bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-world usage of Chronic Kidney Disease – Mineral Bone Disorder (CKD–MBD) biomarkers in nephrology practices
Authors: Fusaro Maria , Barbuto Simona , Gallieni Maurizio , Cossettini Althea , Re Sartò Giulia Vanessa , Cosmai Laura , Cianciolo Giuseppe , La Manna Gaetano , Nickolas Thomas , Ferrari Serge , Bover Jordi , Haarhaus Mathias , Marino Carmela , Mereu Maria Cristina , Ravera Maura , Plebani Mario , Zaninotto Martina , Cozzolino Mario , Bianchi Stefano , Messa Piergiorgio , Gregorini Mariacristina , Gasperoni Lorenzo , Agosto Caterina , Aghi Andrea , Tripepi Giovanni
Published: November 2023

Background

Chronic kidney disease mineral bone disorder (CKD-MBD) is a condition characterized by alterations of calcium, phosphate, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF-23) metabolism that in turn promote bone disorders, vascular calcifications, and increase cardiovascular (CV) risk. Nephrologists’ awareness of diagnostic, prognostic, and therapeutic tools to manage CKD-MBD plays a primary role in adequately preventing and managing this condition in clinical practice.

Methods

A national survey (composed of 15 closed questions) was launched to inquire about the use of bone biomarkers in the management of CKD-MBD patients by nephrologists and to gain knowledge about the implementation of guideline recommendations in clinical practice.

Results

One hundred and six Italian nephrologists participated in the survey for an overall response rate of about 10%. Nephrologists indicated that the laboratories of their hospitals were able to satisfy request of ionized calcium levels, 105 (99.1%) of both PTH and alkaline phosphatase (ALP), 100 (94.3%) of 25(OH)D, and 61 (57.5%) of 1.25(OH)2D; while most laboratories did not support the requests of biomarkers such as FGF-23 (intact: 88.7% and c-terminal: 93.4%), Klotho (95.3%; soluble form: 97.2%), tartrate-resistant acid phosphatase 5b (TRAP-5b) (92.5%), C-terminal telopeptide (CTX) (71.7%), and pro-collagen type 1 N-terminal pro-peptide (P1NP) (88.7%). As interesting data regarding Italian nephrologists’ behavior to start treatment of secondary hyperparathyroidism (sHPT), the majority of clinicians used KDOQI guidelines (n = 55, 51.9%). In contrast, only 40 nephrologists (37.7%) relied on KDIGO guidelines, which recommended referring to values of PTH between two and nine times the upper limit of the normal range.

Conclusion

Results point out a marked heterogeneity in the management of CKD-MBD by clinicians as well as a suboptimal implementation of guidelines in Italian clinical practice.
Metabolomic profile of neuroendocrine tumors identifies methionine, porphyrin, and tryptophan metabolisms as key dysregulated pathways associated with patient survival
Authors: La Salvia Anna , Lens-Pardo Alberto , López-López Angel , Carretero-Puche Carlos , Capdevila Jaume , Benavent Marta , Jiménez-Fonseca Paula , Castellano Daniel , Alonso Teresa , Teule Alexandre , Custodio Ana , Tafuto Salvatore , La Casta Adelaida , Spada Francesca , Lopez-Gonzalvez Angeles , Gil-Calderon Beatriz , Espinosa-Olarte Paula , Barbas Coral , Garcia-Carbonero Rocio , Soldevilla Beatriz
Published: November 2023

Objective

Metabolic profiling is a valuable tool to characterize tumor biology but remains largely unexplored in neuroendocrine tumors (NETs). Our aim was to comprehensively assess the metabolomic profile of NETs and identify novel prognostic biomarkers and dysregulated molecular pathways.

Design and Methods

Multiplatform untargeted metabolomic profiling (GC-MS, CE-MS, and LC-MS) was performed in plasma from 77 patients with G1-2 extra-pancreatic NETs enrolled in the AXINET trial (NCT01744249) (study cohort) and from 68 non-cancer individuals (control). The prognostic value of each differential metabolite (n = 155) in NET patients (P < .05) was analyzed by univariate and multivariate analyses adjusted for multiple testing and other confounding factors. Related pathways were explored by Metabolite Set Enrichment Analysis (MSEA) and Metabolite Pathway Analysis (MPA).

Results

Thirty-four metabolites were significantly associated with progression-free survival (PFS) (n = 16) and/or overall survival (OS) (n = 27). Thirteen metabolites remained significant independent prognostic factors in multivariate analysis, 3 of them with a significant impact on both PFS and OS. Unsupervised clustering of these 3 metabolites stratified patients in 3 distinct prognostic groups (1-year PFS of 71.1%, 47.7%, and 15.4% (P = .012); 5-year OS of 69.7%, 32.5%, and 27.7% (P = .003), respectively). The MSEA and MPA of the 13-metablolite signature identified methionine, porphyrin, and tryptophan metabolisms as the 3 most relevant dysregulated pathways associated with the prognosis of NETs.

