and protozoa. With approximately 900 tick species worldwide, many are expanding their geographical range due to changing socioeconomic and climate factors. The Danube Delta, one of Europe’s largest wetlands, is an ecosystem that, despite its ecological importance, remains understudied concerning the risk of introducing new tick-borne viruses. This region serves as a critical habitat for migratory birds, which can carry ticks over long distances, potentially introducing exotic tick species and their pathogens into the local ecosystem. Hyalomma marginatum ticks, the primary vector of Crimean-Congo hemorrhagic fever virus (CCHFV), are of particular concern due to their expanding presence in Europe and potential to spread other arboviruses. In addition to being the primary vector for CCHFV, Hyalomma sp. ticks are capable of transmitting other pathogens of medical and veterinary importance, including Dugbe virus, West Nile virus, African horse sickness virus, and Kyasanur forest disease virus. Therefore, it is essential to monitor the presence of Hyalomma sp. ticks while simultaneously surveilling arbovirus circulation in tick populations to mitigate the risk of arboviral outbreaks.

Methods

In this work, we used an RNA sequencing technique to analyze the virome of H. marginatum ticks collected from the Danube Delta Biosphere Reserve, Romania, one of the major bird migration hubs from Africa to Europe.

Results

Among the viral taxa detected in H. marginatum ticks, sequences belonging to Volzhskoe tick virus (VTV), Balambala tick virus (BMTV) and Bole tick virus 4 (BTV4) were identified. In addition, we report the first identification of a novel Rhabdoviridae-related virus, Hyalomma marginatum rhabdovirus (HMRV). No CCHFV or any CCHFV-related nairovirus were detected in this study.

Conclusions

To summarize, detecting new viruses is essential for monitoring potential viral outbreaks. Our research expands the understanding of virus diversity in Eastern Europe, including the identification of novel viruses. This insight is crucial for monitoring viruses that may pose risks to both animal and human health, such as CCHFV.

Graphical Abstract
Elevated plasma p-tau231 is associated with reduced generalization and medial temporal lobe dynamic network flexibility among healthy older African Americans
Authors: Budak Miray , Fausto Bernadette A. , Osiecka Zuzanna , Sheikh Mustafa , Perna Robert , Ashton Nicholas , Blennow Kaj , Zetterberg Henrik , Fitzgerald-Bocarsly Patricia , Gluck Mark A.
Published: November 2024

Background

Phosphorylated tau (p-tau) and amyloid beta (Aβ) in human plasma may provide an affordable and minimally invasive method to evaluate Alzheimer’s disease (AD) pathophysiology. The medial temporal lobe (MTL) is susceptible to changes in structural integrity that are indicative of the disease progression. Among healthy adults, higher dynamic network flexibility within the MTL was shown to mediate better generalization of prior learning, a measure which has been demonstrated to predict cognitive decline and neural changes in preclinical AD longitudinally. Recent developments in cognitive, neural, and blood-based biomarkers of AD risk that may correspond with MTL changes. However, there is no comprehensive study on how these generalization biomarkers, long-term memory, MTL dynamic network flexibility, and plasma biomarkers are interrelated. This study investigated (1) the relationship between long-term memory, generalization performance, and MTL dynamic network flexibility and (2) how plasma p-tau231, p-tau181, and Aβ42/Aβ40 influence generalization, long-term memory, and MTL dynamics in cognitively unimpaired older African Americans.

Methods

148 participants (Meanage: 70.88,SDage: 6.05) were drawn from the ongoing longitudinal study, Pathways to Healthy Aging in African Americans conducted at Rutgers University–Newark. Cognition was evaluated with the Rutgers Acquired Equivalence Task (generalization task) and Rey Auditory Learning Test (RAVLT) delayed recall. MTL dynamic network connectivity was measured from functional Magnetic Resonance Imaging data. Plasma p-tau231, p-tau181, and Aβ42/Aβ40 were measured from blood samples.

Results

There was a significant positive correlation between generalization performance and MTL Dynamic Network Flexibility (t = 3.372, β = 0.280, p < 0.001). There were significant negative correlations between generalization performance and plasma p-tau231 (t = -3.324, β = -0.265, p = 0.001) and p-tau181 (t = -2.408, β = -0.192, p = 0.017). A significant negative correlation was found between plasma p-tau231 and MTL Dynamic Network Flexibility (t = -2.825, β = -0.232, p = 0.005).

