bluuebunny/crossref_metadata_2025 huggingface dataset:
Health risk assessment for soil radioactivity around Shidaowan nuclear power plant in Shandong, China
Authors: Zhang Wei , Qi Chenyang , Lim David , Zhang Xianpeng , Gao Rihong , Feng Zhihui
Published: March 2024

Monitoring radioactivity levels in the environment around nuclear power plants is of great significance to assessing environmental safety and impact. Shidaowan nuclear power plant is currently undergoing commissioning; however, the baseline soil radioactivity is unknown. The naturally occurring radionuclides 238U, 232Th, 226Ra and 40K, and artificial radionuclide (AR) 137Cs in soil samples around the Shidaowan nuclear power plant were measured to establish the baseline levels. Human health hazard indices such as external hazard indices (Hex), Radium equivalent (Raeq), outdoor absorbed dose rate (Dout), annual effective dose (AED) and excess lifetime cancer risk (ELCR) were estimated. The average concentration of 232Th, 40K, 137Cs, 238U and 226Ra were 42.6 ± 15, 581 ± 131, 0.68 ± 0.38, 40.13 ± 9.07 and 40.8 ± 12.8 Bq per kg, respectively. The average Hex, Raeq, Dout, AED and ELCR were 0.40, 146 Bq per kg, 68.8 nGy per h, 0.09 mSv per y and 3.29E-04, respectively. These data showed an acceptable level of risk to residents near the nuclear power plant and that the current radioactivity in the soil may not pose immediate harm to residents living close to the nuclear power plant. The observed lower AED and 40 K and 137Cs concentrations were comparable to other studies, whilst ELCR was higher than the world average of 2.9E-04. The commissioning of the Shidaowan nuclear power plant is potentially safe for the surrounding residents; further continuous monitoring is recommended.
Cattle, carcass, economic, and estimated emission impacts of feeding finishing steers lubabegron or ractopamine hydrochloride
Authors: McAtee T B , Renter D G , Murphy T , Betts N B , Depenbusch B E
Published: March 2024

Lubabegron (Experior; Elanco, Greenfield, IN, USA) is the first U.S. Food and Drug Administration approved feed additive for reducing gas emissions from feedlot animals or their waste; it does not have live or carcass performance claims. Our primary objective was to determine the effect of lubabegron on feedlot performance and carcass traits in finishing beef steers compared to ractopamine hydrochloride (Optaflexx; Elanco, Greenfield, IN, USA). A commercial feedlot trial using cross-bred beef steers (n = 2,117; 373 ± 15 kg initial body weight [BW]) was completed with a randomized complete block design. Treatments consisted of two feed additives: (1) OPT targeted to deliver 300 mg/animal/d of ractopamine hydrochloride for 28 ± 7 d out from harvest and (2) EXP targeted to deliver 36 mg/animal/d of lubabegron 56 ± 7 d out from harvest and a 4-d preslaughter withdrawal period. Twenty 70 to 142 hd pens with 10 pens per treatment were used. Cattle were weighed at arrival processing and at harvest and fed for an average of 167 d. Data were used to calculate production metrics, partial budgets, and estimated greenhouse gas emissions using published methods, and were analyzed using linear mixed models with pen as the experimental unit and block as a random intercept. A statistical significance threshold of α = 0.05 was determined a priori. There was no evidence for statistically significant differences between treatments for initial BW (P = 0.70), health-related outcomes (P values ≥ 0.43), or mobility scores (P = 0.09). Cattle-fed EXP had increased final BW, ADG, G:F, and decreased dry matter intake (P values ≤ 0.01) compared to OPT. Carcasses were 11 ± 1.76 kg (hot carcass weight) heavier in EXP group (P < 0.01), and differed between treatments for both yield grades (YG) and quality grades distributions (P values ≤ 0.01). Cattle-fed EXP had a shift toward more YG 1 and 2, select and sub-select carcasses compared to OPT, which had as shift toward more YG 3, 4, 5, prime and choice carcasses. With increased beef production and efficiency compared to OPT, the estimated CO2 equivalent emissions from production were reduced by 6.2% per unit of carcass weight for EXP (P ≤ 0.01). Estimated net returns/animal shipped were $56.61 ± 9.37 more for EXP than OPT (P ≤ 0.01). In conclusion, when cattle were fed for the same total number of days, feeding EXP compared to OPT increased net returns, feedlot performance, and efficiency, but resulted in carcass yield and quality characteristics that may impact marketing programs.
Safety of biologic agents for the management of rheumatic diseases during pregnancy
Authors: D’Gama Jonathan D. , Bermas Bonnie L.
Published: March 2024

Purpose of review

To discuss the current understanding regarding the use of biologic therapeutics in pregnancy.

Recent findings

Our understanding of the mechanisms underlying the potential fetal and infant exposure to biologics as well as a growing body of empirical evidence from real world use of biologics in pregnancy have demonstrated that biologics are generally compatible preconception and during pregnancy. Long-term effects of exposure to biologic agents in utero are not known, but will be uncovered in time. Biosimilars, which are becoming more popular, may not always share the same safety profiles as their originators.