Conclusions

We identified a metabolomic signature that improves prognostic stratification of NET patients beyond classical prognostic factors for clinical decisions. The enriched metabolic pathways identified reveal novel tumor vulnerabilities that may foster the development of new therapeutic strategies for these patients.
Population size shapes trade-off dilution and adaptation to a marginal niche unconstrained by sympatric habitual conditions
Authors: Chavhan Yashraj , Malusare Sarthak , Dey Sutirth
Published: November 2023

How does niche expansion occur when the habitual (high-productivity) and marginal (low-productivity) niches are simultaneously available? Without spatial structuring, such conditions should impose fitness maintenance in the former while adapting to the latter. Hence, adaptation to a given marginal niche should be influenced by the identity of the simultaneously available habitual niche. This hypothesis remains untested. Similarly, it is unknown if larger populations, which can access greater variation and undergo more efficient selection, are generally better at niche expansion. We tested these hypotheses using a large-scale evolution experiment with Escherichia coli. While we observed widespread niche expansion, larger populations consistently adapted to a greater extent to both marginal and habitual niches. Owing to diverse selection pressures in different habitual niches (constant vs. fluctuating environments; environmental fluctuations varying in both predictability and speed), fitness in habitual niches was significantly shaped by their identities. Surprisingly, despite this diversity in habitual selection pressures, adaptation to the marginal niche was unconstrained by the habitual niche’s identity. We show that in terms of fitness, two negatively correlated habitual niches can still have positive correlations with the marginal niche. This allows the marginal niche to dilute fitness trade-offs across habitual niches, thereby allowing costless niche expansion. Our results provide fundamental insights into the sympatric niche expansion.
Gut microbiome biogeography in reindeer supersedes millennia of ecological and evolutionary separation
Authors: Kamenova Stefaniya , de Muinck Eric J , Veiberg Vebjørn , Utsi Tove Aagnes , Steyaert Sam M J G , Albon Steve D , Loe Leif Egil , Trosvik Pål
Published: November 2023

Ruminants are dependent on their gut microbiomes for nutrient extraction from plant diets. However, knowledge about the composition, diversity, function, and spatial structure of gut microbiomes, especially in wild ruminants, is limited, largely because analysis has been restricted to faeces or the rumen. In two geographically separated reindeer subspecies, 16S rRNA gene amplicon sequencing revealed strong spatial structuring, and pronounced differences in microbial diversity of at least 33 phyla across the stomach, small intestine, and large intestine (including faeces). The main structural feature was the Bacteroidota to Firmicutes ratio, which declined from the stomach to the large intestine, likely reflecting functional adaptation. Metagenome shotgun sequencing also revealed highly significant structuring in the relative occurrence of carbohydrate-active enzymes (CAZymes). CAZymes were enriched in the rumen relative to the small and large intestines. Interestingly, taxonomic diversity was highest in the large intestine, suggesting an important and understudied role for this organ. Despite the two study populations being separated by an ocean and six millennia of evolutionary history, gut microbiome structuring was remarkably consistent. Our study suggests a strong selection for gut microbiome biogeography along the gastrointestinal tract in reindeer subspecies.
Wildfire and Family Forest Owners: Concern, Advice, and Wildfire Reduction Behaviors from the United States National Woodland Owner Survey
Authors: Butler Sarah M , Butler Brett J , Sass Emma M
Published: November 2023

Extreme wildfire is an increasing threat to lives, property, and ecosystems across the United States and many parts of the world. Family forest owners (FFOs) own a large percentage of forestland in the United States, and actions and behaviors on their forestland have a large impact on wildfire prevention and mitigation across the landscape. Using data from the USDA Forest Service’s 2018 National Woodland Owner Survey, we investigated national and regional FFO wildfire attitudes and behaviors. We see that concern for wildfire is relatively high across the United States; however, this concern does not always lead to wildfire reduction activities on the landscape. There is some variation among regions, with concern about wildfire and past wildfire reduction activities highest in the western US (76% and 37%, respectively), followed by the South (63% and 11%, respectively), and lowest in the northern region (50% and 8%, respectively). Understanding these aspects of wildfire and FFOs on a national level provides a broader context for the more focused studies across the country and acts as a launch point for more in-depth research in the future.

Study Implications: This study assesses family forest owner (FFO) wildfire concern, information needs, and action, both past and intended, at national and regional levels across the United States. As wildfire is predicted to increase in frequency and severity into the future due to climate change, this research provides a reference line and a launch point for future studies. Understanding current concern levels and landowner characteristics can inform programs and policies aimed at mitigating severe wildfires. For example, the disconnect between concerns and actions can be used as an entry point for motivating additional owners to take steps towards active management. Concentrating efforts in fire-prone areas is important, but seeing that wildfire is a concern of family forest owners across much of the country suggests that this can be an important issue for starting conversations with many owners and possibly increasing their engagement with conservation efforts.
Regional and temporal variation in escape history of Norwegian farmed Atlantic salmon
Authors: Strand Nina , Glover Kevin A , Meier Sonnich , Ayllon Fernando , Wennevik Vidar , Madhun Abdullah , Skaala Øystein , Hamre Kristin , Fjelldal Per Gunnar , Hansen Tom , Niemelä Eero , Knutar Sofie , Fjeldheim Per Tommy , Solberg Monica F
Published: November 2023