Conclusions

Increased levels of p-tau231 are associated with impaired generalization abilities and reduced dynamic network flexibility within the MTL. Plasma p-tau231 may serve as a potential biomarker for assessing cognitive decline and neural changes in cognitively unimpaired older African Americans.
Utilizing a domain-specific large language model for LI-RADS v2018 categorization of free-text MRI reports: a feasibility study
Authors: Matute-González Mario , Darnell Anna , Comas-Cufí Marc , Pazó Javier , Soler Alexandre , Saborido Belén , Mauro Ezequiel , Turnes Juan , Forner Alejandro , Reig María , Rimola Jordi
Published: November 2024

Objective

To develop a domain-specific large language model (LLM) for LI-RADS v2018 categorization of hepatic observations based on free-text descriptions extracted from MRI reports.

Material and methods

This retrospective study included 291 small liver observations, divided into training (n = 141), validation (n = 30), and test (n = 120) datasets. Of these, 120 were fictitious, and 171 were extracted from 175 MRI reports from a single institution. The algorithm’s performance was compared to two independent radiologists and one hepatologist in a human replacement scenario, and considering two combined strategies (double reading with arbitration and triage). Agreement on LI-RADS category and dichotomic malignancy (LR-4, LR-5, and LR-M) were estimated using linear-weighted κ statistics and Cohen’s κ, respectively. Sensitivity and specificity for LR-5 were calculated. The consensus agreement of three other radiologists served as the ground truth.

Results

The model showed moderate agreement against the ground truth for both LI-RADS categorization (κ = 0.54 [95% CI: 0.42–0.65]) and the dichotomized approach (κ = 0.58 [95% CI: 0.42–0.73]). Sensitivity and specificity for LR-5 were 0.76 (95% CI: 0.69–0.86) and 0.96 (95% CI: 0.91–1.00), respectively. When the chatbot was used as a triage tool, performance improved for LI-RADS categorization (κ = 0.86/0.87 for the two independent radiologists and κ = 0.76 for the hepatologist), dichotomized malignancy (κ = 0.94/0.91 and κ = 0.87) and LR-5 identification (1.00/0.98 and 0.85 sensitivity, 0.96/0.92 and 0.92 specificity), with no statistical significance compared to the human readers’ individual performance. Through this strategy, the workload decreased by 45%.

Conclusion

LI-RADS v2018 categorization from unlabelled MRI reports is feasible using our LLM, and it enhances the efficiency of data curation.

Critical relevance statement

Our proof-of-concept study provides novel insights into the potential applications of LLMs, offering a real-world example of how these tools could be integrated into a local workflow to optimize data curation for research purposes.

Key Points

Automatic LI-RADS categorization from free-text reports would be beneficial to workflow and data mining.

LiverAI, a GPT-4-based model, supported various strategies improving data curation efficiency by up to 60%.

LLMs can integrate into workflows, significantly reducing radiologists’ workload.

Graphical Abstract
Intratumoral and peritumoral MRI-based radiomics for predicting extrapelvic peritoneal metastasis in epithelial ovarian cancer
Authors: Wang Xinyi , Wei Mingxiang , Chen Ying , Jia Jianye , Zhang Yu , Dai Yao , Qin Cai , Bai Genji , Chen Shuangqing
Published: November 2024

Objectives

To investigate the potential of intratumoral and peritumoral radiomics derived from T2-weighted MRI to preoperatively predict extrapelvic peritoneal metastasis (EPM) in patients with epithelial ovarian cancer (EOC).

Methods

In this retrospective study, 488 patients from four centers were enrolled and divided into training (n = 245), internal test (n = 105), and external test (n = 138) sets. Intratumoral and peritumoral models were constructed based on radiomics features extracted from the corresponding regions. A combined intratumoral and peritumoral model was developed via a feature-level fusion. An ensemble model was created by integrating this combined model with specific independent clinical predictors. The robustness and generalizability of these models were assessed using tenfold cross-validation and both internal and external testing. Model performance was evaluated by the area under the receiver operating characteristic curve (AUC). The Shapley Additive Explanation method was employed for model interpretation.

Results

The ensemble model showed superior performance across the tenfold cross-validation, with the highest mean AUC of 0.844 ± 0.063. On the internal test set, the peritumoral and ensemble models significantly outperformed the intratumoral model (AUC = 0.786 and 0.832 vs. 0.652, p = 0.007 and p < 0.001, respectively). On the external test set, the AUC of the ensemble model significantly exceeded those of the intratumoral and peritumoral models (0.843 vs. 0.750 and 0.789, p = 0.008 and 0.047, respectively).