Biologics have revolutionized the management of rheumatologic disease and ushered in a new era of clinical remission among patients. These agents, developed and introduced into clinical use at the beginning of the new millennium, are very potent, yet their efficacy in treating disease often in reproductive aged women, raises questions regarding their safety during pregnancy. These therapeutics can cause immunosuppression and can inhibit immunologic circuits that are not only involved in disease pathophysiology but hypothetically could impact the development of the fetal immune system. Reassuringly, biologics, typically antibodies or antibody-based proteins, are introduced to the fetus via the typical route of transplacental antibody transfer, and thus only begin to be transferred in appreciable amounts in the second trimester (after organogenesis). From theoretic and empirical standpoints, biologic use during pregnancy appears well tolerated for fetal development and to not substantially affect infant immune development.
Talar Neck Fractures with Associated Ipsilateral Foot and Ankle Fractures Have a Higher Risk of Avascular Necrosis
Authors: Srinath Arjun , Southall Wyatt G. S. , Nazal Mark R. , Mechas Charles A. , Foster Jeffrey A. , Griffin Jarod T. , Muhammad Maaz , Moghadamian Eric S. , Landy David C. , Aneja Arun
Published: March 2024

OBJECTIVES:

To determine if talar neck fractures with concomitant ipsilateral foot and/or ankle fractures (TNIFAFs) are associated with higher rates of avascular necrosis (AVN) compared to isolated talar neck fractures (ITNs).

METHODS:

Design:

Retrospective Cohort

Setting:

Single Level I Trauma Center

Patient Selection Criteria:

Skeletally mature patients who sustained talar neck fractures from January 2008 to January 2017 with at least six months follow-up. Based on radiographs at the time of injury, fractures were classified as ITN or TNIFAF and by Hawkins classification.

Outcome Measures and Comparisons: The primary outcome was the development of AVN based on follow-up radiographs, with secondary outcomes including nonunion and collapse.

RESULTS:

There were 115 patients who sustained talar neck fractures, with 63 (55%) in the ITN group and 52 (45%) in the TNIFAF group. In total, 63 (54.7%) patients were female with mean age of 39 years (range, 17-85), and 111 (96.5%) fractures occurred secondary to high-energy mechanisms of injury. There were no significant differences in demographic or clinical characteristics between groups (p>0.05). Twenty-four (46%) patients developed AVN in the TNIFAF group compared to 19 (30%) patients in the ITN group (p = 0.078). After adjusting for Hawkins classification and other variables, the odds of developing AVN was higher in the TNIFAF group compared to the ITN group [Odds Ratio, 2.43 (95% CI, 1.01-5.84); (p = 0.047)].

CONCLUSIONS:

This study found a significantly higher likelihood of AVN in patients with talar neck fractures with concomitant ipsilateral foot and/or ankle fractures compared to those with isolated talar neck fractures after adjusting for Hawkins classification and other potential prognostic confounders.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Successful treatment with selpercatinib after pralsetinib-related pneumonitis and intracranial failure in a patient with RET-rearranged nonsmall cell lung cancer
Authors: Cognigni Valeria , Giudice Giulia Claire , Bozzetti Francesca , Milanese Gianluca , Moschini Ilaria , Casali Miriam , Mazzaschi Giulia , Tiseo Marcello
Published: March 2024

Pralsetinib and selpercatinib are two highly potent and selective rearranged during transfection (RET) inhibitors that substantially improved the clinical outcome of patients with RET-rearranged non-small cell lung cancer. Treatment with one RET inhibitor after failure of the other is generally not recommended because of cross-resistance mechanisms. We report the case of a patient affected by metastatic RET-rearranged non-small cell lung cancer who experienced long-lasting disease control with pralsetinib. After 13 months from treatment start, the patient developed recurrent drug-related pneumonitis, requiring temporary interruptions and dose reductions and eventually failing to control the disease. Selpercatinib was then started as an off-label treatment, allowing both clinical and radiological intracranial disease control. Selpercatinib was well-tolerated at full dosage, and no pulmonary event occurred. In our case report, after pralsetinib dose reduction due to pulmonary toxicity, the therapeutic switch to selpercatinib allowed the patient to receive a full-dose treatment, eventually restoring disease control. Our case report and a few literature data suggest that switching from pralsetinib to selpercatinib may represent a therapeutic opportunity, especially for patients with brain metastases.
Better tools for better estimates: improving approaches to handling missing data in Swiss cancer registries
Authors: Richter Cornelia , Wildisen Lea , Rohrmann Sabine , Haile Sarah R.
Published: March 2024

Objective

Various approaches have been used in the literature to handle missing vital status data in cancer registries. We aimed to compare these approaches to determine which led to the least biased estimates in typical analytic tasks of cancer registries.

Methods

A simulation study was performed using data from the Swiss National Agency for Cancer Registration for six tumor types. First, 5%, 10% and 15% missingness in the vital status were introduced artificially in the complete data. Second, missing vital status data were handled by applying no, single or multiple imputations. Five-year overall survival estimates, relative survival or standardized incidence ratio were computed. Estimates were compared with the true value.

Results

Standardized incidence ratio estimates for colorectal cancer obtained with multiple imputation yielded least biased results (−0.06 to −0.04), but the widest confidence intervals. Single imputation was more biased (−0.32) than using no imputation at all (−0.21). A similar pattern was observed for overall survival and relative survival.