Each year thousands of farmed Atlantic salmon escape from seawater net pens, and introgression has been documented in a range of wild populations. Due to greater experience in the wild, escapees that have been on the run for a longer period, and successfully transitioned to a wild diet (classified: “early escapees”), could potentially have a higher spawning success and contribute more to introgression than those that have been on the run for a shorter period and/or have not transitioned to a wild diet (classified: “recent escapees”). This is the first study to examine how the escape history of farmed Atlantic salmon captured in multiple rivers and coastal fisheries, varies in time and space. During 2011–2021, adult farmed escaped salmon were captured in four rivers and at six coastal sites in Norway. The level of linoleic acid, a terrestrial fatty acid high in commercial salmon feeds but low in the natural diet of wild salmon, was used to classify the farmed salmon as early or recent escapees. We observed temporal declines in the relative proportions of escaped vs. wild salmon in the catches, and the relative proportion of early vs. recent escapees in the most southern river (driven by samples from 2011 to 2015). Overall, 14% of the escaped salmon caught in the period were classified as early escapees. The relative proportion of early escapees was lower in the two southernmost rivers (21.2% and 6.30%), as compared to the coastal fisheries (40.9%) and the northernmost river (77.6%). Both aquaculture–management regulations and production strategies have likely influenced these observations.
Theorizing Decision-Making in International Bureaucracies: UN Peacekeeping Operations and Responses to Norm Violations
Authors: Oksamytna Kseniya , Tansey Oisín , von Billerbeck Sarah , Gippert Birte Julia
Published: November 2023

Many international organizations (IOs) provide assistance to governments through country offices or peacekeeping operations. Sometimes, government authorities in countries receiving IO services violate norms that underpin the IO’s engagement. IO officials must then choose between confrontational and conciliatory responses. These responses are located on a spectrum that ranges from a firm and public response to silence and downplaying. How do IO officials decide on their response? Based on over 200 interviews with UN peacekeeping officials, we argue that the factors that shape their decision-making are found across three categories: individual, departmental, and positional. In terms of individual characteristics, previous experience, career security, and the length of service at a particular duty station matter. Regarding departmental factors, politicization of work, professional composition, and the type of interlocutors predispose departments to be supporters or critics of authorities in recipient countries. In terms of positional considerations, the place of a post or department in the IO hierarchy, relations with other IO entities, and the distance from the field play a role. While important in its own right, decision-making by civilian UN peacekeeping officials is informative about similar processes in other complex international bureaucracies that employ individuals from diverse backgrounds.
Multiphase neutral interstellar medium: analysing simulation with H i 21cm observational data analysis techniques
Authors: Bhattacharjee Soumyadeep , Roy Nirupam , Sharma Prateek , Seta Amit , Federrath Christoph
Published: November 2023

Several different methods are regularly used to infer the properties of the neutral interstellar medium (ISM) using atomic hydrogen (H i) 21cm absorption and emission spectra. In this work, we study various techniques used for inferring ISM gas phase properties, namely the correlation between brightness temperature and optical depth (TB(v), τ(v)) at each channel velocity (v), and decomposition into Gaussian components, by creating mock spectra from a 3D magnetohydrodynamic simulation of a two-phase, turbulent ISM. We propose a physically motivated model to explain the TB(v) − τ(v) distribution and relate the model parameters to properties like warm gas spin temperature and cold cloud length-scales. Two methods based on Gaussian decomposition – using only absorption spectra and both absorption and emission spectra – are used to infer the column density distribution as a function of temperature. In observations, such analysis reveals the puzzle of large amounts (significantly higher than in simulations) of gas with temperature in the thermally unstable range of ∼200–2000 K and a lack of the expected bimodal (two-phase) temperature distribution. We show that, in simulation, both methods are able to recover the actual gas distribution in the simulation till temperatures ≲2500 K (and the two-phase distribution in general) reasonably well. We find our results to be robust to a range of effects such as noise, varying emission beam size, and simulation resolution. This shows that the observational inferences are unlikely to be artefacts, thus highlighting a tension between observations and simulations. We discuss possible reasons for this tension and ways to resolve it.
Influence of departures from LTE on determinations of the scandium abundances in A–B-type stars
Authors: Mashonkina Lyudmila
Published: November 2023

We developed a comprehensive model atom of Sc ii–Sc iii. Abundances of scandium for a sample of eight unevolved A9–B3-type stars with well-determined atmospheric parameters were determined based on the non-local thermodynamical equilibrium (NLTE) line formation for Sc ii–Sc iii and high-resolution observed spectra. For the Sc ii lines, the abundance differences between NLTE and local thermodynamical equilibrium (LTE) grow rapidly with increasing effective temperature (Teff), from slightly negative at Teff = 7250 K to positive ones of up to 0.6 dex at Teff = 10 400 K. For Sc iii in ι Her, NLTE reduces the line-to-line scatter substantially compared to the LTE case. The NLTE abundances of Sc in our five superficially normal stars are consistent within the error bars with the Solar system Sc abundance, while the LTE abundances of the late B-type stars are greatly subsolar. NLTE reduces but does not remove a deficiency of Sc in the Am stars HD 72660 and Sirius. Based on our own and the literature data, the Ca/Sc abundance ratios of the sample of 16 Am stars were found to be close together, with [Ca/Sc] = 0.6–0.7. We propose the Ca/Sc abundance ratio, but not the abundances of individual Ca and Sc elements to be used for classifying a star as Am and for testing the diffusion models. We provide the NLTE abundance corrections for 10 lines of Sc ii in a grid of model atmospheres appropriate for A to late B-type stars.
SN 2022vqz: a peculiar subluminous Type Ia supernova with prominent early excess emission
Authors: Xi Gaobo , Wang Xiaofeng , Li Gaici , Liu Jialian , Yan Shengyu , Lin Weili , Zhao Jieming , Filippenko Alexei V , Zheng WeiKang , Brink Thomas G , Yang Y , Ehgamberdiev Shuhrat A , Mirzaqulov Davron , Reguitti Andrea , Pastorello Andrea , Tomasella Lina , Cai Yongzhi , Zhang Jujia , Li Zhitong , Zhang Tianmeng , Sai Hanna , Chen Zhihao , Liu Qichun , Ma Xiaoran , Xiang Danfeng
Published: November 2023