Conclusion

Peritumoral radiomics provide more informative insights about EPM than intratumoral radiomics. The ensemble model based on MRI has the potential to preoperatively predict EPM in EOC patients.

Critical relevance statement

Integrating both intratumoral and peritumoral radiomics information based on MRI with clinical characteristics is a promising noninvasive method to predict EPM to guide preoperative clinical decision-making for EOC patients.

Key Points

Peritumoral radiomics can provide valuable information about extrapelvic peritoneal metastasis in epithelial ovarian cancer.

The ensemble model demonstrated satisfactory performance in predicting extrapelvic peritoneal metastasis.

Combining intratumoral and peritumoral MRI radiomics contributes to clinical decision-making in epithelial ovarian cancer.

Graphical Abstract
Impact of hepatic steatosis on liver stiffness measurement by vibration-controlled transient elastography and its diagnostic performance for identifying liver fibrosis in patients with chronic hepatitis B
Authors: Chen Zhiyuan , Huang Ye , Zhang Yan , Zhou Dongjing , Yang Yu , Zhang Shuping , Xiao Huanming , Li HaiXia , Liu Yupin
Published: November 2024

Objectives

To explore the impact of hepatic steatosis measured by MRI-proton density fat fraction (MRI-PDFF) on liver stiffness measurement (LSM) value and its diagnostic performance for staging liver fibrosis in patients with chronic hepatitis B (CHB).

Methods

A total of 914 patients with CHB who underwent liver biopsy and MRI-PDFF were retrospectively reviewed. The influence of MRI-PDFF on LSM value was assessed using univariate and multivariate linear analyses. To assess the influence of liver steatosis on the diagnostic performance of LSM, a series of ROC analyses were performed and compared by stratifying patients into non-steatosis (PDFF < 5%) and steatosis (PDFF ≥ 5%) groups according to MRI-PDFF values. The effects of different LSM cut-off values on the false-positive rate in the steatosis cohort were compared using McNemar’s test.

Results

LSM values were significantly affected by MRI-PDFF in the entire cohort (B-coefficient: 0.003, p < 0.001), F1 cohort (B-coefficient: 0.005, p < 0.001), and F2 cohort (B-coefficient: 0.003, p = 0.002). Hepatic steatosis was not observed to have a significant influence on the ROC curve of LSM for staging liver fibrosis. Compared with using the cut-off values for the CHB cohort, using relatively higher cut-off values for hepatic steatosis significantly improved the false-positive rate of LSM in the steatosis cohort.

Conclusion

Steatosis significantly influenced LSM, with a higher value in the early stage of liver fibrosis but did not affect the diagnostic efficiency of LSM for staging liver fibrosis. Moreover, using relatively high cut-off values significantly improved the false-positive rate of LSM in CHB patients with steatosis.

Clinical relevance statement

The identified correlation between MRI-PDFF and VCTE-measured LSM is not clinically relevant since the diagnostic performance of LSM in staging liver fibrosis is not affected by steatosis. A higher cut-off should be applied in CHB patients with steatosis to improve the false-positive rate.

Key Points

Steatosis can affect liver stiff measurement (LSM) values in the early stage of liver fibrosis.

The diagnostic performance of LSM in staging liver fibrosis is not affected by steatosis.

LSM’s cutoffs should be increased in patients with steatosis to improve the false-positive rate.

Graphical Abstract
Patient-related prognostic factors for function and pain after shoulder arthroplasty: a systematic review
Authors: Hesseling Brechtje , Prinsze Nisa , Jamaludin Faridi , Perry Sander I. B. , Eygendaal Denise , Mathijssen Nina M. C. , Snoeker Barbara A. M.
Published: November 2024

Background

While shared decision making is a cornerstone of orthopedic care, orthopedic surgeons face challenges in tailoring their advice and expectation management to individual shoulder arthroplasty patients due to the lack of systematically summarized evidence-based knowledge. This systematic review aims to provide an overview of current knowledge on independent predictive effects of patient-related factors on functional and pain-related outcomes after shoulder arthroplasty.

Methods

We included longitudinal cohort studies including patients receiving total or reverse shoulder arthroplasty or hemiarthroplasty for primary osteoarthritis or cuff tear arthropathy. Studies with only univariable analyses were excluded. MEDLINE, Embase, and CINAHL databases were last searched on June 27, 2023. Risk of bias was evaluated using the QUIPS tool. For the analyses, we divided outcomes into three domains (Functional Recovery, Pain, and Functional Recovery & Pain) and four time points (short term, medium-short term, medium-long term and long term). When appropriate, meta-analyses were conducted to pool regression coefficients or odds ratios. Otherwise, results were summarized in a qualitative analysis. We used the GRADE approach to rate the certainty of the evidence.