Conclusion

This simulation study indicated that often used single imputation (sometimes referred to as simulating follow-up times) techniques to fill in missing vital status data are likely too biased to be useful in practice. Multiple imputation approaches yielded standardized incidence ratio, overall and relative survival estimates with the least bias, indicating reasonable performance that is likely to generalize to other settings.
Developing an Online Health Community Platform for Facilitating Empowerment in Chronic Disease Prevention and Health Promotion
Authors: Park Myonghwa , Bui Linh Khanh , Kim Jahyeon , Kim Jinju , Jung Jihye , Shin Ouckyoung , Na Junsik , Guk Hyunjeong , Jang Joong Shik , Oh Soomin , Kim Da Seul
Published: March 2024

This study aimed to develop an online health community platform for facilitating the empowerment of people with chronic diseases dwelling in the community regarding disease prevention and health promotion. The user-centered design approach included four main steps: (1) identifying the health problems and needs of target users, (2) developing the content of the platform, (3) constructing the platform, and (4) pilot testing, refinement, and finalization. An online health community platform available both in a mobile application and a Web-enabled application has been launched to facilitate empowerment and self-management by people with chronic conditions. The main components of the application comprised (1) screening for chronic diseases and health problems, (2) setting personal goals for health promotion and action planning to achieve the goals themselves, (3) offering an online health community with shared group goals that help users engage with their peers to attain their goals, and (4) creating one's own online health community and inviting others to participate. The platform has the potential to encourage people with chronic conditions to proactively engage in their own health promotion. Future studies are needed to determine the impact of the application on self-management and empowerment for its users.
The Effect of Video-Based Simulation Training on Nursing Students' Motivation and Academic Achievement
Authors: Koçan Sema , Kulakaç Nurşen , Aktuğ Cemile , Demirel Sevgül
Published: March 2024

This study was conducted to determine the effect of video-based simulation education on nursing students' motivation and academic achievement. The research was designed in a mixed model. A quasi-experimental method with a pretest-posttest control group was used for the quantitative part, and the descriptive phenomenology approach was used as the qualitative research method. The sample of the study consisted of second-year nursing students in two state universities in eastern Turkey. The data were collected with the Student Information Form, the Academic Achievement Test, and the Motivation Resources and Problems Scale using Google Forms Web application. Qualitative data were collected through online semistructured interview forms and focus group interviews. According to the results, the posttest academic achievement and Motivation Resources and Problems Scale mean scores of the students in the intervention group were significantly higher than those of the control group (P< .05). In the analysis of the qualitative, three main themes emerged: We felt fortunate that it increased information retention,” “We felt like we were in real practice environment,” and “It made us feel that we were nurses.” The results showed the use of video-based simulation can be suggested as a strategy to promote classroom teaching and engage students.
Febrile Ulceronecrotic Mucha-Habermann Disease Associated With Hemophagocytic Lymphohistiocytosis: A Case Report and Review of the Literature
Authors: Chen Caroline , Fahmy Lauren M. , Schreidah Celine M. , Magro Cynthia M. , Geskin Larisa J.
Published: March 2024

Mucha-Habermann disease (MHD) is an inflammatory skin disease characterized by polymorphous eruptions of erythematous, necrotic macules that have been reported for similarities to cutaneous T-cell lymphoma. Febrile ulceronecrotic MHD (FUMHD) represents a severe variant of MHD, marked by ulcers, hemorrhagic bullae, and systemic symptoms. Herein, we report a case of a severely atypical lymphomatoid expression of FUMHD associated with hemophagocytic lymphohistiocytosis (HLH). A previously healthy 21-year-old woman was admitted to the hospital with a rapidly progressive necrotic papular rash. Physical examination revealed right orbital swelling, bilateral hemorrhagic auricular bullae, and multiple ulcerative purpuric papulonodules on the trunk, face, and extremities. Biopsy indicated a dermal and subcutaneous infiltrate of atypical CD8+ lymphocytes with loss of CD5 and reduction in CD7 expression, along with features of lymphomatoid vasculitis. A diagnosis of a severely atypical lymphomatoid expression of FUMHD was made. The patient also met 7 of 9 HLH-2004 criteria, leading to a diagnosis of HLH. Positron emission tomography/computed tomography, flow cytometry, and rheumatologic workup were unremarkable. Treatment with an eight-week course of etoposide and dexamethasone for HLH led to rapid clinical improvement. Over time, her skin lesions regressed and eventually scabbed over to leave hyperpigmented scars, confirming the diagnosis of MHD. She has remained stable, off therapy for 4 years. Although potentially fatal, FUMHD often exhibits favorable outcomes and may resolve without recurrence, as in our patient. FUMHD should be considered in the differential diagnosis for patients presenting with cutaneous CD8+ necrotizing angiocentric lymphoproliferative disease complicated by HLH.
Three Useful Tips and Tricks for Intraoperative Nerve Stimulation
Authors: Liu Wen-Chih , Raasveld Floris V. , Mayrhofer-Schmid Maximilian , Eberlin Kyle R. , Valerio Ian L.
Published: March 2024

Disposable handheld nerve stimulators are widely used in peripheral nerve surgery. Such devices stimulate a motor nerve or the motor component of a mixed nerve by applying electrical current to the proximal region, targeting the main nerve trunk. This stimulation then travels along the motor nerve, reaching the distal end to control the corresponding muscle(s). In this study, the authors demonstrate three useful tips and tricks for handheld nerve stimulation during targeted muscle reinnervation and peripheral nerve surgery. The three tips are (1) identification of proximal muscle contraction by retrograde electrical stimulation of a distal sensory nerve; (2) graded stimulation for identifying motor nerves within fibrotic scarred tissue beds or parallel to the major motor/mixed nerve of interest; and (3) proximal stimulation for validation of adequate post-targeted muscle reinnervation coaptation(s).
Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids
Authors: Lawera Nathan G. , Madzia Jules , Casey Liann C. , Guyton Rodney L. , Woodyard De Brito Kiersten C. , Kinzer Alexandra , Ulma Raquel M. , Pan Brian S. , Schwentker Ann R. , Leto Barone Angelo A.
Published: March 2024

Background:

The objective of this meta-analysis was to examine the effectiveness of keloid intralesional excision (KILE) in preventing recurrence. Treatment of keloids using surgical excision alone leads to high rates of recurrence. To date, there are no widely accepted guidelines for keloid treatment, and a multitude of adjunctive therapies are used to reduce recurrence. Despite these efforts, recurrence remains high. In this study, we conducted a meta-analysis of the existing literature on KILE to determine its role in recurrence reduction.