We present extensive photometric and spectroscopic observations of the peculiar Type Ia supernova (SN Ia) 2022vqz. It shares many similarities with the SN 2002es-like SNe Ia, such as low luminosity ($M_{B,\rm max}=-18.11\pm 0.16$ mag) and moderate post-peak decline rate (Δm15,B = 1.33 ± 0.11 mag). The nickel mass synthesized in the explosion is estimated as 0.20 ± 0.04 M⊙ from the bolometric light curve, which is obviously lower than that of normal SNe Ia. SN 2022vqz is also characterized by slowly expanding ejecta, with Si ii velocities persisting around 7000 km s−1 since 16 d before peak brightness, unique among all known SNe Ia. While all of these properties imply a lower energy thermonuclear explosion that should leave a considerable amount of unburnt materials, the absent signature of unburnt carbon in spectra of SN 2022vqz is puzzling. A prominent early peak is clearly detected in the Asteroid Terrestrial-impact Last Alert System c- and o-band light curves and in the Zwicky Transient Facility gr-band data within days after the explosion. Possible mechanisms for the early peak are discussed, including the sub-Chandrasekhar-mass double-detonation model and interaction of SN ejecta with circumstellar material. We find that both models face some difficulties in replicating all aspects of the observed data. As an alternative, we propose a hybrid C–O–Ne white dwarf as the progenitor of SN 2022vqz; it can simultaneously reconcile the tension between low ejecta velocity and the absence of carbon. We further discuss the diversity of SN 2002es-like objects and their origin in the context of different scenarios.
The influence of hemispherical albedo on the dynamics of cometary particles
Authors: Wesołowski Marcin , Potera Piotr , Gronkowski Piotr , Skała Patrycja , Sobaszek Joanna
Published: November 2023

This paper presents a new approach to determining the dimensions of particles that can be lifted to a coma by the sublimation flux of water ice. Due to the diverse colour of the cometary surfaces, in the presented calculations we take into account the influence of the reflectance coefficient (hemispherical albedo) on the size of particles lifted from the surface of the nucleus. A Cary 5000 spectrometer was used to measure hemispherical albedo. Spectroscopic measurements used dust particles that consisted of pure silicate or were a mixture of pure silicate and organic compounds such as charcoal, soot, and ash. In addition, these admixtures acted as a means of darkening the tested sample. Depending on the colour of the sample and the wavelength, the measured value of hemispherical albedo oscillated in the range from 4.93 per cent to 48.65 per cent. A thermodynamic model of cometary matter emission was developed based on the results of hemispherical albedo measurements. The performed numerical simulations show that the temperature decreases with the increase of the hemispherical albedo, which translates into the sublimation flux and the dynamics of the dust-ice particles present on the surface of the cometary nucleus. Taking into account the extreme values of the hemispherical albedo, the differences in the size of particles carried away from the surface of the nucleus are in the order of centimeters.
21-cm signal from the Epoch of Reionization: a machine learning upgrade to foreground removal with Gaussian process regression
Authors: Acharya Anshuman , Mertens Florent , Ciardi Benedetta , Ghara Raghunath , Koopmans Léon V E , Giri Sambit K , Hothi Ian , Ma Qing-Bo , Mellema Garrelt , Munshi Satyapan
Published: November 2023

In recent years, a Gaussian process regression (GPR)-based framework has been developed for foreground mitigation from data collected by the LOw-Frequency ARray (LOFAR), to measure the 21-cm signal power spectrum from the Epoch of Reionization (EoR) and cosmic dawn. However, it has been noted that through this method there can be a significant amount of signal loss if the EoR signal covariance is misestimated. To obtain better covariance models, we propose to use a kernel trained on the grizzly simulations using a Variational Auto-Encoder (VAE)-based algorithm. In this work, we explore the abilities of this machine learning-based kernel (VAE kernel) used with GPR, by testing it on mock signals from a variety of simulations, exploring noise levels corresponding to ≈10 nights (≈141 h) and ≈100 nights (≈1410 h) of observations with LOFAR. Our work suggests the possibility of successful extraction of the 21-cm signal within 2σ uncertainty in most cases using the VAE kernel, with better recovery of both shape and power than with previously used covariance models. We also explore the role of the excess noise component identified in past applications of GPR and additionally analyse the possibility of redshift dependence on the performance of the VAE kernel. The latter allows us to prepare for future LOFAR observations at a range of redshifts, as well as compare with results from other telescopes.
INSPIRE: INvestigating Stellar Population In RElics – V. A catalogue of ultra-compact massive galaxies outside the local Universe and their degree of relicness
Authors: Spiniello C , D’Ago G , Coccato L , Hartke J , Tortora C , Ferré-Mateu A , Pulsoni C , Cappellari M , Maksymowicz-Maciata M , Arnaboldi M , Bevacqua D , Gallazzi A , Hunt L K , La Barbera F , Martín-Navarro I , Napolitano N R , Radovich M , Saracco P , Scognamiglio D , Spavone M , Zibetti S
Published: November 2023

