bluuebunny/crossref_metadata_2025 huggingface dataset:
Uniportal thoracoscopic plication of diaphragmatic eventration: loop needle technique for better visualization
Authors: Kumagai Ryosuke , Kabemura Shinsaku , Kojima Fumitsugu , Bando Toru
Published: September 2024

Symptomatic unilateral diaphragmatic eventration require surgical intervention. A 56-year-old woman complained of dyspnoea on exertion and was noted to have left diaphragm elevation on chest radiographs. Dynamic magnetic resonance imaging showed paradoxical movement of the left diaphragm. We performed diaphragmatic plication by uniportal thoracoscopy with knifeless endostaplers and a loop needle device. Her symptoms significantly improved immediately after the operation, and this condition had been maintained for 6 months. We thus suggest this minimally invasive technique as an easy and safe method for diaphragmatic plication.
Infodemic, Ignorance, or Imagination? The Problem of Misinformation in Health Emergencies
Authors: Kirk Jessica
Published: September 2024

In understanding and responding to the problem of misinformation during global health emergencies, health experts and organizations such as the WHO have relied on the concept of the “infodemic,” or the idea that there is such an overabundance of information that ascertaining trustworthy sources and reliable guidance is difficult. Is this the best way to understand the problem of misinformation, however? A large and multidisciplinary literature has argued that such an approach misses the important role of individual psychological factors and societal “mega-trends” such as hyperpolarization, structural shifts in the media, and public mistrust in elites. This article argues that such contributions are important in understanding the multifaceted problem of misinformation but may miss another, equally important component: the politics of emergency. Specifically, the prominent role of speculation during moments of emergency—the need to respond to “what ifs” rather than just “what is”—provides a conducive context for misinformation, facilitating its production and spread while also problematizing efforts to correct it. The article illuminates this relationship through a discourse analysis of prominent misinformation claims during the US responses to Ebola in 2014 and COVID-19 in 2020.
MS Pattern Explorer: interactive visual exploration of temporal activity patterns for multiple sclerosis
Authors: Morgenshtern Gabriela , Rutishauser Yves , Haag Christina , von Wyl Viktor , Bernard Jürgen
Published: September 2024

Objectives

This article describes the design and evaluation of MS Pattern Explorer, a novel visual tool that uses interactive machine learning to analyze fitness wearables’ data. Applied to a clinical study of multiple sclerosis (MS) patients, the tool addresses key challenges: managing activity signals, accelerating insight generation, and rapidly contextualizing identified patterns. By analyzing sensor measurements, it aims to enhance understanding of MS symptomatology and improve the broader problem of clinical exploratory sensor data analysis.

Materials and Methods

Following a user-centered design approach, we learned that clinicians have 3 priorities for generating insights for the Barka-MS study data: exploration and search for, and contextualization of, sequences and patterns in patient sleep and activity. We compute meaningful sequences for patients using clustering and proximity search, displaying these with an interactive visual interface composed of coordinated views. Our evaluation posed both closed and open-ended tasks to participants, utilizing a scoring system to gauge the tool’s usability, and effectiveness in supporting insight generation across 15 clinicians, data scientists, and non-experts.

Results and Discussion

We present MS Pattern Explorer, a visual analytics system that helps clinicians better address complex data-centric challenges by facilitating the understanding of activity patterns. It enables innovative analysis that leads to rapid insight generation and contextualization of temporal activity data, both within and between patients of a cohort. Our evaluation results indicate consistent performance across participant groups and effective support for insight generation in MS patient fitness tracker data. Our implementation offers broad applicability in clinical research, allowing for potential expansion into cohort-wide comparisons or studies of other chronic conditions.

Conclusion

MS Pattern Explorer successfully reduces the signal overload clinicians currently experience with activity data, introducing novel opportunities for data exploration, sense-making, and hypothesis generation.
Epidural steroid injections and fracture incidence among older individuals with radiculopathy
Authors: Yun Huifeng , Liu Ye , Curtis Jeffrey R , Saag Kenneth , D’Erasmo Giavanna , Haseltine Katherine , Stein Emily M
Published: September 2024

Epidural steroid injections (ESIs) are a common and often effective treatment for radicular back pain. While oral glucocorticoids increase fracture incidence, little is known regarding fracture risk after ESI. This study investigated the incidence of fractures among individuals who received ESI and those who did not. We hypothesized that ESI exposure would be associated with an increased incidence of osteoporotic fractures and specifically vertebral fractures. Using 2005-2018 5% Medicare data, individuals with radicular pain who had ≥1 ESI and those who did not (non-ESI) were matched 1:10 by age, sex, and month of radicular pain diagnosis using exposure density sampling (EDS). Using a high-dimensional propensity score (HDPS) calculated based on the top 500 covariates across multiple data dimensions, ESI and non-ESI individuals were matched 1:1. Fractures were identified using validated ICD-9/10 diagnosis codes. Fracture incidence rate (IR) was calculated by group, and hazard ratios (HR) compared using Cox regression. 25 062 ESI patients and 221 735 non-ESI patients who met eligibility criteria were identified using EDS. Mean age was 76 yr (74% female). Among ESI-treated individuals, there were 2296 fractures, IR 49.1 (95% CI: 47.2-51.2) per 1000 person yr. For non-ESI individuals, there were 11 917 fractures, IR 35.2 (95% CI: 34.5-35.8). Individuals who received ESI had a greater hazard of fracture at typical osteoporotic sites, HR 1.39 (95% CI 1.33-1.46) by EDS and 1.32 (1.12-1.54) by HDPS, and a greater hazard of vertebral fracture, 1.54 (1.45-1.64) by EDS and 1.69 (1.38-2.07) by HDPS. Patients who received greater cumulative ESI doses (≥3 in 1 yr) had a higher risk of fractures within the first 6 mo of follow-up. ESI exposure in older individuals is associated with an increased risk of fracture, suggesting there may be lasting detrimental skeletal effects of ESI. Further research into strategies to reduce fracture risk in this population is warranted.
Unfair competition law in Ghana: unravelling the scope, evolving jurisprudence, challenges and future directions
Authors: Kunko Isaac Kundakogo
Published: September 2024