Results

Thirty-three studies analyzing over 6900 patients were included; these studied 16 PROMs and 52 prognostic factors. We could perform meta-analyses for six combinations of prognostic factor, domain, and time point. Only the meta-analysis for medium-long term poor ASES scores indicated worse outcomes for previous shoulder surgery (OR (95%CI) of 2.10 (1.33–3.33)). The majority of reported factors showed unclear or neutral independent effects on functional outcomes.

Conclusions

Methodological heterogeneity and selective/incomplete reporting prevented us from pooling most results, culminating in a largely qualitative analysis. Depression, preoperative opioid use, preoperative ASES and SST scores, surgery on the dominant side, previous surgery, male gender, no. of patient-reported allergies, back pain, living alone, CTA vs OA, diabetes, and greater preoperative external ROM predicted neutral to worse or worse outcomes. In contrast, higher electrical pain threshold on the operative side, OA/RCA vs other diagnosis, and private insurance vs Medicaid/Medicare predicted neutral to better or better outcomes.

These results can help orthopedic surgeons tailor their advice and better manage expectations.

Systematic review registration

PROSPERO CRD42021284822.
CUL4A-DDB1-circRFWD2 E3 ligase complex mediates the ubiquitination of p27 to promote multiple myeloma proliferation
Authors: Min Jie , Mao Jialei , Shi Hui , Peng Yumeng , Xu Xiaoning , Guo Mengjie , Tang Xiaozhu , Yang Ye , Gu Chunyan
Published: November 2024

Multiple myeloma (MM) is an incurable disease characterized by the abnormal expansion of plasma cells in the bone marrow (BM). Numerous studies have shown that BM tumor cells can influence the tumor microenvironment (TME) through communication with extracellular vesicle circular RNAs (circRNAs), a type of noncoding RNA. Our study revealed that a circular RNA, circRFWD2 (hsa_circ_0015361), is expressed by MM cells and translated into a new protein, circRFWD2_369aa. We found that elevated levels of circRFWD2_369aa in MM peripheral blood samples were closely associated with poor outcomes in MM patients. Further investigation revealed that circRFWD2 promoted the degradation of p27 through the ubiquitination pathway, leading to increased proliferation of MM cells. We also confirmed the interaction between circRFWD2 and its downstream genes DDB1 and CUL4A, indicating that circRFWD2 could form an E3 ligase complex with other genes to mediate the ubiquitination of p27. Notably, the protein translated by a circular RNA of RFWD2 can also function as an E3 ligase. Our study highlights the potential of circRFWD2 as a biomarker for MM, which may improve the sensitivity and specificity of diagnosis and efficacy analyses.
An integrated multistage ensemble machine learning model for fraudulent transaction detection
Authors: Talukder Md. Alamin , Khalid Majdi , Uddin Md Ashraf
Published: November 2024

Fraudulent transactions continue to pose a concern for financial institutions and organizations, necessitating the development of effective detection tools. Identification and prevention of fraudulent transactions depend heavily on the detection of credit card fraud. Even though instances of credit card fraud are uncommon, they can nonetheless cause significant financial losses because of the high cost of fraudulent transactions. When fraud is discovered early on, investigators can act quickly to stop additional losses. But because the investigation process takes a while, there are only so many warnings that can be looked through in detail in a given day. Thus, a fraud detection model’s main goal is to minimize false alarms and missed fraud situations while producing accurate alerts. To improve fraud identification, we provide in this study an integrated multistage ensemble Machine Learning (IMEML) model that incorporates various multistage ensemble models intelligently, such as Ensemble Independent Classifier (EIC), Ensemble Bagging Classifier (EBC), and Ensemble ML Classifier (EMC). In order to overcome the problem of data imbalance, we use a number of methods-including Instant Hardness Threshold with EMC (IHT+EMC), Cluster Centroids (CC), and Randon Under Sampler (RUS)-that go beyond traditional methods. We run our studies on a 284,807-transaction credit card dataset that is made available to the public. The accuracy rates of 99.94%, 99.91%, 99.14%, 99.52%, and perfect 100% for accuracy, precision, recall, f1-score, and AUC score, respectively, are achieved by the suggested model, demonstrating remarkable performance scores. For real-world fraud detection applications, the EIBMC model sets a new benchmark for identifying fraudulent transactions in high-frequency scenarios by outperforming cutting-edge techniques.