This paper presents the third data release of the INvestigating Stellar Population In RElics (INSPIRE) project, comprising 52 ultra-compact massive galaxies (UCMGs) observed with the X-Shooter spectrograph. We measure integrated stellar velocity dispersion, [Mg/Fe] abundances, ages, and metallicities for all the INSPIRE objects. We thus infer star formation histories and confirm the existence of a degree of relicness (DoR), defined in terms of the fraction of stellar mass formed by z = 2, the time at which a galaxy has assembled 75 per cent of its mass, and the final assembly time. Objects with a high DoR assembled their stellar mass at early epochs, while low-DoR objects show a non-negligible fraction of later formed populations and hence a spread in ages and metallicities. A higher DoR correlates with larger [Mg/Fe], supersolar metallicity, and larger velocity dispersion values. The 52 UMCGs span a large range of DoR from 0.83 to 0.06, with 38 of them having formed more than 75  per cent of their mass by z = 2. Of these, nine are extreme relics (DoR>0.7), since they formed the totality ($\gt 99~{{\ \rm per\ cent}}$) of their stellar mass by redshift z = 2. The remaining 14 UCMGs cannot be considered relics, as they are characterized by more extended star formation histories. With INSPIRE  we built the first sizeable sample of relics outside the local Universe, up to z ∼ 0.4, increasing the number of confirmed relics by a factor of >10, and opening up an important window to explain the mass assembly of massive galaxies in the high-z Universe.
New design strategies for ultra-specific CRISPR-Cas13a-based RNA detection with single-nucleotide mismatch sensitivity
Authors: Molina Vargas Adrian M , Sinha Souvik , Osborn Raven , Arantes Pablo R , Patel Amun , Dewhurst Stephen , Hardy Dwight J , Cameron Andrew , Palermo Giulia , O’Connell Mitchell R
Published: November 2023

An increasingly pressing need for clinical diagnostics has required the development of novel nucleic acid-based detection technologies that are sensitive, fast, and inexpensive, and that can be deployed at point-of-care. Recently, the RNA-guided ribonuclease CRISPR-Cas13 has been successfully harnessed for such purposes. However, developing assays for detection of genetic variability, for example single-nucleotide polymorphisms, is still challenging and previously described design strategies are not always generalizable. Here, we expanded our characterization of LbuCas13a RNA-detection specificity by performing a combination of experimental RNA mismatch tolerance profiling, molecular dynamics simulations, protein, and crRNA engineering. We found certain positions in the crRNA-target–RNA duplex that are particularly sensitive to mismatches and establish the effect of RNA concentration in mismatch tolerance. Additionally, we determined that shortening the crRNA spacer or modifying the direct repeat of the crRNA leads to stricter specificities. Furthermore, we harnessed our understanding of LbuCas13a allosteric activation pathways through molecular dynamics and structure-guided engineering to develop novel Cas13a variants that display increased sensitivities to single-nucleotide mismatches. We deployed these Cas13a variants and crRNA design strategies to achieve superior discrimination of SARS-CoV-2 strains compared to wild-type LbuCas13a. Together, our work provides new design criteria and Cas13a variants to use in future easier-to-implement Cas13-based RNA detection applications.
Changing trends in Chlamydia and gonorrhea infections among female sex workers in Southern China: a surveillance data analysis spanning 2019 to 2022
Authors: Wang Jinshen , Zhao Peizhen , Xu Wenqian , Wang Cheng
Published: November 2023

Background

Female sex workers (FSW) are particularly vulnerable to chlamydia and gonorrhea infections. However, there were few studies that detail the evolving patterns of chlamydia and gonorrhea among Chinese FSW. Therefore, our study endeavors to assess the prevalence of chlamydia and gonorrhea epidemics within FSW, investigate their changing trends and scrutinize associated factors.

Methods

In 2019, China instituted a sentinel surveillance network focused on FSW in Guangdong Province. This network conducted an annual serial cross-sectional survey spanning from April to August. All analyses are predicated on surveillance data accumulated between 2019 and 2022.

Results

The prevalence of chlamydia increased from 10.1 to 12.3%, exhibiting an annual percentage shift of 6.8%. Conversely, the prevalence of gonorrhea dwindled from 2.0 to 1.3%, marking an annual percentage decline of 13.4% (P < 0.001). After adjusting for covariates, chlamydia exhibited associations with having household registration in other provinces (adjusted odds ratio (aOR = 0.55)), displaying symptoms of sexually transmitted infections (STIs) (aOR = 1.65) and infected with gonorrhea (aOR = 5.68). In parallel, gonorrhea demonstrated associations with providing oral sex to clients (aOR = 3.74), manifesting STIs symptoms (aOR = 4.27) and those infected with chlamydia (aOR = 5.43).