Despite its implications for businesses and consumer welfare, unfair competition law has received limited scholarly attention in Ghana. This article fills a significant research gap by examining Ghana’s legal framework for unfair competition, focusing on legislative measures and court decisions in an attempt to facilitate comprehensive academic inquiry into the subject. The article explores how Ghana addresses unfair competition in line with international standards, particularly Article 10bis of the Paris Convention and the Trade-Related Aspects of Intellectual Property Rights Agreement. It assesses how Ghanaian courts have developed unfair competition protection jurisprudence over time with co-existing statutory and common law regimes. Additionally, it highlights the challenges in applying the law and areas for improving it. The study demonstrates how Ghana adopts various approaches to unfair competition, comprising a single source statutory reference point which coexists with the common law tort of passing off. The statutory approach, alone or with the other approaches, meets Ghana’s international obligations. However, there is a need for coherence and effectiveness in the interaction between statutory law and common law principles. Understanding this interaction is essential for ensuring Ghana’s consistent and effective application of unfair competition laws.
Trends in breast cancer–specific death by clinical stage at diagnoses between 2000 and 2017
Authors: Marczyk Michal , Kahn Adriana , Silber Andrea , Rosenblit Mariya , Digiovanna Michael P , Lustberg Maryam , Pusztai Lajos
Published: September 2024

Background

Approximately 40 000 individuals die from metastatic breast cancer each year. We examined what fractions of annual breast cancer–specific death are due to stage I, II, III, and IV disease and if these proportions changed over time.

Methods

We used data from Surveillance, Epidemiology, and End Results Program covering 1975-2017. After filtering for female sex at birth, 1 primary tumor type, surgery, American Joint Committee on Cancer Staging Manual (6th edition) stage above 0, no bilateral cancer, and survival data available, the final analysis included 972 763 patients. Temporal trends were assessed using a linear model and analysis of variance test.

Results

The contribution of stage I and II cancers to breast cancer–specific death increased statistically significantly from 16.2% to 23.1% and from 30.7% to 39.5%, respectively, between 2000 and 2017. The contribution of stages III and IV cancers decreased from 36.4% to 30.3% and from 16.7% to 7.1%, respectively. In 2000, 0.92%, 4.0%, and 10.7% breast cancer–specific deaths were due to T1a, T1b, and T1c node-negative cancers, respectively, which increased significantly to 1.9%, 5.8%, and 14.7% by 2017. These temporal trends were similar for hormone receptor–positive and hormone receptor–negative cancers. The contribution of breast cancer–specific death to all-cause mortality declined from 23.9% to 16.6% for stage I and from 47.7% to 36.9% for stage II cancers by 2017.

Conclusions

Patients with stage I and II breast cancers have excellent prognosis, yet these cancers account for more than 60% of current breast cancer–specific death because of their large absolute numbers. To further reduce breast cancer death, strategies are needed to identify and treat patients with stage I and II disease who remain at risk for recurrence.
Automated patient selection and care coaches to increase advance care planning for patients with cancer
Authors: Gensheimer Michael F , Teuteberg Winifred , Patel Manali I , Gupta Divya , Noroozi Mahjabin , Ling Xi , Fardeen Touran , Seevaratnam Briththa , Lu Ying , Alves Nina , Rogers Brian , Asuncion Mary Khay , DeNofrio Jan , Hansen Jennifer , Shah Nigam H , Chen Thomas , Cabebe Elwyn , Blayney Douglas W , Colevas Alexander D , Ramchandran Kavitha
Published: September 2024

Background

Advance care planning and serious illness conversations can help clinicians understand patients’ values and preferences. Data are limited on how to increase the number of these conversations and what their effects are on care patterns. We hypothesized that using a machine learning survival model to select patients for serious illness conversations, along with trained care coaches to conduct the conversations, would increase uptake in patients with cancer at high risk of short-term mortality.

Methods

We conducted a cluster-randomized, stepped-wedge study on the physician level. Oncologists entered the intervention condition in a random order over 6 months. Adult patients with metastatic cancer were included. Patients with a less than 2-year computer-predicted survival and no prognosis documentation were classified as high priority for serious illness conversations. In the intervention condition, clinicians received automated weekly emails highlighting high-priority patients and were asked to document prognoses for them. Care coaches contacted these patients to conduct the remainder of the conversation. The primary endpoint was the proportion of visits with prognosis documentation within 14 days.