Methods:

A literature review using PubMed, Scopus, and Web of Science databases was performed. Two authors independently evaluated studies for eligibility. Incidence of keloid recurrence was recorded, and a comprehensive meta-analysis was performed to assess the pooled keloid recurrence rate, as well as the effect of additional therapies.

Results:

Twenty-two studies evaluating intralesional excision of 608 keloids were included in the study. Average time to follow-up was 19.2 months (range 6–35 months). A meta-analysis of proportions was conducted, demonstrating a pooled recurrence rate of 13% (95% confidence interval, 9%–16%). There was no evidence that using therapies in addition to KILE had a significant effect on the overall pooled recurrence rate.

Conclusions:

A meta-analysis of 608 keloids shows that KILE is an effective technique in preventing keloid recurrence, with a pooled recurrence rate of 13% compared with previously reported rates of 45%–100% after complete excision. Although there are no standard guidelines for keloid treatment, our meta-analysis shows that KILE is promising in recurrence reduction.
Restoring SRSF3 in Kupffer cells attenuates obesity-related insulin resistance
Authors: Gao Hong , Rocha Karina C. E. , Jin Zhongmou , Kumar Deepak , Zhang Dinghong , Wang Ke , Das Manasi , Farrell Andrea , Truong Tyler , Tekin Yasemin , Jung Hyun Suh , Kempf Julia , Webster Nicholas J. G. , Ying Wei
Published: March 2024

Background and Aims:

In obesity, depletion of KCs expressing CRIg (complement receptor of the Ig superfamily) leads to microbial DNA accumulation, which subsequently triggers tissue inflammation and insulin resistance. However, the mechanism underlying obesity-mediated changes in KC complement immune functions is largely unknown.

Approach and Results:

Using KC-specific deactivated Cas9 transgenic mice treated with guide RNA, we assessed the effects of restoring CRIg or the serine/arginine-rich splicing factor 3 (SRSF3) abundance on KC functions and metabolic phenotypes in obese mice. The impacts of weight loss on KC responses were evaluated in a diet switch mouse model. The role of SRSF3 in regulating KC functions was also evaluated using KC-specific SRSF3 knockout mice. Here, we report that overexpression of CRIg in KCs of obese mice protects against bacterial DNA accumulation in metabolic tissues. Mechanistically, SRSF3 regulates CRIg expression, which is essential for maintaining the CRIg+ KC population. During obesity, SRSF3 expression decreases, but it is restored with weight loss through a diet switch, normalizing CRIg+ KCs. KC SRSF3 is also repressed in obese human livers. Lack of SRSF3 in KCs in lean and obese mice decreases their CRIg+ population, impairing metabolic parameters. During the diet switch, the benefits of weight loss are compromised due to SRSF3 deficiency. Conversely, SRSF3 overexpression in obese mice preserves CRIg+ KCs and improves metabolic responses.

Conclusions:

Restoring SRSF3 abundance in KCs offers a strategy against obesity-associated tissue inflammation and insulin resistance by preventing bacterial DNA accumulation.
Reversing malnutrition and low muscle strength with targeted enteral feeding in patients awaiting liver transplant: A randomized controlled trial
Authors: Chapman Brooke , Wong Darren , Sinclair Marie , Hey Penelope , Terbah Ryma , Gow Paul , Majumdar Avik , Testro Adam
Published: March 2024

Background and Aims:

Most patients with decompensated cirrhosis fail to meet their nutrition targets. The impact of nasogastric feeding (NGF) on malnutrition in cirrhosis remains unknown. This study aims to assess the impact of pretransplant NGF on pre–liver transplant and post–liver transplant outcomes.

Approach and Results:

This single-center, prospective randomized controlled trial of 55 patients with severe malnutrition and low handgrip strength (HGS) compared a standard high-energy high-protein diet to diet plus supplemental nocturnal NGF while awaiting transplant. The primary outcome was a change in HGS. The median age was 58.5 years (IQR: 51.1–64), median MELD was 24 (20–28.5), and 32 (58%) patients were male. The median duration of NGF was 63.0 days (34.5–127), following which time the median between-group difference in HGS was 3.6 kg (95% CI: 1.7–5.2, p<0.001), an increase of 20% from baseline. Mid–upper-arm circumference, triceps skinfold, and immune function all increased significantly with NGF. Muscle and nutritional parameters continued to improve with increasing duration of feeding. NGF significantly increased daily energy intake between groups by 1285 kcal (95% CI: 860–1677) and protein intake by 51 g (95% CI: 32–71) (both p<0.001). All NGF patients met >100% of their measured nutritional requirements. Posttransplant clinical outcomes were similar between groups.