Conclusions

Our observations underscore the imperative to implement a comprehensive intervention strategy concentrating on chlamydia, while simultaneously fortifying endeavors to expand the scope of gonorrhea prevention services.
Retrograde Intramedullary Nailing Versus Locked Plating for Extreme Distal Periprosthetic Femur Fractures: A Multicenter Retrospective Cohort Study
Authors: Van Rysselberghe Noelle L. , Seltzer Ryan , Lawson Taylor A. , Kuether Justin , White Parker , Grisdela Phillip , Daniell Hayley , Amirhekmat Arya , Merchan Nelson , Seaver Thomas , Samineni Aneesh , Saiz Augustine , Ngo Daniel , Dorman Clark , Epner Eden , Svetgoff Reese , Terle Megan , Lee Mark , Campbell Sean , Dikos Gregory , Warner Stephen , Achor Timothy , Weaver Michael J. , Tornetta Paul , Scolaro John , Wixted John J , Weber Timothy , Bellino Michael J , Goodnough L Henry , Gardner Michael J. , Bishop Julius A.
Published: November 2023

OBJECTIVE:

To compare clinical and radiographic outcomes following retrograde intramedullary nailing vs locked plating of “extreme distal” periprosthetic femur fractures, defined as those which contact or extend distal to the anterior flange.

METHODS

Design:

Retrospective review

Setting:

Eight academic level I trauma centers

Patient Selection Criteria:

adult patients with periprosthetic distal femur fractures at or distal to the anterior flange (OTA/AO 33B-C[VB1]) treated with rIMNs or LPs.

Outcome Measures and Comparisons: The primary outcome was reoperation to promote healing or to treat infection (re-operation for elective removal of symptomatic hardware was excluded from this analysis). Secondary outcomes included nonunion, delayed union, fixation failure, infection, overall reoperation rate, distal femoral alignment, and ambulatory status at final follow-up. Compared, were patients treated with rIMNs or LPs.

RESULTS:

71 patients treated with rIMNs and 224 patients treated with LPs were included. The rIMN group had fewer points of fixation in the distal segment (rIMN: 3.5 +/- 1.1 vs LP: 6.0 +/- 1.1, p<0.001) and more patients who were allowed to weight-bear as tolerated immediately post-operatively (rIMN: 45%; LP: 9%, p<0.01). Reoperation to promote union and/or treat infection was 8% in the rIMN group and 16% in the LP group (p=0.122). There were no significant differences in nonunion (p >0.999), delayed union (p=0.079), fixation failure (p>0.999), infection (p=0.084), or overall reoperation rate (p>0.999). Significantly more patients in the rIMN group were ambulatory without assistive devices at final follow-up (rIMN: 35%, LP: 18%, p=0.008).

CONCLUSIONS:

Retrograde intramedullary nailing of extreme distal periprosthetic femur fractures has similar complication rates compared to locked plating, with a possible advantage of earlier return to weight-bearing. Surgeons can consider this treatment strategy in all fractures with stable implants and amenable prosthesis geometry, even extreme distal fractures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
No Difference in Acute Outcomes for Patients Undergoing Fix and Replace versus Fixation Alone in the Treatment of Geriatric Acetabular Fractures
Authors: Gencarelli Pasquale , Menken Luke G. , Hong Ian S. , Robbins Conner J. , Jankowski Jaclyn M. , Yoon Richard S. , Liporace Frank A.
Published: November 2023

OBJECTIVE

(s): To compare acute outcomes between patients undergoing fix and replace (FaR) versus open reduction and internal fixation (ORIF) alone in the treatment of geriatric acetabular fractures.

METHODS:

Design:
Retrospective Cohort Study

Setting:
Single Level 2 Trauma Center

Patient Selection Criteria:
Consecutive acetabular fracture patients aged ≥ 55 years old treated by two orthopedic trauma surgeons at one tertiary care center from January 2017 to April 2022 with FaR vs ORIF were identified. Included were those with complete datasets within the 180-day global period. Excluded were patients with previous ORIF of the acetabulum or femur, or revision total hip arthroplasty.

Outcome Measures and Comparisons
: The primary outcomes were length of hospital stay (LOS), postoperative weight-bearing status, postoperative disposition, time to postoperative mobilization, and 90-day readmission rates. Secondary outcomes compared included demographic information, injury mechanism, surgical time, complications, revisions, and pre- and postoperative Hip Disability and Osteoarthritis Outcomes Score for Joint Replacement (HOOS Jr.) scores. These were compared between FaR and ORIF groups.