Results

We included 6372 visits with 1825 patients in the primary analysis. The proportion of visits with prognosis documentation within 14 days was higher in the intervention condition than in the control condition: 2.9% vs 1.1% (adjusted odds ratio = 4.3, P < .001). The proportion of visits with advance care planning documentation was also higher in the intervention condition: 7.7% vs 1.8% (adjusted odds ratio = 14.2, P < .001). For high-priority visits, the advance care planning documentation rate in intervention visits was 24.2% and in control visits was 4.0%.

Conclusion

The intervention increased documented conversations, with contributions by both clinicians and care coaches.
Family communication and courageous coping in Korean adolescents and young adults: a cross-sectional study
Authors: Son Heeyeon , Silva Susan G , Hong Sungsil , Haase Joan E , Han Jung Woo , Docherty Sharron L
Published: September 2024

Objective

Adolescents and young adults (AYAs) with cancer are a vulnerable population during a critical developmental transition that can benefit from the adoption of courageous coping. Parental support is crucial in enhancing adjustment and coping skills. The linkage between parent–adolescent communication (PAC) and the use of courageous coping (UCC), however, remains unclear. This study examined the association between PAC and UCC and possible mediators of this relationship among Korean AYAs with cancer.

Methods

In this cross-sectional, correlational study, self-report data were collected from 144 AYAs aged 11–26 years. A path analytic approach was employed using a hierarchical regression model to test for the direct relationship between PAC and UCC and the indirect effects of a proposed primary mediator (family cohesion) and two intermediary mediators (uncertainty of illness, hope) on PAC–UCC relationship.

Results

The mean age of the sample was 17 years (SD = 3.8), with 42% currently receiving cancer treatment. Greater PAC was significantly associated with increased UCC (mother figure: p = .0024, father figure: p  = .0042). Increased family cohesion significantly mediated the PAC–UCC relationship, indicated by a diminished PAC-UCC relationship after controlling for family cohesion (mother: p = .2753; father: p = .8107). Mediated mediation models indicated that increased hope stemming from decreased uncertainty was the mechanism through which family cohesion impacted the PAC–UCC relationship.

Conclusions

Findings underscore that greater PAC can facilitate UCC among Korean AYAs with cancer and provide insights for therapeutic parent–child communication. Results further demonstrate the complex mediating role of fostering family cohesion, reducing uncertainty, and fostering hope can play in the PAC–UCC relationship.
Code review in digital humanities
Authors: Damerow Julia , Koeser Rebecca Sutton , Carver Jeffrey C , Vogl Malte
Published: September 2024

Software and computational methods offer tremendous possibilities for digital humanities research, both accelerating existing work and opening up entirely new questions. However, software also has the potential to introduce new kinds of errors into the research workflow. How do we know that the software developed for a digital humanities project is error free and does what we think it does? Code review is a widespread technique to improve software quality and reduce the number of flaws, where a programmer other than the author reviews and comments on the source code. However, given that many digital humanities developers work in developer teams of one, code review is often not possible. In this article, we share progress and insights from an effort to establish a community code review process for digital humanities, and provide background to help understand the need and potential impacts of this work.
An Empirically Informed Framework for Multimethod Assessment with a Focus on Psychosis
Authors: Mihura Joni L. , Starin Madeleine
Published: September 2024

Conducting multimethod psychological assessments is a professional competency that uniquely distinguishes psychologists from other health providers. However, no overarching professional guidance exists as to what specific assessment methods to use for what specific purposes. This chapter serves as a basic primer to address that gap in the literature, focusing primarily on psychosis as the exemplar. The Hierarchical Taxonomy of Psychopathology (HiTOP) model is used as a framework from which to choose the key psychopathology dimensions: emotional dysfunction (internalizing, somatoform), externalizing (antagonistic, disinhibited), and psychosis (thought disorder, detachment). Key assessment methods are the clinical interview using a collaborative phenomenological approach that includes the patient’s self-reported subjective experiences, follow-up interview, and behavioral observations; self-, informant-, and clinician-rating scales; cognitive and personality performance tests, both maximal and typical performance; records review; newly emerging technologies; and expert clinical judgment. The Internalizing dimension requires assessing the client’s internal subjective experience by self-report and self-reported behaviors outside the session. The Externalizing dimension focuses primarily on external sources to assess behavior, such as school and police records, and informant reports. The Psychosis dimension requires assessing the patient directly with clinical interview, exploration of the subjective experiences associated with psychosis, behavioral observations, standardized performance-based assessment, supplemented with informant report, and all informed by clinical judgment as to whether the symptoms qualify as psychotic and whether a self-disorder exists. Communication of the assessment results should be shaped by assessment method. Finally, the authors describe current limitations of using HiTOP in clinical practice.
Long-term retention rate, adverse event temporal patterns and rescue treatment strategies of mycophenolate mofetil in systemic sclerosis: insights from real-life
Authors: De Lorenzis Enrico , Natalello Gerlando , Pellegrino Greta , Verardi Lucrezia , Batani Veronica , Lepri Gemma , Stano Stefano , Armentano Giuseppe , De Pinto Marco , Motta Francesca , Di Donato Stefano , Kakkar Vishal , Fiore Silvia , Bisconti Ilaria , Campochiaro Corrado , Cometi Laura , Tonutti Antonio , Spinella Amalia , Truglia Simona , Cavalli Silvia , De Santis Maria , Giuggioli Dilia , Del Papa Nicoletta , Guiducci Serena , Cacciapaglia Fabio , De Luca Giacomo , Iannone Fiorenzo , Ricceri Valeria , Matucci Cerinic Marco , D’Agostino Maria Antonietta , Del Galdo Francesco , Bosello Silvia Laura
Published: September 2024

Objectives

MMF is a mainstay for the treatment of SSc. The occurrence and implications of MMF-related adverse events (AEs) on drug retention rates in real life remain poorly defined. We aimed to determine the MMF retention rate and to investigate the causes and patterns of discontinuation, AEs and treatment options used after discontinuation.

Methods

SSc patients who started MMF treatment underwent a retrospective longitudinal assessment for up to 5 years. We documented the incidence, predictors and impacts of MMF treatment on gastrointestinal intolerance, infections, laboratory abnormalities and cancer. Rescue strategies implemented after MMF discontinuation were recorded.

Results

The 5-year MMF retention rate of 554 patients stood at 70.7%, and 19.6% of them stopped MMF due to AEs. One out of every four patients experienced a dose reduction or discontinuation of MMF due to AEs, with gastrointestinal intolerance being the predominant cause. The 5-year cumulative incidence rates for gastrointestinal intolerance, cancer, severe infections and laboratory toxicity leading to MMF discontinuation were 6.4%, 4.1%, 3.1% and 2.1%, respectively. Lower respiratory tract was the most affected, with bacteria being the predominant causative agent. Intestinal and pulmonary circulation involvement were tied to elevated AE rates and MMF discontinuation. The most common approaches post-MMF cessation were ‘watch and wait’ and switch to rituximab.

Conclusions

: MMF use in SSc appears to be limited by the occurrence of AEs, both in terms of persistence and dosing of the drug. Rescue options after MMF discontinuation are limited and many patients remain without immunosuppressant.
Corticotropin-releasing hormone and vasopressin challenge affects metabolic, hematologic, and rumen fermentation parameters of growing beef steers
Authors: Geeslin Meagan D , Richeson John T , Hernandez Gifford Jennifer A , Soto-Navarro Sergio A , Burdick Sanchez Nicole C , Samuelson Kendall L
Published: September 2024

The objective of this study was to evaluate the impacts of stress challenge duration on metabolic, hematologic, and rumen fermentation parameters of beef steers. Thirty steers (416 ± 19 kg) were used in a randomized complete block design with 2 blocks and 3 treatments. Treatments were intravenous injection of (1) saline at 0, 24, 48, and 72 h (n = 10; control); (2) corticotropin-releasing hormone (CRH) and vasopressin (VP) at 0 h and saline at 24, 48, and 72 h (n = 10; acute); or (3) CRH and VP at 0, 24, 48, and 72 h (n = 10; chronic). Serum samples were collected at various time points for analysis of serum chemistry and nonesterified fatty acids (NEFA). Whole blood was collected for analysis of complete blood count, and ruminal fluid was collected via oral lavage to evaluate volatile fatty acid (VFA) composition. Serum cortisol was greater (treatment × hour; P ≤ 0.01) for cattle receiving acute and chronic than control at 1 h (P < 0.01) and greater for chronic than acute and control at 25, 26, 49, 50, 73, and 74 h (P < 0.01). Similarly, there was a treatment × hour interaction (P < 0.01) for serum glucose concentrations such that cattle receiving acute and chronic had greater glucose at 1 h than control (P < 0.01), and cattle receiving chronic had greater glucose at 25, 49, 73, and 74 h than acute and control (P ≤ 0.04). Serum insulin concentrations were greater (treatment × hour P < 0.01) in chronic and acute than control at 1 h (P < 0.01) and greater for chronic compared to acute and control at 25, 49, and 73 h (P ≤ 0.01). Serum NEFA tended (P = 0.09) to be greater in stressed cattle compared to control. There was a treatment × hour interaction (P = 0.003) for total white blood cell count such that chronic had greater concentration than control at 72 h (P < 0.01). Conversely, monocyte concentration was less (treatment × hour interaction P < 0.01) for chronic than acute and control at 144 h (P < 0.01) and eosinophil concentration was greater (treatment × hour interaction P = 0.02) for chronic than control steers at 48 h (P = 0.02) and greater for chronic than acute at 72 and 144 h (P ≤ 0.03). Minimal differences were observed in VFA concentrations with the exception of acetate (treatment × hour interaction P = 0.05). These results demonstrate that administration of CRH and VP affects complete blood count and serum chemistry, and longer duration of treatment exposure prolongs the physiological responses to a stress challenge.
Schisandrin C prevents regorafenib-induced cardiotoxicity by recovering EPHA2 expression in cardiomyocytes
Authors: Xu Bo , Liu Ning , Zhou Taicheng , Chen Jian , Jiang Liyu , Wu Wentong , Fu Huangxi , Chen Xueqin , Yan Hao , Yang Xiaochun , Luo Peihua , Yang Bo , Xu Zhifei , He Qiaojun
Published: September 2024

Regorafenib, an oral multikinase inhibitor of angiogenic, stromal, and oncogenic receptor tyrosine kinases, has been approved for the treatment of metastatic colorectal cancer, gastrointestinal stromal tumors, and hepatocellular carcinoma by the US Food and Drug Administration and European Medicines Agency. However, regorafenib-induced cardiotoxicity increases the risk of mortality. Despite reports that regorafenib can cause mitochondrial dysfunction in cardiomyocytes, the molecular mechanism of regorafenib-induced cardiotoxicity is much less known and there is an urgent need for intervention strategies. Here, we treated mice with vehicle or 200 mg/kg regorafenib daily for 42 d by gavage or treated cardiomyocyte lines with 8, 16, or 32 μM regorafenib, and we found that regorafenib could cause apoptosis, mitochondrial injury, and DNA damage in cardiomyocytes. Mechanistically, regorafenib can reduce the expression of EPHA2, which inhibits AKT signaling, leading to cardiomyocyte apoptosis and cardiotoxicity. In addition, we showed that recovering EPHA2 expression via plasmid-induced overexpression of EPHA2 or schisandrin C, a natural product, could prevent regorafenib-induced cardiotoxicity. These findings demonstrated that regorafenib causes cardiomyocyte apoptosis and cardiac injury by reducing the expression of EPHA2 and schisandrin C could prevent regorafenib-induced cardiotoxicity by recovering EPHA2 expression, which provides a potential management strategy for regorafenib-induced cardiotoxicity and will benefit the safe application of regorafenib in clinic.
Effects of unilateral nasal obstruction on mandibular condyle in mice of different ages: An exploration based on H‐type angiogenesis coupling osteogenesis
Authors: Hu Yun , Li Hegang
Published: September 2024

Nasal obstruction leads to a hypoxia condition throughout the entire body. In this study, the unilateral nasal obstruction (UNO) mouse model was established by blocking the left nostril of mice. The aim of this study was to investigate the effects of UNO‐induced hypoxia on mandibular condyle in juvenile (3‐week‐old), adolescent (6‐week‐old) and adult (12‐week‐old) male C57BL/6J mice from the perspective of H‐type angiogenesis coupling osteogenesis. Firstly, UNO exerted a significant inhibitory effect on weight gain in mice of all ages. However, only in adolescent mice did UNO have an obvious detrimental effect on femoral bone mass accrual. Subsequently, micro‐computed tomography (CT) analysis of mandibular condylar bone mass revealed that UNO significantly retarded condylar head volume gain but increased condylar head trabecular number (Tb.N) in juvenile and adolescent mice. Furthermore, UNO promoted the ratio of proliferative layer to cartilage layer in condylar cartilage and facilitated the chondrocyte‐to‐osteoblast transformation in juvenile and adolescent mice. Moreover, although UNO enhanced the positive expression of hypoxia‐inducible factor (HIF)‐1α in the condylar subchondral bone of mice in all ages, an increase in H‐type vessels and Osterix+ cells was only detected in juvenile and adolescent mice. In summary, on the one hand, in terms of condylar morphology, UNO has a negative effect on condylar growth, hindering the increase in condylar head volume in juvenile and adolescent mice. However, on the other hand, in terms of condylar microstructure, UNO has a positive effect on condylar osteogenesis, promoting the increase of condylar Tb.N, chondrocyte‐to‐osteoblast transformation, HIF‐1α expression, H‐type angiogenesis and Osterix+ cells in juvenile and adolescent mice. Although the changes in condylar morphology and microstructure caused by UNO have not yet been fully elucidated, these findings improve our current understanding of the effects of UNO on condylar bone homeostasis.
Autologous hematopoietic stem cell transplant for systemic sclerosis associated interstitial lung disease
Authors: Zielonka Jana , Higuero Sevilla Jean Paul
Published: September 2024

Purpose of review

Over the last 25 years, the role of autologous hematopoietic stem cell transplant (HSCT) in the treatment of diffuse cutaneous systemic sclerosis (dcSSc) has been elucidated. However, multiple critical questions remain regarding this therapy. Of particular interest is the role of HSCT in the treatment of systemic sclerosis (SSc)-associated interstitial lung disease since this is the leading cause of death in SSc.

Recent findings

Most clinical trials and observational studies of HSCT for the treatment of dcSSc have reported pulmonary outcomes as secondary outcomes, Also, most studies have excluded patients with significant pulmonary function impairment. Despite these limitations, there is increasing evidence that suggests that HSCT leads to interstitial lung disease stabilization and possibly improvement of lung function based on pulmonary function tests and imaging.

HSCT has demonstrated improved long-term outcomes compared to conventional therapies for dcSSC. Future research is needed to refine or expand patient selection, optimize conditioning regimens, and evaluate the potential role of maintenance immunosuppression. We recommend an increased focus on interstitial lung disease since this is the primary cause of death in SSc.
Global status and trends in coronary chronic total occlusion over the period 2000–2023: a bibliometric analysis
Authors: Wen Song , Tan Qing , Xu Zhengyu , Huang Zehan , Han Feihuang , Zhang Bin , Huang Yuqing
Published: September 2024

Background and purpose:

Chronic total occlusion (CTO) affects 25% to 30% of individuals with coronary heart disease (CHD), posing significant challenges in percutaneous revascularization. This study investigates the advancement sand research trends in CTO by analyzing publication contributions from diverse countries, institutions, journals, and authors.

Methods:

We conducted a comprehensive literature review of CTO publications spanning from 2000 to 2023, utilizing the Web of Science Core Collection (WoSCC). Articles included were limited to those published in English. Research trends in the field were analyzed using CiteSpace 6.2.R4 (Chaomei Chen, Drexel University, Philadelphia, PA, USA) and VOSviewer 1.6.19 (Leiden University, Leiden, The Netherlands).

Results:

A total of 2,202 articles related to CTO were identified. The United States (US) emerged as the top contributor with 438 papers, followed by China with 305 papers, and Italy with 185 papers. Leading institutions included the US Department of Veterans Affairs with 353 publications, and Minneapolis Heart Institute Foundation with 217 publications. The Journal of the American College of Cardiology was the journal with the most publications in the field of CTO. Emmanouil S. Brilakis was identified as the most prolific author, while Gerald S. Werner had the highest average citation count. Cluster analysis highlighted chronic total occlusion percutaneous coronary intervention (CTO-PCI) as a focal area of research attention, indicating a promising trajectory for the field.

Conclusions:

This study provides a comprehensive analysis of the global research trends of CTO. The substantial increase in high-quality publications over the past 24 years highlights a promising future for the research and advancement of CTO-PCI.
HDL-C mediates the causal relationship between serum urate and aortic aneurysm: a Mendelian randomization study
Authors: Xu Yani , Wu Chenyang , Yao Lina , Liu Yanping , Hao Panpan
Published: September 2024

Background and purpose:

Studies have indicated a close relationship between serum urate and an increased risk of aortic aneurysm or aortic dissection. However, the causality between them and the mediators of this association have not been identified. This study employs bidirectional and multivariable Mendelian randomization (MR) to investigate the causality between serum urate and aortic aneurysm or dissection and identify mediators of this relationship.

Methods:

We first investigated the causal association between serum urate and aortic aneurysm or aortic dissection using two-sample bidirectional MR, with the inverse-variance-weighted method as the principal analysis technique. Subsequently, we applied multivariable MR to determine probable mediators.

Results:

Genetically serum urate levels were linked to an increased risk of aortic aneurysm (odds ratio [OR]: 1.160, 95% confidence interval [95% CI]: 1.011–1.332, P = 0.034), with high-density lipoprotein cholesterol (HDL-C) mediating this causal relationship, accounting for 10.2% of the effect. No causal relationship was found between serum urate and aortic dissection.

Conclusions:

Serum urate is a risk factor for aortic aneurysm, and this causal relationship is mediated through HDL-C. Monitoring HDL-C levels in patients with hyperuricemia is essential to prevent and slow the progression of aortic aneurysm.
Chinese Clinical Practice Guidelines for the Prevention and Treatment of Mother-to-Child Transmission of Hepatitis B Virus (Version 2024)
Authors: Liu Jinfeng , Zeng Qinglei , Ji Fanpu , Ren Hong , Zhang Wenhong , Li Lanjuan , Zhao Yingren ,   Infectious Diseases Physicians Branch of Chinese Medical Doctor Association, Chinese Society of Infectious Diseases of Chinese Medical Association
Published: September 2024

The Chinese Clinical Practice Guidelines for the prevention and treatment of mother-to-child transmission of hepatitis B virus, developed by the Chinese Society of Infectious Diseases of the Chinese Medical Association in 2019, serves as a valuable reference for standardizing the process of preventing mother-to-child transmission in China. As new evidence emerges, it is crucial that timely and regular updates are made to the clinical practice guidelines so as to optimize guidance for clinical practice and research. To this end, the Infectious Disease Physician Branch of Chinese Medical Doctor Association and the Chinese Society of Infectious Diseases of Chinese Medical Association, in collaboration with multidisciplinary experts, have updated the guidelines based on the latest domestic and international research advancements and clinical practice, in order to provide guidance and reference for clinicians and maternal and child healthcare workers.
Citrobacter Koseri Skin and Soft Tissue Infection Complicated By Abscess Formation: A Case Report and a Review of Literature
Authors: Khreis Dima , Dalle Samar , Akel Samir , Hanna-Wakim Rima
Published: September 2024

Citrobacter koseri (C. koseri) can lead to severe infections in the neonates, elderly and immunocompromised patients. We describe the first reported case of an axillary abscess due to C. koseri in a healthy adolescent, and review the clinical aspects and associated risk factors of this rare condition.
A Web-Based Education Program About Primary Palliative Care for Heart Failure
Authors: Togashi Shintaro , Wakabayashi Rumi , Takehara Ayumu , Higashitsuji Asahiko , Ikarashi Aoi , Nakashima Naoko , Tanaka Naoko , Nakano Naomi , Shibata Tatsuhiro , Oishi Shogo , Sakashita Akihiro
Published: September 2024

Background

The number of patients with heart failure (HF) is rapidly increasing as palliative care is being integrated into HF management and the need for a nursing workforce to meet these demands grows. To address this, we have developed a Web-based educational program on primary palliative care for HF among general registered nurses caring for patients with HF in Japan.

Objective

The aim of this study was to evaluate the program's effectiveness on nurse-reported palliative care practice, difficulty, and knowledge.

Methods

In this open-label, individual-level, wait-listed randomized controlled trial, 150 Japanese general registered nurses, with experience in caring for patients with HF and clinical ladder level ≥ 2 in inpatient, outpatient, and home-visiting care settings, will be randomly divided (1:1 ratio) into a Web-based educational program group and a wait-list control group. The follow-up period is 6 months after the intervention. The primary outcome is the nurse-reported practice score in primary palliative care, and the secondary outcomes are the nurse-reported difficulties score and knowledge score.

Conclusions and Clinical Implications

We herein describe the study protocol of a wait-listed randomized controlled trial regarding a Web-based educational program, which is a novel approach for these nurses. If the results of this study support our hypothesis, they could help expand primary palliative care, including daily nursing practices, such as symptom management and interdisciplinary collaboration, in the field of cardiovascular nursing.
Immunosuppression protocols for emerging oncological indications in liver transplantation: A systematic review and pooled analysis
Authors: Angelico Roberta , Bonaccorsi Riani Eliano , De Martin Eleonora , Parente Alessandro , Foguenne Maxime , Sensi Bruno , Rodríguez-Perálvarez Manuel L. ,   on behalf of the Liver Transplant Immunology Special Interest Group of the International Liver Transplant Society (ILTS)
Published: September 2024

The evolving field of liver transplant (LT) oncology calls for tailored immunosuppression protocols to minimize the risk of tumor recurrence. We systematically reviewed the available evidence from inception to May 2023 regarding immunosuppression protocols used in patients undergoing LT for cholangiocarcinoma, neuroendocrine tumors (NET), hepatic-endothelial hemangioendothelioma, and colorectal liver metastases (CRLM) to identify common practices and to evaluate their association with oncological outcomes. Studies not involving humans, case reports, and short case series (ie, n < 10) were excluded. Among 3374 screened references, we included 117 studies involving 6797 patients distributed as follows: cholangiocarcinoma (58.1%), NETs (18.8%), hepatic-endothelial hemangioendothelioma (7.7%), CRLM (6.8%), mixed neoplasms (6.8%), or others (1.7%). Only 41% of the studies disclosed details of the immunosuppression protocol, and 20.8% of studies provided drug trough concentrations during follow-up. The immunosuppression protocols described were heterogeneous and broadly mirrored routine practices for nontumoral indications. The only exception was CRLM, where tacrolimus minimization—or even withdrawal—in combination with inhibitors of the mammalian target of rapamycin (mTORi) were consistently reported. None of the studies evaluated the relationship between the immunosuppression protocol and oncological outcomes. In conclusion, based on low-quality and indirect scientific evidence, patients with tumoral indications for LT should receive the lowest tacrolimus level tolerated under close surveillance. The combination with mTORi titrated to achieve the top therapeutic range of trough concentrations could allow complete tacrolimus withdrawal. This approach may be particularly useful in patients with cholangiocarcinoma and CRLM, in whom tumor recurrence is the main cause of death. We propose a tool for reporting immunosuppression protocols, which could be implemented in future transplant oncology studies.
Ten-year evaluation on efficacy, safety, and predictability of femtosecond laser corneal small incision lenticule extraction for correction of myopia and myopic astigmatism: a case series
Authors: Zhao Guo-Hong , Zhang Li-Jun , Sun Yan , Wang Jin-Da , Chen Chang-Xi , Cao Kai
Published: September 2024

Objective:

The objective was to evaluate the 10-year long-term outcomes of patients undergoing small incision lenticule extraction (SMILE).

Methods:

In this continuous case series, the authors enrolled a total of 113 patients (208 eyes) who underwent SMILE 10 years prior. Measured parameters included uncorrected visual acuity (UCVA), corrected distance visual acuity (CDVA), and cycloplegia spherical equivalent error (SER).

Results:

One hundred thirteen patients were enrolled in this study. Patients’ age ranged from 18 to 44 years (mean: 30.2 years). One hundred ninety-three eyes (92.8%) and 176 eyes (84.6%) had an UCVA≥20/20 at 3 months and 10 years postoperatively. The mean efficacy index, measured at 3 months and 10 years postoperatively, were 1.041 and 1.023, respectively; the difference was not statistically significant. Three months after the operation, best-corrected visual acuity (BCVA) decreased by 1 line in 19 eyes (9.1%), remained unchanged in 158 eyes (76.0%), and increased by ≥1 line in 31 eyes (14.9%). Ten years after operation, BCVA decreased by 2 lines in 15 eyes (7.2%) and by 1 line in 35 eyes (16.8%); remained unchanged in 142 eyes (68.3%); increased ≥1 line in 16 eyes (7.7%). The mean safety index, measured at 3 months and 10 years postoperatively, were 1.147 and 1.331, respectively; the difference was not statistically significant. The mean SER at 3 months and 10 years postoperatively was −0.112 and −0.276, respectively; the difference was statistically significant.

Conclusion:

There was a decrease in SER 10 years after SMILE surgery compared with 3 months postoperatively, there was no significant decrease in the efficacy index or safety index.
Knowledge attitude and practice towards foreign body aspiration management among kindergarten teachers in south-west Amhara, rural Ethiopia
Authors: Belete Kumlachew G. , Tamire Tadese , Sisay Amanuel , Asmare Mekuanint , Dessie Belayneh , Muluadam Belete , Adamu Abrehet , Dessalegn Kaletsidk , Yalew Getachew A. , Oumer Keder E.
Published: September 2024

Background:

Aspiration of a foreign body (FB) is the act of unintentionally ingesting food, drink, or typically items. In every country on earth, it is the main cause of death. Aspirations of a foreign body in kids are typically emergency situations and account for a significant part of accidental fatalities. Problems are made worse by a lack of community understanding about foreign body aspiration.

Objective:

To assess the level and determinants of knowledge, attitude, and practice towards the first aid management of foreign body aspiration and airway obstruction among kindergarten teachers in northwest Amhara, Ethiopia, 2022.

Methods:

An institution-based cross-sectional study was undergone on kindergarten teachers.

Result:

The result of this study showed that 78.4% of the participants had good knowledge or scored equal or more than the mean score. The total score of the attitude was calculated by rating the respondent’s correct-full responses on the attitude questions; a total of 337 (93.4%) answered all the six questions above the mean level of 5.98, indicating that 93.4% of the respondents have a positive attitude.

Discussion:

In the present study, 78.4% of kindergarten teachers demonstrated good knowledge. In contrast, a study conducted in Addis Ababa, and Ethiopia, revealed that only 37% of participants exhibited good knowledge regarding foreign body aspiration management, significantly lower than the current study’s findings. Additionally, the same study found that 93% of kindergarten teachers held a positive attitude toward foreign body aspiration management, aligning with the results of a cross-sectional study in Addis Ababa, and Ethiopia, where the attitude score was 95.1%.

Conclusion and recommendation:

The result of this research shows that majority participants of this study have good knowledge and attitude towards foreign body aspiration management, but poor practice about it.
Breaking boundaries: exploring recent advances in anticoagulation and thrombosis management: a comprehensive review
Authors: Qureshi Zaheer , Altaf Faryal , Jamil Abdur , Siddique Rimsha , Shah Shivendra
Published: September 2024

Background:

Thromboembolic disorders globally contribute to morbidity and mortality, emphasizing adequate anticoagulation and thrombosis management. Therapeutic advances are essential in preventing complications like pulmonary embolism, stroke, and myocardial infarction. This review summarizes recent anticoagulation advances, current challenges, future directions, and novel anticoagulants and drug delivery systems on clinical outcomes.

Methods:

This paper assesses the effectiveness and safety of new anticoagulants through a systematic review of recent clinical trials, meta-analyses, and guideline publications. Key studies, including PACIFIC-AF, RIVER, ENAVLE, ENVISAGE-TAVI AF, and ARCADIA, were analyzed to provide a perspective on therapeutic advancements.

Results:

The review highlights key findings from vital clinical trials. Asundexian, in the PACIFIC-AF trial, demonstrated a 34% reduction in bleeding events compared to Apixaban. In the RIVER trial, Rivaroxaban reduced significant bleeding events by 20% compared to warfarin in patients with bioprosthetic mitral valves. In the ENAVLE trial, Edoxaban achieved a 3.7% decrease in thromboembolic events compared to warfarin without increasing significant bleeding rates. In the ENVISAGE-TAVI AF trial, edoxaban was noninferior to VKAs in preventing thromboembolic events but showed a slight increase in major bleeding events by 1.5%. Lastly, the ARCADIA trial highlighted that apixaban did not significantly reduce recurrent stroke risk compared to aspirin, with both treatments having an annualized stroke rate of 4.4%.

Conclusion:

Advances in anticoagulant therapies and drug delivery systems aim to enhance patients’ clinical outcomes for thromboembolic disorders. While recent trials show promising data, ongoing patient-specific responses and monitoring challenges require further research. Continuous innovation and investigation are essential to refine anticoagulation practices and tailor treatments.
Self-diagnosis and self-medication based on internet search among Non-Medical University students of Karachi
Authors: Raja Adarsh , Bin Amin Shafin , Azeem Bazil , Raja Sandesh , Aftab Yusra , Rafi Maham , Abheman Fnu , Sukhani Kumar , Mal Piyasi , Ul-Ain Noor , Manan Fazal , Aqeel Rabbia , Rahat Hamza , Ali Pervaiz , Kumar Naresh , Khan Kiran , Sharma Varsha
Published: September 2024

Background:

For a decade, the topic of self-diagnosis and self-medication has gained significant attention due to the widespread availability of information on the internet and over-the-counter medication. This research explores the rational considerations behind individuals’ self-diagnosis and self-medication practices. Our main objective is to find out the frequency of self-diagnosis and self-medication in the general population and its associated risks and benefits.

Methods:

A cross-sectional community-based prospective study was conducted over 7 months and included 160 students from various nonmedical universities in Karachi. A questionnaire regarding baseline characteristics, self-medication, and self-diagnosis was made, and the data was collected from the participants and then analyzed using SPSS statistical software.

Results:

One-fifth of the participants used the method of diagnosing themselves regularly, whereas 9% of the involved population demonstrated medicating themselves very often. However, most of the population had self-diagnosed (50.6) or self-medicated (61.9) sometimes. The internet was the primary source of searching (75%), and home remedies were the preferred medications (71.7%). The two primary reasons for this were the scarcity of time and resources.

Conclusion:

Overall, our study points out the significance of self-medication and self-diagnosis among different nonmedical students of Karachi. Teaching people about medicines, enforcing strong prescription policies, and providing medical facilities are vital steps toward preventing this problem. The role of doctors and medical students is significant; therefore, detailed doctor-patient communication needs to be encouraged.