Conclusions:

Targeted enteral feeding before liver transplant improves HGS, anthropometry, and immune function in severely malnourished patients with cirrhosis. These findings provide a strong rationale for early consideration of NGF to reverse malnutrition and improve muscle strength. Appropriately powered studies should explore whether NGF can also impact clinically relevant outcomes including pretransplant and posttransplant mortality.
Symptoms Associated With Exercise Intolerance and Resting Heart Rate Following Mild Traumatic Brain Injury
Authors: Thorne Jacinta , Hellewell Sarah C. , Cowen Gill , Ring Alexander , Jefferson Amanda , Chih HuiJun , Gozt Aleksandra K. , Buhagiar Francesca , Thomas Elizabeth , Papini Melissa , Bynevelt Michael , Celenza Antonio , Xu Dan , Honeybul Stephen , Pestell Carmela F. , Fatovich Daniel , Fitzgerald Melinda
Published: March 2024

Objectives:

People may experience a myriad of symptoms after mild traumatic brain injury (mTBI), but the relationship between symptoms and objective assessments is poorly characterized. This study sought to investigate the association between symptoms, resting heart rate (HR), and exercise tolerance in individuals following mTBI, with a secondary aim to examine the relationship between symptom-based clinical profiles and recovery.

Methods:

Prospective observational study of adults aged 18 to 65 years who had sustained mTBI within the previous 7 days. Symptoms were assessed using the Post-Concussion Symptom Scale, HR was measured at rest, and exercise tolerance was assessed using the Buffalo Concussion Bike Test. Symptom burden and symptom-based clinical profiles were examined with respect to exercise tolerance and resting HR.

Results:

Data from 32 participants were assessed (mean age 36.5 ± 12.6 years, 41% female, 5.7 ± 1.1 days since injury). Symptom burden (number of symptoms and symptom severity) was significantly associated with exercise intolerance (P = .002 and P = .025, respectively). Physiological and vestibular-ocular clinical profile composite groups were associated with exercise tolerance (P = .001 and P = .014, respectively), with individuals who were exercise intolerant having a higher mean number of symptoms in each profile than those who were exercise tolerant. Mood-related and autonomic clinical profiles were associated with a higher resting HR (>80 bpm) (P = .048 and P = .028, respectively), suggesting altered autonomic response for participants with symptoms relating to this profile. After adjusting for age and mechanism of injury (sports- or non–sports-related), having a higher mood-related clinical profile was associated with persisting symptoms at 3 months postinjury (adjusted odds ratio = 2.08; 95% CI, 1.11-3.90; P = .013).

Conclusion:

Symptom-based clinical profiles, in conjunction with objective measures such as resting HR and exercise tolerance, are important components of clinical care for those having sustained mTBI. These results provide preliminary support for the concept that specific symptoms are indicative of autonomic dysfunction following mTBI.
Rasch Analysis of the Mayo-Portland Adaptability Inventory for Posthospital Brain Injury Rehabilitation
Authors: Malec James F. , Logan Daniel M. , McGrath Claire , Parrott Devan , Walters G. Joseph
Published: March 2024

Objectives:

Reexamine the item structure and reliability of the Mayo-Portland Adaptability Inventory (4th ed; MPAI-4) through Rasch analysis of admission and discharge scores for a large sample of adults with acquired brain injury (ABI) who participated in various types of posthospital brain injury rehabilitation (PHBIR) programs; (2) compare differential item functioning (DIF) for traumatic brain injury (TBI), stroke and other ABI; and (3) explore the viability of more specific subscales in addition to the established indices.

Setting:

Data from Residential Neurobehavioral, Residential Neurorehabilitation, Home and Community, Day Treatment, and Outpatient rehabilitation programs serving individuals with ABI.

Participants:

A total of 2154 individuals with TBI, stroke, or other ABI.

Design:

Retrospective analysis of de-identified admission and discharge data from the Foundation to Advance Brain Rehabilitation (FABR) consortium database.

Main Measure:

MPAI-4.

Results:

After adjusting 4 misfitting items and eliminating 20 misfitting persons, the MPAI-4 demonstrated real person reliability/separation = 0.93/3.52 and real item reliability/separation = 1.00/24.02. Independent Rasch analyses by diagnostic category found similar reliabilities and separations. Residual item correlations and principal component analysis of residuals (PCAR) indicated areas of local dependence arranged hierarchically reflecting the full-scale item hierarchy and providing the basis for 3 new subscales of Physical Abilities, Cognitive Abilities, and Autonomy. DIF across diagnostic categories revealed differences in item elevations characteristic of typical patients in each category. Measure means and SDs were very similar across categories.

Conclusions:

MPAI-4 items demonstrate very good person and item reliabilities for individuals with TBI, stroke, and other ABI at a level that supports individual evaluation. Variations in item calibrations across diagnostic categories reflect the differential characteristics of typical patients within categories. The entire measure provides an overall assessment of common sequalae of ABI, and standard indices used in combination with newly derived subscales provide more specific assessments of rehabilitation needs for treatment planning.
Association Between Participation and Satisfaction With Life Over Time in Older Adults With Traumatic Brain Injury: A TBI Model Systems Study
Authors: Taiwo Zinat , Sander Angelle M. , Juengst Shannon B. , Liu Xiangyi , Novelo Luis Leon , Hammond Flora M. , O'Neil-Pirozzi Therese M. , Perrin Paul B. , Gut Nicholas
Published: March 2024

Objective:

To examine the association between participation and satisfaction with life at 1, 2, 5, and 10 years after traumatic brain injury (TBI) in older adults.

Setting:

Community.

Participants:

Participants (N = 2362) who sustained complicated mild to severe TBI, requiring inpatient rehabilitation, at age 60 years or older and had follow-up data on participation and satisfaction with life for at least 1 follow-up time point across 1, 2, 5, and 10 years. Age at each time period was categorized as 60 to 64 years, 65 to 75 years, and 75 years or older.

Design:

Secondary data analysis of a large multicenter database.

Main Measures:

Three domains (Productivity, Social Relations, Out and About) of the Participation Assessment With Recombined Tools-Objective (PART-O); Satisfaction With Life Scale (SWLS).

Results:

SWLS increased over the 10 years after TBI and was significantly associated with greater frequency of participation across all domains. There was a significant interaction between age and PART-O Social Relations such that there was a weaker relationship between Social Relations and SWLS in the oldest group (75 years or older). There was no interaction between Productivity or Out and About and age, but greater participation in both of these domains was associated with greater life satisfaction across age groups.

Conclusions:

These findings indicate that greater participation is associated with increased satisfaction with life in older adults, across all participation domains over the first 10 years postinjury, suggesting that rehabilitation should target improving participation even in older adults. The decreased association of social relations with satisfaction with life in the oldest age group suggests that frequency of social relations may not be as important for life satisfaction in the oldest adults, but quality may still be important.
The Association Between Impaired Dyadic Coping and Frailty in Elderly Patients With Hypertension
Authors: Wang Yaqi , Xu Xueying , Lv Qingyun , Zhang Xiaonan , Yang Weiling , Li Yanting , Zhao Yue , Zang Xiaoying
Published: March 2024

Background

Lifelong hypertension highlights the importance of dyadic engagement in coping with the disease. Although dyadic coping is heterogeneous in patients with other diseases, little is known about it in elderly patients with hypertension. In addition, whether impaired dyadic coping is associated with frailty has yet to be elucidated.

Objectives

The aim of this study was to investigate the latent profiles and characteristics of dyadic coping and the potential association between impaired dyadic coping and frailty in elderly patients with hypertension.

Methods

We recruited a total of 741 elderly patients with hypertension. Latent profile analysis was then used to identify the best-fitting model. Then, we used regression analysis to determine profile predictors and identify the association between impaired dyadic coping and frailty.

Results

The 5-profile model was considered to be the best-fitting model, as follows: profile 1, severely impaired dyadic coping; profile 2, mildly impaired dyadic coping; profile 3, normal dyadic coping; profile 4, better dyadic coping; and profile 5, the highest dyadic coping. In the fully adjusted model, the probability of frailty was 1.94-fold higher in the mildly impaired dyadic coping group (odds ratio, 1.94; 95% confidence interval, 1.09–3.47) and 2.66-fold higher in the severely impaired dyadic coping group (odds ratio, 2.66; 95% confidence interval, 1.11–6.39).

Conclusions

We identified heterogeneity in dyadic coping and demonstrated that impaired dyadic coping was associated with frailty. Those at risk of dyadic coping impairment need to be identified early, followed by dyadic coping–based interventions to prevent or delay frailty.
Ventricular Arrhythmias and Sudden Cardiac Death in Left Ventricular Assist Device Patients Without Implantable Cardioverter Defibrillators
Authors: Gokhale Sanket , Malesz Alexandra , Masha Luke
Published: March 2024

Patients with left ventricular assist devices (LVAD) can develop sustained ventricular arrhythmias (VA). The history and presentation of VA in implantable cardioverter defibrillator (ICD)-naive patients with LVAD is not well described in the literature and the risks/benefits of ICD implantation are unknown. This single-center retrospective cohort study included patients >18 years old who did not have an ICD during LVAD implantation from 2010 to 2022. The primary outcome was VA event rate per 100 patient-years. Two hundred thirty-seven patients underwent LVAD implantation and we identified 46 (19.4%) ICD naive patients. The etiology of heart failure in most patients was nonischemic cardiomyopathy (67.4%). Of all patients, only five were found to have documented VA. Only two episodes of VA occurred in the ambulatory setting. The estimated index VA rate was 5.89 events per 100 patient-years in our entire ICD-naive LVAD population. In the ambulatory ICD-naive population, the estimated VA rate was 2.42 events per 100 patient-years with no associated mortality. The rate of index VA in ICD-naive patients was below thresholds associated with benefits from ICD insertion. No ambulatory mortality from VA was seen and VA was well tolerated by the LVAD population. Perioperative VA in this population is associated with high mortality.
Extracorporeal Membrane Oxygenation After Liver Transplant in Children: A Review of the ELSO Registry
Authors: Di Nardo Matteo , Cousin Vladimir L. , Alunni-Fegatelli Danilo , Grazioli Serge , Rycus Peter , Thiagarajan Ravi R. , Joye Raphael , Polito Angelo
Published: March 2024