RESULTS:

Seventeen FaR patients (average age 74.5 ± 9.0 years) and 11 ORIF patients (average age 69.4 ± 9.6 years) met inclusion criteria. Mean follow-up was 26.4 months (range: 6 – 75.6 months). More FaR group patients were ordered immediate weightbearing as tolerated or partial weightbearing compared to ORIF alone (70% vs 9.0%, p=0.03). More patients in the FaR group had pre-existing hip osteoarthritis compared to ORIF alone (71% vs 27%, p=0.05). Fracture classification (p=0.03) and Charlson Comorbidity Index (p=0.02) differed between the two groups. There were no other differences in demographics, LOS (p=0.99), postoperative disposition (p=0.54), time to postoperative mobilization (p=0.38), 90-day readmission rates (p=0.51), operative time (p=0.06), radiographic union (p=0.35), time to union (p=0.63), pre- (p=0.32) or postoperative HOOS Jr. scores (p=0.80), delta HOOS Jr. scores (p=0.28), or reoperation rates between groups (p=0.15).

CONCLUSION:

Both FaR and ORIF appear to be sound treatment options in the management of geriatric acetabular fractures. Patients in the FaR group achieved immediate or partial weightbearing earlier than the ORIF group, however time to postoperative mobilization did not differ between the two groups. The remainder of acute postoperative outcomes (LOS, postoperative disposition, and 90-day readmission rates) did not differ between the two groups.
Naturally Occurring Atherosclerosis Progression and In-stent Restenosis: Exploring Histomorphologic Associations Using Optical Coherence Tomography
Authors: Zhang Wei , Zhang Wei , Gu Ning , Qiu Zhimei , Pan Li , Zhao Yongchao , Shi Bei
Published: November 2023

The mechanism of in-stent restenosis (ISR) remains elusive, and in-stent neoatherosclerosis (ISNA) may hold significant pathophysiologic implications. Nevertheless, the correlation between ISNA and the progression of untreated coronary segments affected by native atherosclerosis remains incompletely investigated. This study enrolled 225 patients diagnosed with coronary heart disease and multivessel disease. These patients underwent successful percutaneous coronary intervention and intraoperative placement of the drug-eluting stent, followed by optical coherence tomography assessment of the culprit stent. The mechanism of ISR was examined through qualitative and quantitative analysis of optical coherence tomography imaging. A significantly higher proportion of patients in the ISR with nontarget lesion progression (N-TLP) group exhibited lipid plaque formation compared with the ISR without N-TLP group (69.0% vs. 39.8%, P < 0.001). The incidence of thin-cap fibroatheroma (33.3% vs. 11.4%, P = 0.001) and ISNA (60.7% vs. 38.6%, P < 0.001) was markedly elevated in the ISR with N-TLP group compared with the ISR without N-TLP group. Regarding manifestations, heterogeneous hyperplasia was predominantly observed in the ISR with N-TLP group (76.2% vs. 38.6%, P < 0.001), whereas homogeneous hyperplasia was primarily presented in the ISR without N-TLP group (61.4% vs. 23.8%, P < 0.001). Patients displaying notable progression of naturally occurring atherosclerosis manifest histomorphologic features of ISR, primarily characterized by heterogeneous intimal hyperplasia and a higher prevalence of ISNA. In contrast, patients without substantial progression of naturally occurring atherosclerosis exhibit histomorphologic features of ISR primarily characterized by homogeneous intimal hyperplasia.
The Postmenopausal Vaginal Microbiome and Genitourinary Syndrome of Menopause
Authors: Micks Elizabeth , Reed Susan D. , Mitchell Caroline
Published: November 2023

This review summarizes our current understanding of associations of the postmenopausal vaginal microbiome with genitourinary syndrome of menopause. We review the normal postmenopausal microbiota, examine the association of the microbiome with vulvovaginal symptoms, describe microbial communities associated with physical and laboratory findings, and report the impact of different treatments for genitourinary syndrome of menopause on microbiota and symptom improvement. Postmenopausal vaginal symptoms have an underlying pathophysiology that has not been fully elucidated. Estrogen treatment may not be sufficient to relieve symptoms of vaginal discomfort in all postmenopausal individuals. In addition, other interventions targeted at changing the microbiota or pH do not consistently improve symptom severity.
Dietary Composition, Meal Timing, and Cancer-Related Fatigue: Insights From the Women’s Healthy Eating and Living Study
Authors: Kleckner Amber S. , Kleckner Ian R. , Renn Cynthia L. , Rosenblatt Paula Y. , Ryan Alice S. , Zhu Shijun
Published: November 2023

Background

Cancer-related fatigue is difficult to treat, and dietary interventions are promising yet underused.

Objective

We explored associations between dietary patterns and fatigue, and the effect of a dietary intervention versus control on fatigue using Women’s Healthy Eating and Living study data, plus mediators and moderators of the intervention effect.

Methods

The Women’s Healthy Eating and Living study was a randomized controlled trial among early-stage breast cancer survivors. The 4-year intervention encouraged fruits, vegetables, fiber, and 15% to 20% calories from fat. Fatigue outcomes included a 9-item energy scale and a single-item tiredness question. Dietary quality was estimated using a modified Healthy Eating Index (24-hour dietary recall) and serum carotenoid concentrations. Nutrient timing was obtained from 4-day food logs.

Results

Among 2914 total participants, lower body mass index was associated with less tiredness and more energy at baseline (P < .001 for both). Earlier start and end times for daily eating windows were associated with less tiredness (P = .014 and P = .027, respectively) and greater energy (P = .006 and P = .102, respectively). The intervention did not lead to improvements in fatigue on average (P > .125). However, the intervention was more effective for participants who were younger, had fewer comorbidities, and did not have radiation treatment. Mediators included increases in serum carotenoids, increases in the modified Healthy Eating Index, and weight loss/maintenance.