There are minimal data describing use of extracorporeal membrane oxygenation (ECMO) in pediatric patient after a liver transplantation (LT). This study aimed at describing ECMO run in this specific situation using the data from Extracorporeal Life Support Organization (ELSO) Registry between January 1, 2010, to December 31, 2022. We described patients’ characteristics at ECMO initiation, outcome and mortality risk factors. We identified 27 patients with a median age of 2.7 years (interquartile range (IQR) = 1.5–9.9). Main indication for ECMO support was respiratory (14/27 [52%]) followed by extracorporeal cardiopulmonary resuscitation (ECPR) (7/27 [26%]) and cardiac (6/27 [22%]). Overall in-hospital mortality was 63% (17/27). Mortality rate according to ECMO indications was 50% for both respiratory and cardiac failure and reached 100% for ECPR patients. Overall, nonsurvivors experienced significantly more complications under ECMO support (p = 0.007). Main on-ECMO complications were hemorrhagic (11/27 [41%]) and thrombotic (7/27 [26%]). No clinical or biologic factors was predictive of patients’ outcome. Our results suggest that ECMO support is a viable option for cardiac and respiratory indications after pediatric LT. Occurrence of complications while on ECMO are associated with unfavorable outcomes. The extremely high mortality rate in ECPR patients merits further research.
Banxia-Shengjiang drug pair inhibits gastric cancer development and progression by improving body immunity
Authors: Yang Yating , Yuan Ling , Liu Wenjing , Lu Doudou , Meng Fandi , Yang Yi , Zhou Ziying , Ma Ping , Nan Yi
Published: March 2024

To investigate the mechanism of action of Banxia-Shengjiang drug pair on the inhibition of gastric cancer (GC) using network pharmacology and bioinformatics techniques. The action targets of the Banxia (Pinellia ternata (Thunb.) Makino) -Shengjiang (Zingiber officinale Roscoe) drug pair obtained from the TCMSP database were intersected with differentially expressed genes (DEGs) and GC-related genes, and the intersected genes were analyzed for pathway enrichment to identify the signaling pathways and core target genes. Subsequently, the core target genes were analyzed for clinical relevance gene mutation analysis, methylation analysis, immune infiltration analysis and immune cell analysis. Finally, by constructing the PPI network of hub genes and corresponding active ingredients, the key active ingredients of the Banxia-Shengjiang drug pair were screened for molecular docking with the hub genes. In this study, a total of 557 target genes of Banxia-Shengjiang pairs, 7754 GC-related genes and 1799 DEGs in GC were screened. Five hub genes were screened, which were PTGS2, MMP9, PPARG, MMP2, and CXCR4. The pathway enrichment analyses showed that the intersecting genes were associated with RAS/MAPK signaling pathway. In addition, the clinical correlation analysis showed that hub genes were differentially expressed in GC and was closely associated with immune infiltration and immunotherapy. The results of single nucleotide variation (SNV) and copy number variation (CNV) indicated that mutations in the hub genes were associated with the survival of gastric cancer patients. Finally, the PPI network and molecular docking results showed that PTGS2 and MMP9 were potentially important targets for the inhibition of GC by Banxia-Shengjiang drug pair, while cavidine was an important active ingredient for the inhibition of GC by Banxia-Shengjiang drug pair. Banxia-Shengjiang drug pair may regulate the immune function and inhibit GC by modulating the expression of core target genes such as RAS/MAPK signaling pathway, PTGS2 and MMP9.
Comparison of different interventions for the reduction of labor pain: A systematic review and network meta-analysis
Authors: Yu Mengxian , Qian Haiyan , Gan Miao
Published: March 2024

Objective:

This systematic review and network meta-analysis were performed to compare different interventions for the reduction of labor pain.

Methods:

PubMed, Embase, Cochrane Library, Web of Science and ScienceDirect databases were searched for the randomized controlled trials (RCTs) meeting prespecified inclusion criteria up to January, 2023. Interventions including electrical acupoint stimulation (TEAS), epidural analgesia (EA) and control treatments. The primary outcomes included pain scores, failure rate of natural delivery, adverse events and Apgar scores. The methodological quality was assessed by the Cochrane risk of bias tool. Meta-analysis was performed by R software with gemtc package. Surfaces under the cumulative ranking curves (SUCRA) were used to rank the intervention.

Results:

Twelve studies met the inclusion criteria and were included in the network meta-analysis. TEAS (WMD −3.1, 95% CrI −3.8, −2.5) and EA (WMD −2.1, 95% CrI −2.8, −1.3) was more effective than the control in decreasing VAS. TEAS ranked first (SUCRA, 90.9%), EA ranked second (SUCRA, 74.0%) and control ranked last (SUCRA, 35.0%) for reducing VAS. For patients with labor pain, with respect to the most effective treatment for reducing failure rate of natural delivery, TEAS ranked first (SUCRA, 96.6%), EA ranked second (SUCRA, 50.4%) and control ranked last (SUCRA, 3.0%). With regard to the Apgar scores, there was high probability that TEAS ranked first (SUCRA, 80.7%), compared to control (SUCRA, 41.4%) and EA (SUCRA 27.9%). With regard to the adverse events, there was high probability that TEAS ranked first (SUCRA, 99.9%), compared to control (SUCRA, 33.2%) and EA (SUCRA 17.6%).

Conclusion:

TEAS has the potential to serve as a viable alternative for women in labor, offering a simple, noninvasive, and non-pharmacological intervention that surpasses EA in terms of both analgesic effectiveness and safety for both mothers and neonates.
Efficacy and safety of endoscopic cardia peripheral tissue scar formation (ECSF) for the treatment of refractory gastroesophageal reflux disease: A systematic review with meta-analysis
Authors: Shi Chaoyi , ZhuoMa GeSang , Ying Lina , Zhang Zhenyu , Cui Liyang , Li Ruifang , Zhang Jun
Published: March 2024

Background:

Endoscopic treatment is increasingly used for refractory gastroesophageal reflux disease (rGERD). Unlike the mechanism of conventional surgical fundoplication, gastroesophageal junction ligation, anti-reflux mucosal intervention, and radiofrequency ablation have extremely similar anti-reflux mechanisms; hence, we collectively refer to them as endoscopic cardia peripheral tissue scar formation (ECSF). We conducted a systematic review and meta-analysis to assess the safety and efficacy of ECSF in treating rGERD.

Methods:

We performed a comprehensive search of several databases, including PubMed, Embase, Medline, China Knowledge Network, and Wanfang, to ensure a systematic approach for data collection between January 2011 and July 2023. Forest plots were used to summarize and combine the GERD-health-related quality of life (HRQL), gastroesophageal reflux questionnaire score, and DeMeester scores, acid exposure time, lower esophageal sphincter pressure, esophagitis, proton pump inhibitors use, and patient satisfaction.

Results:

This study comprised 37 studies, including 1732 patients. After ECSF, significant improvement in gastroesophageal reflux disease health-related quality of life score (mean difference [MD] = 18.27 95% CI: 14.81–21.74), gastroesophageal reflux questionnaire score (MD = 4.85 95% CI: 3.96–5.75), DeMeester score (MD = 42.34, 95% CI: 31.37–53.30), acid exposure time (MD = 7.98, 95% CI: 6.03–9.92), and lower esophageal sphincter pressure was observed (MD = −5.01, 95% CI: −8.39 to 1.62). The incidence of serious adverse effects after ECSF was 1.1% (95% CI: 0.9%–1.2%), and postoperatively, 67.4% (95% CI: 66.4%–68.2%) of patients could discontinue proton pump inhibitor-like drugs, and the treatment outcome was observed to be satisfactory in over 80% of the patients. Subgroup analyses of the various procedures showed that all 3 types improved several objective or subjective patient indicators.

Conclusions:

Based on the current meta-analysis, we conclude that rGERD can be safely and effectively treated with ECSF as an endoscopic procedure.
Gut microbiota-based discriminative model for patients with ulcerative colitis: A meta-analysis and real-world study
Authors: Zhang Rong , Chen Jing , Liu Li , Li Xiankun , Qiu Changwei
Published: March 2024

Gut microbiota directly interacts with intestinal epithelium and is a significant factor in the pathogenesis of ulcerative colitis (UC). A meta-analysis was performed to investigate gut microbiota composition of patients with UC in the United States. We also collected fecal samples from Chinese patients with UC and healthy individuals. Gut microbiota was tested using 16S ribosomal RNA gene sequencing. Meta-analysis and 16S ribosomal RNA sequencing revealed significant differences in gut bacterial composition between UC patients and healthy subjects. The Chinese UC group had the highest scores for Firmicutes, Clostridia, Clostridiales, Streptococcaceae, and Blautia, while healthy cohort had the highest scores for P-Bacteroidetes, Bacteroidia, Bacteroidales, Prevotellaceae, and Prevotella_9. A gut microbiota-based discriminative model trained on an American cohort achieved a discrimination efficiency of 0.928 when applied to identify the Chinese UC cohort, resulting in a discrimination efficiency of 0.759. Additionally, a differentiation model was created based on gut microbiota of a Chinese cohort, resulting in an area under the receiver operating characteristic curve of 0.998. Next, we applied the model established for the Chinese UC cohort to analyze the American cohort. Our findings suggest that the diagnostic efficiency ranged from 0.8794 to 0.9497. Furthermore, a combined analysis using data from both the Chinese and US cohorts resulted in a model with a diagnostic efficacy of 0.896. In summary, we found significant differences in gut bacteria between UC individuals and healthy subjects. Notably, the model from the Chinese cohort performed better at diagnosing UC patients compared to healthy subjects. These results highlight the promise of personalized and region-specific approaches using gut microbiota data for UC diagnosis.
Pyoderma gangrenosum complicated with hematological malignancies: Two case reports
Authors: Li Fen , Zhao Jie , Duan Huanan , Zhang Haixi , Zhang Lin , Zhao Liangyun , Wen Yan , Gu Xuezhong
Published: March 2024

Introduction:

Pyoderma gangrenosum (PG) is a rare noninfectious neutrophilic skin disease. The diagnosis of PG is mainly based on clinical manifestations. Therefore, the clinical features of PG are important for confirming the diagnosis of this disease. Herein, the clinical data of 2 young males with PG complicated with hematological malignancies were reported, and the literature were reviewed.

Case presentation:

The first case was a 22-year-old male who was admitted due to a systemic rash, headache, and fever. Physical examination showed black scabs on the skins of the extremities, trunk, scalp, and face. Biopsy of the skin lesion showed epidermal edema, spongy formation, neutrophil infiltration, acute and chronic inflammatory cell infiltration in the dermis, showing purulent inflammation with epidermal erosion. The bone marrow biopsy showed obviously active proliferation of nucleated cells, granulocytes at various stages, abnormal morphological neutrophils, and occasionally observed young red blood cells. The diagnosis of PG and chronic myelomonocytic leukemia (CMML-0) was made. The second case was a 28-year-old male who presented a swollen, painful right calf following injury and then developed ulcers on skin and soft tissues. Bone marrow biopsy showed obviously active nucleated cell proliferation, suggesting a myeloid tumor. He was also diagnosed with PG and hematological malignancies. They both received hormone and antiinfection therapy. After treatment, their body temperature, infection, and skin lesions were improved. However, both of them were readmitted and had a poor prognosis.

Conclusions:

PG may be associated with hematological malignancies. For patients with typical skin lesions and obvious abnormal blood routines, it is necessary to investigate the possibility of PG with hematological malignancies.