Conclusion

Diet quality and earlier eating windows were associated with less fatigue.

Implications for Practice

Programs that encourage high diet quality and a morning meal and discourage nighttime eating should be tested for efficacy in reducing cancer-related fatigue in survivorship.
Reducing Cancer Risk Through Primary Prevention Activities Among Children: A Demonstration Project
Authors: Tai Eric , Chovnick Gary , Momin Behnoosh , Townsend Julie S. , Holman Dawn M. , Siegel David , House Marnie
Published: November 2023

Context:

Opportunities to reduce the risk of cancer, including cervical, liver, and skin cancer, start early in life. To encourage adoption of primary prevention activities in childhood to reduce cancer risk later in life, Centers for Disease Control and Prevention conducted a demonstration project with 3 National Comprehensive Cancer Control Program (NCCCP) recipients.

Program:

Iowa, Northwest Portland Area Indian Health Board (NPAIHB), and Pennsylvania NCCCP recipients implemented evidence-based primary prevention activities for cervical, liver, and skin cancer among children using health care provider education, patient education, and policy development.

Implementation:

Iowa implemented an announcement approach to improve provider education on human papillomavirus (HPV) vaccination. Pennsylvania focused on patient education for reducing skin cancer risk and both provider and patient education for liver cancer prevention. NPAIHB created a sun safety intervention for tribal organizations, including a policy guide, media materials, and patient education.

Results:

In Iowa, health care providers taking the announcement approach reported significantly higher mean scores on a posttest compared with a pretest regarding perceptions about HPV vaccination, self-efficacy, and behavioral intentions related to vaccination. Pennsylvania integrated sun safety education and sunscreen dispenser programs as a health and wellness initiative in 8 state parks and the Pennsylvania Department of Conservation and Natural Resources incorporated the program in its Pennsylvania Outdoor Recreation Plan. Pennsylvania also implemented health care provider education on the primary prevention of liver cancer through hepatitis B and hepatitis C screening and hepatitis B vaccination. The NPAIHB skin cancer policy guide was created and distributed for use to all 43 federally recognized tribes of Oregon, Washington, and Idaho served by NPAIHB.

Discussion:

The identification, dissemination, and implementation of these efforts can serve as best practices for future childhood primary prevention programs. NCCCP recipients and public health professionals can use health care provider education, patient education, and policy development to reduce future risk for cervical, liver, and skin cancer among children.
Polysubstance Use Profiles and HIV Viremia in a South African Cohort of Female Sex Workers: A Latent Class Analysis
Authors: Rosen Joseph G. , Knox Justin R. , Rucinski Katherine B. , Mcingana Mfezi , Mulumba Ntambue , Comins Carly A. , Shipp Lillian , Makama Siyanda , Beckham S. Wilson , Hausler Harry , Baral Stefan D. , Schwartz Sheree R.
Published: November 2023

Background:

Given intersecting social and structural factors, female sex workers (FSW) exhibit elevated risk of HIV and substance use. However, there is limited study of how distinct substance use typologies influence HIV treatment outcomes among FSW.

Setting:

A cross-sectional survey with objective viral load assessments of 1391 FSW enrolled into a treatment optimization-focused trial in Durban, South Africa (2018–2020).

Methods:

We used latent class analysis to uncover discrete patterns in past-month self-reported use of the following substances: heavy alcohol use, cannabis, cocaine, crack, ecstasy, methamphetamine, heroin, and Whoonga. We used Wald tests to identify multilevel predictors of latent class membership and multivariable mixture modeling to quantify associations of substance use classes with HIV viremia (≥50 RNA copies/mL).

Results:

Substance use (87%) and HIV viremia (62%) were highly prevalent. Latent class analysis uncovered 3 polysubstance use profiles: Heavy Alcohol Use Only (∼54%); Cannabis, Heavy Alcohol, & Crack Use (∼28%); and Whoonga & Crack Use (∼18%). Whoonga & Crack Use was associated with social and structural adversities, including homelessness, outdoor/public sex work, HIV stigma, and violence. Relative to Heavy Alcohol Use Only, HIV viremia was significantly higher in the Whoonga & Crack Use class (adjusted odds ratio 1.97, 95% confidence interval: 1.13 to 3.43), but not in the Cannabis, Heavy Alcohol, & Crack Use class (adjusted odds ratio 1.17, 95% confidence interval: 0.74 to 1.86).

Conclusion:

HIV viremia differed significantly across identified polysubstance use profiles among South African FSW. Integrating drug treatment and harm reduction services into HIV treatment programs is key to improving virologic outcomes in marginalized communities.
A Stepped-Wedge Cluster-Randomized Controlled Trial of Multi-interventional Approach for Fall Prevention
Authors: Najafpour Zhila , Arab Mohammad , Rashidian Arash , Shayanfard Kamran , Yaseri Mehdi , Biparva-Haghighi Somayeh
Published: November 2023

Background and Objectives:

Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries.

Methods:

The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing “fall alert” signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS.

Results:

The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P = .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P = .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = −0.13 [95% CI, −0.53 to 0.27], P = .52).

Conclusions:

This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts.