bluuebunny/crossref_metadata_2025 huggingface dataset:
Whey Protein Intervention and Inflammatory Factors and Oxidative Stress: Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Farahmandpour Fatemeh , Haidari Fatemeh , Heidari Zeinab , Hajarzadeh Samaneh , Ahangarpour Akram
Published: August 2024

Context

Whey protein (WP), a high-biological-value protein contained in milk, may have anti-inflammatory properties and can reduce proinflammatory cytokines; however, the current evidence is inconclusive.

Objective

The aim of this study was to further investigate the effects of whey protein supplementation on inflammatory factors and oxidative stress in adults.

Data Sources

We conducted a comprehensive search up to March 2022 using relevant key words in databases such as PubMed, Scopus, Embase, and the Cochrane Central Register of Controlled Trials, focusing on randomized controlled trials (RCTs).

Data Extraction

RCTs that examined the impact of WP on C-reactive protein, tumor necrosis factor alpha, interleukin-6, glutathione, malondialdehyde, and total antioxidant capacity were selected independently by 2 authors. Results were pooled using a random-effects model as weighted mean differences and 95% CIs.

Data Analysis

The results of the present study demonstrated that WP supplementation had no significant effect on the modulation of inflammation and oxidative stress compared with the control. None of the predefined subgroup analyses explained the differences in the effects of WP supplementation on inflammatory factors and oxidative stress.

Conclusion

This research suggests that WP supplementation had no significant effect on inflammatory factors and oxidative stress.

Systematic Review Registration

PROSPERO registration no. CRD42022325855.
Correlates of Nucleocapsid Antibodies and a Combination of Spike and Nucleocapsid Antibodies Against Protection of SARS-CoV-2 Infection During the Omicron XBB.1.16/EG.5–Predominant Wave
Authors: Yamamoto Shohei , Oshiro Yusuke , Inamura Natsumi , Nemoto Takashi , Tan Tomofumi , Horii Kumi , Okudera Kaori , Konishi Maki , Mizoue Tetsuya , Sugiyama Haruhito , Aoyanagi Nobuyoshi , Sugiura Wataru , Ohmagari Norio
Published: August 2024

Background

We aimed to examine the association among nucleocapsid (N) antibodies, a combination of N and spike (S) antibodies, and protection against SARS-CoV-2 reinfection.

Methods

We conducted a prospective cohort study among staff at a national medical research center in Tokyo and followed them for the incidence of SARS-CoV-2 infection between June and September 2023 (Omicron XBB.1.16/EG.5 wave). At baseline, participants donated blood samples to measure N- and S-specific antibodies. Cox regression was used to estimate the hazard ratio and protection ([1 – hazard ratio] × 100) against subsequent SARS-CoV-2 infection across these antibody levels.

Results

Among participants with previous infection, higher pre-reinfection N antibodies were associated with a lower risk of reinfection, even after adjusting S antibody levels (P < .01 for trend). Estimation of the protection matrix for N and S antibodies revealed that high levels in N and S antibodies conferred robust protection (>90%) against subsequent infection. In addition, a pattern of low pre-reinfection N antibodies but high vaccine-enhanced S antibodies showed high protection (>80%).

Conclusions

Pre-reinfection N antibody levels correlated with protection against reinfection, independent of S antibodies. If the N antibodies were low, vaccine-boosted S antibodies might enhance the reinfection protection.
Effectiveness of the Original Monovalent and Bivalent COVID-19 Vaccines Against COVID-19–Associated Emergency Department and Urgent Care Encounters in Pregnant Persons Who Were Not Immunocompromised: VISION Network, June 2022–August 2023
Authors: Avrich Ciesla Allison , Lazariu Victoria , Dascomb Kristin , Irving Stephanie A , Dixon Brian E , Gaglani Manjusha , Naleway Allison L , Grannis Shaun J , Ball Sarah , Kharbanda Anupam B , Vazquez-Benitez Gabriela , Klein Nicola P , Natarajan Karthik , Ong Toan C , Embi Peter J , Fleming-Dutra Katherine E , Link-Gelles Ruth , Zerbo Ousseny
Published: August 2024

Pregnant people face increased risk of severe COVID-19. Current guidelines recommend updated COVID-19 vaccination (2023–2024) for those aged ≥6 months, irrespective of pregnancy status. To refine recommendations for pregnant people, further data are needed. Using a test-negative design, we evaluated COVID-19 vaccine effectiveness against medically attended COVID-19 with COVID-19–like illness among pregnant people aged 18 to 45 years during June 2022 to August 2023. When doses were received during pregnancy, vaccine effectiveness was 52% (95% CI, 29%–67%); when received <6 months prior to pregnancy, 28% (95% CI, 11%–42%); and when received ≥6 months prior to pregnancy, 6% (95% CI, −11% to 21%). Pregnant people should stay up-to-date with recommended COVID-19 vaccination.
The Impact of GeneXpert Cerebrospinal Fluid Testing on Tuberculous Meningitis Diagnosis in Routine Care in Botswana
Authors: Milburn James , Ntwayagae Ookeditse , Ngoni Kebatshabile , Suresh Rachita , Lemme Neo , Northcott Cassie , Penney James , Kinsella Matthew , Mechie Imogen , Ensor Samuel , Chebani Tony , Grint Daniel , Tenforde Mark W , Avalos Ava , Ramaabya Dinah , Doyle Ronan , Mokomane Margaret , Mine Madisa , Kranzer Katharina , Jarvis Joseph N
Published: August 2024

Background

Tuberculous meningitis (TBM) disproportionately impacts high–HIV prevalence, resource-limited settings where diagnosis is challenging. The GeneXpert platform has utility in TBM diagnosis, but uptake remains limited. In Botswana, before the introduction of GeneXpert, tuberculosis (TB) testing was only available through mycobacterial culture at the National TB Reference Laboratory. Data describing routine use of Xpert MTB/RIF for cerebrospinal fluid (CSF) testing in resource-limited settings are scarce.

Methods

Electronic records for patients with CSF tested in government facilities in Botswana between 2016 and 2022 were obtained from a central online repository as part of ongoing national meningitis surveillance. Samples were excluded from 1 site where Xpert MTB/RIF is performed universally. The proportion receiving TB-specific investigation on CSF and the number positive for Mycobacterium tuberculosis following increased Xpert MTB/RIF capacity were determined.

Results

The proportion of CSF samples receiving TB-specific investigation increased from 4.5% (58/1288) in 2016 to 29.0% (201/693) in 2022, primarily due to increased analysis with Xpert MTB/RIF from 0.9% (11/1288) to 23.2% (161/693). There was an overall decline in the annual number of CSF samples analyzed, but the proportion with microbiologically confirmed TBM increased from 0.4% to 1.2%. The proportion of samples tested for TB that were collected from health care facilities >100 km from the National TB Reference Laboratory increased with Xpert MTB/RIF rollout from 65.9% (87/132) to 78.0% (494/633).

Conclusions

In Botswana, access to TB culture is challenging in remote populations; more accessible near-patient testing using Xpert MTB/RIF increased the number of patients receiving TB-specific testing on CSF and the number of confirmed TBM cases.
Immune checkpoint inhibitor infusion times and clinical outcomes in patients with melanoma
Authors: Fletcher Kylie , Rehman Saba , Irlmeier Rebecca , Ye Fei , Johnson Douglas
Published: August 2024

Background

Circadian rhythms impact immune function; a previous study demonstrated that immunotherapy treatment times taking place later in the day correlated with poorer outcomes in patients with melanoma. However, this finding has not been replicated, and other infusion timing schemas are unexplored. The objective of this retrospective, cohort study was to determine if the time of immunotherapy infusion affects outcomes.

Materials and Methods

Five hundred and sixteen participants age ≥18 years diagnosed with cutaneous, acral, mucosal, or unknown primary melanoma treated with >1 infusion of nivolumab, pembrolizumab, or combination ipilimumab/PD-1 inhibitors were included. Response rate, toxicity rate, overall survival (OS), and progression-free survival (PFS) were determined based on infusion timing.

Results

Patients with ≥1 late infusion (after 4 pm) among their first 4 infusions had slightly poorer objective response rate compared with only pre-4 pm infusions (39.7% vs 44.5%), but no significant associations with late infusions and PFS and OS (P = .23, .93, respectively). Multivariable analyses showed no statistically significant association with outcomes for patients with any post-4 pm infusion among the first 4; median infusion time was also not associated with outcomes. However, considering all infusion times, we found inferior PFS (median 10.6 vs 38.9 months, P < .0001), and numerically inferior OS (median 54.6 vs 81.2 months, P = .19) in patients with ≥20% late infusions. Multivariable models had similarly inferior response and PFS for patients with ≥20% late infusions, and later median infusion times were associated with inferior response, PFS, and OS.

Conclusions

Late immunotherapy infusion times were associated with inferior outcomes when considering all infusions, but not when considering initial (first 4) infusions.
Relacorilant plus nab-paclitaxel for the treatment of metastatic pancreatic ductal adenocarcinoma: results from the open-label RELIANT study
Authors: Borazanci Erkut H , Bahary Nathan , Chung Vincent , Huyck Timothy K , Kio Ebenezer A , Chiorean Elena Gabriela , Skeel Roland T , Alese Olatunji B , Cardin Dana B , Fountzilas Christos , Hanna Wahid T , Leal Alexis D , Lee Valerie , Noonan Anne M , Philip Philip A , Wainberg Zev A , Pashova Hristina , Mann Grace , Oberstein Paul E
Published: August 2024

Background

Modulation of glucocorticoid receptor (GR) activity in tumor cells enhances chemotherapy efficacy. We evaluated the selective GR modulator relacorilant plus nab-paclitaxel in patients with metastatic pancreatic ductal adenocarcinoma (mPDAC) who had received at least 2 prior therapy lines.

Patients and Methods

In this open-label, single-arm, phase III study, patients received once-daily oral relacorilant (100 mg, titrated to 150 mg in 25 mg increments/cycle) and nab-paclitaxel (80 mg/m2) on days 1, 8, and 15 of 28-day cycles. The primary efficacy endpoint was objective response rate (ORR) by blinded independent central review. Progression-free survival (PFS), overall survival (OS), target gene modulation, and safety were also assessed.

Results

Of 43 patients enrolled, 31 were evaluable for ORR (12 did not reach first postbaseline radiographic assessment). An interim analysis to assess whether ORR was ≥10% showed no confirmed responses and the study was discontinued. Two (6.5%) patients attained unconfirmed partial responses and 15 (48.4%) had stable disease. Fourteen of 31 (45.2%) patients had reductions in target lesion size, despite prior nab-paclitaxel exposure in 12 of the 14. Median PFS and OS were 2.4 months (95% CI, 1.4-4.2) and 3.9 months (95% CI, 2.8-4.9), respectively. The most common adverse events were fatigue and nausea. RNA analysis confirmed that relacorilant plus nab-paclitaxel suppressed 8 cortisol target genes of interest.

Conclusion

Relacorilant plus nab-paclitaxel showed modest antitumor activity in heavily pretreated patients with mPDAC, with no new safety signals. Studies of this combination in other indications with a high unmet medical need are ongoing.
Task sharing for increasing access to obstetric ultrasonography: a formative qualitative study of nurse-led scanning with telemedicine review in Kenya
Authors: Kumar Meghan Bruce , Mulongo Caleb Mike , Pincerato Lucia , De Vita Maria Vittoria , Saidi Salima , Gakii Yvonne , Morino GianFranco , Kumar Pratap
Published: August 2024

The informal settlements of Nairobi have higher neonatal and infant mortality rates than the average for Nairobi. Universal access to important diagnostics like ultrasonography is poor and inequitable due to the high cost of devices and limited availability of skilled sonographers. Recent advances of mobile ultrasound probes connected to smartphones, with or without artificial intelligence support, have improved access to devices; but skills to perform and interpret scans continue to be limited. The SonoMobile intervention involved training nurse-midwives to conduct point-of-care obstetric ultrasound scans in antenatal care clinics in urban informal settlements. Scan data and images were shared, using telemedicine technology, with remote sonographers, who reviewed scan images and data, and provided reports. This study of 61 respondents from diverse stakeholder groups describes the acceptability, utility and considerations for sustainability of nurse-led, point-of-care obstetric ultrasonography with telemedicine review. Perceived value of nurse-led obstetric ultrasonography includes improving access and affordability of obstetric ultrasonography services, timely identification and referral of high-risk pregnancies, and improving awareness of appropriate antenatal care among underserved populations. The relative affordability of SonoMobile was described as a critical enabler for a business model targeting low- and middle-income segments of the population, and for increasing quality and equity of antenatal care coverage. Areas highlighted for improvement include strengthening supervision of nurse trainees, broadening the scope of nurse training and development of clear regulatory guidelines for nurse-led obstetric ultrasonography. The study highlights the complex task shifting required to provide universal access to a life-saving technology in a low- and middle-income country health system.
A Taxonomy for Set-Theoretic Potentialism
Authors: Sutto Davide
Published: August 2024

Set-theoretic potentialism is one of the most lively trends in the philosophy of mathematics. Modal accounts of sets have been developed in two different ways. The first, initiated by Charles Parsons, focuses on sets as objects. The second, dating back to Hilary Putnam and Geoffrey Hellman, investigates set-theoretic structures. The paper identifies two strands of open issues, technical and conceptual, to clarify these two different, yet often conflated, views and categorize the potentialist approaches that have emerged in the contemporary debate. The final outcome is a taxonomy that should help researchers navigate the rich landscape of modal set theories.
Missing-Mass Measurement of the 12C(K-, K+) Reaction at 1.8 GeV/c with the Superconducting Kaon Spectrometer
Authors: Ichikawa Yudai , Ahn Jung Keun , Akazawa Yuya , Aoki Kanae , Botta Elena , Ekawa Hiroyuki , Evtoukhovitch Petr , Feliciello Alessandro , Fujita Manami , Gogami Toshiyuki , Hasegawa Shoichi , Hasegawa Tomoyuki , Hayakawa Shuhei , Hayakawa Tomonori , Honda Ryotaro , Hosomi Kenji , Imai Ken’ichi , Jung Wooseung , Kanatsuki Shunsuke , Kim Shin Hyung , Kinbara Shinji , Kobayashi Kazuya , Lee Jaeyong , Marcello Simonetta , Miwa Koji , Moon Taejin , Nagae Tomofumi , Nakada Yoshiyuki , Nakagawa Manami , Nanamura Takuya , Naruki Megumi , Sakaguchi Atsushi , Sako Hiroyuki , Sasaki Yuki , Sato Susumu , Shirotori Kotaro , Sugimura Hitoshi , Takahashi Toshiyuki , Tamura Hirokazu , Tanida Kiyoshi , Tsamalaidze Zviadi , Ukai Mifuyu , Yamamoto Takeshi O
Published: August 2024

We performed a measurement of the inclusive missing-mass spectrum of the $^{12}$C$(K^-, K^+)$ reaction at an incident beam momentum of 1.8 GeV/c. This measurement was carried out by using the Superconducting Kaon Spectrometer (SKS) and the K1.8 beamline spectrometer at the Hadron Experimental Facility in J-PARC. From the missing-mass of the $^{12}$C$(K^-, K^+)$ reaction, the binding energy of a $\Xi ^-$ hyperon in a core $^{11}$B nucleus, $B_{\Xi ^-}$, can be calculated. Our experimental setup yielded a good energy resolution of 8.2 MeV (full width at half maximum), which allowed us to observe significant enhancements in the proximity of the $^{12}_{\Xi }$Be production threshold region. In order to extract information from the missing-mass spectrum, we employed several fitting parameters assumptions. A good agreement with the spectrum shape was obtained by adding two Gaussian functions, with the constant experimental resolution for the $\Xi$-hypernuclear states, to the background distribution. The peak positions were obtained to be $B_{\Xi ^-} = 8.9 \pm 1.4$ (stat.) $^{+3.8}_{-3.1}$ (syst.) MeV and $B_{\Xi ^-} = -2.4 \pm 1.3$ (stat.) $^{+2.8}_{-1.2}$ (syst.) MeV. Another model assumption, one Breit–Wigner function with $B_{\Xi ^-} = -2.7 \pm 2.2$ (stat.) $^{+0.5}_{-0.7}$ (syst.) MeV and $\Gamma = 4.1 \pm 2.1$ (stat.) $^{+1.2}_{-0.7}$ (syst.) MeV, also yielded a similar $\chi ^2$ value.
Cowper’s Pauses
Authors: Turner Joseph
Published: August 2024

This essay is about the status and significance of pauses in the poetry of William Cowper. The pause, it argues, is not only a formal feature of that poetry, manifest in caesurae and line-endings, but a human experience with which Cowper displays a richly vexed fascination. Consideration of Cowper’s prose writings reveals his sense that the proper management of pauses is a crucial and distinguishing characteristic of blank verse as against rhyming couplets. Attending to Cowper’s pauses, it is argued, can help us better to understand the distinctive mode of attention that his verse demands of its readers, especially in the long poem The Task (1785). Cowper’s complicated and ambivalent sense of the value of pausing is related, on the one hand, to a Protestant tradition of temporal improvement, and, on the other, to eighteenth-century debates about the nature of blank verse. Cowper’s sense of religious experience, the essay suggests, cannot properly be separated from the way in which he chose to write poetry. At their ambiguous best, Cowper’s pauses place the reader in a position akin to that in which the poet found himself as a Christian believer, doubtfully poised between election and reprobation, between salvation and damnation, and uncertain of what the future holds.
Assessment of radiation dose values in common orthopaedic trauma examinations performed under X-ray fluoroscopy guidance
Authors: Genetay Tristan , Gamulin Axel , Lorimier Arnaud , Sans Merce Marta
Published: August 2024

This study aims to provide radiation reference levels in orthopaedic surgery. A total of 753 procedures were collected within 1 y. Categories containing several similar procedures were created based on four criteria: same anatomical area, same level of complexity, only single procedures, and at least 10 cases per category. Exposure was defined in terms of air kerma-area product, fluoroscopy time, and air kerma at the patient entrance reference point. For common procedures, median effective doses to patient were calculated using the Monte Carlo Software PCXMC. Most irradiating procedure in this study i.e. intramedullary nailing of the proximal femur was equivalent to an air kerma at the patient entrance reference point of 37.1 mGy, which is ~50 times lower than the threshold for acute deterministic effects of radiation. Optimization remains a must to reduce the dose while maintaining the image quality and reducing the likelihood of stochastic effects.
A sociodemographic index identifies sex-related effects on insomnia in the Hispanic Community Health Study/Study of Latinos
Authors: Sorajja Natali , Chung Joon , Alcántara Carmela , Wassertheil-Smoller Sylvia , Penedo Frank J , Ramos Alberto R , Perreira Krista M , Daviglus Martha L , Suglia Shakira F , Gallo Linda C , Liu Peter Y , Redline Susan , Isasi Carmen R , Sofer Tamar
Published: August 2024

Study Objectives

Sex differences are related to both biological factors and the gendered environment. We constructed measures to model sex-related differences beyond binary sex.

Methods

Data came from the baseline visit of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). We applied the least absolute shrinkage and selection operator penalized logistic regression of male versus female sex over sociodemographic, acculturation, and psychological factors jointly. Two “gendered indices,” the gendered index of sociodemographic environment (GISE) and gendered index of psychological and sociodemographic environment, summarizing the sociodemographic environment (GISE) and psychosocial and sociodemographic environment (GIPSE) associated with sex, were calculated by summing these variables, weighted by their regression coefficients. We examined the association of these indices with insomnia, a phenotype with strong sex differences, in sex-adjusted and sex-stratified analyses.

Results

The distribution of GISE and GIPSE differed by sex with higher values in male individuals. In an association model with insomnia, male sex was associated with a lower likelihood of insomnia (odds ratio [OR] = 0.60, 95% CI [0.53, 0.67]). Including GISE in the model, the association was slightly weaker (OR = 0.63, 95% CI [0.56, 0.70]), and weaker when including instead GIPSE in the association model (OR = 0.78, 95% CI [0.69, 0.88]). Higher values of GISE and of GIPSE, more common in the male sex, were associated with a lower likelihood of insomnia, in analyses adjusted for sex (per 1 standard deviation of the index, GISE OR = 0.92, 95% CI [0.87, 0.99], GIPSE OR = 0.65, 95% CI [0.61, 0.70]).

Conclusions

New measures such as GISE and GIPSE capture sex-related differences beyond binary sex and have the potential to better model and inform research studies of sleep health.
Bibliometric Networks for Researchers in Health Professions Education
Authors: Ninkov Anton Boudreau , Frank Jason R. , Costello Joseph A. , Artino Anthony R. , Maggio Lauren A.
Published: August 2024

Bibliometric network analysis is an analytical approach that enables researchers to visualize the relationships between a set of research items (e.g., journal articles, books). There are 3 types of bibliometric network analyses, and multiple tools to conduct the analysis and visualize results (e.g., VOSviewer,1
Gephi
2). For health professions educators, bibliometric network analysis is valuable for discovering the field’s emerging trends, popular topics, and multidisciplinary relationships.3,4
Evaluating the Role of Competency-Based Behavioral Interviewing in Holistic Medical School Admissions
Authors: Davidson Mario A. , Russell Regina G. , Walker Philip D. , Zic John A. , Churchill Larry R. , Fuchs D. Catherine , Miller Bonnie M.
Published: August 2024

Problem

Holistic review is a multifaceted concept that aims to increase diversity and applicant fit with program needs by complementing traditional academic requirements with appraisal of a wider range of personal characteristics and experiences. Behavioral interviewing has been practiced and studied in human resources, business, and organizational psychology for over 50 years. Its premise is that future performance can be anticipated from past actions. However, many of the interview approaches within the holistic framework are resource intensive and logistically challenging.

Approach

The Vanderbilt University School of Medicine instituted a competency-based behavioral interview (CBBI) to augment the selection process in 2012. Behavioral interviews are based on key competencies needed for entering students and require applicants to reflect on their actual experiences and what they learned from them. The authors reviewed 5 years of experience (2015–2019) to evaluate how CBBI scores contributed to the overall assessment of applicants for admission.

Outcomes

The final admission committee decision for each applicant was determined by reviewing multiple factors, with no single assessment determining the final score. The CBBI and summary interview scores showed a strong association (P < .005), suggesting that the summary interviewer, who had access to the full applicant file, and the CBBI interviewer, who did not, assessed similar strengths despite the 2 different approaches, or that the strengths assessed tracked in the same direction. Students whose 2 interview scores were not aligned were less likely to be accepted to the school.

Next Steps

The review raised awareness about the cultural aspects of interpreting the competencies and the need to expand our cultural framework throughout interviewer training. Findings indicate that CBBIs have the potential to reduce bias related to overreliance on standardized metrics; however, additional innovation and research are needed.
Guiding Principles for Patient and Public Engagement in the Educational Missions of Medical Schools
Authors: Towle Angela , Wang Lucy , Ong Kenneth , Kline Cathy C.
Published: August 2024

Purpose

The purpose of this research was to cocreate with patients and the public a set of evidence-informed guiding principles for their authentic, responsive, ongoing, and sustainable engagement in the mission, goals, curriculum, and delivery of medical education.

Method

A set of guiding principles of relevance to medical education was identified from the literature. Eight focus groups with patients and community members representing a wide variety of perspectives were conducted in April and May 2022. Participants reviewed, prioritized, and discussed the principles and described successful engagement, resulting in 8 guiding principles in priority order. A summary report was circulated to participants for feedback. The principles were reviewed and endorsed by senior leaders in the medical school.

Results

The 8 focus groups were attended by 38 people (age range, mid-20s to postretirement; 7 male, 27 female, and 4 unknown gender). Accountability (19%), inclusion (18%), reciprocity (17%), and partnership and shared decision-making (14%) were chosen as the most important principles. Participants want evidence that their contributions are valued and have made a difference. They want the medical school to include and support a diversity of perspectives that reflect the populations being served by the health care system. They want the medical school to invest in building trusting and respectful long-term relationships with patients and the public.

Conclusions

The guiding principles could be used by medical schools as a starting point to build relationships with their local communities to increase the authentic and sustainable engagement of patients and the public in the educational mission of the medical school.
Gastrointestinal disease in systemic sclerosis: the neglected organ system?
Authors: McMahan Zsuzsanna , Pandolfino John , Perlman Harris , Del Galdo Francesco , Hinchcliff Monique
Published: August 2024

Purpose of review

Identifying outcomes and clinical trial endpoints enabled the discovery of new inflammatory bowel disease (IBD) treatments. Herein, we describe efforts to advance the study of gastrointestinal (GI) manifestations in systemic sclerosis (SSc).

Recent findings

Insights into the scope of the problem, as well as advancements in the measurement and treatment of SSc-GI, are underway. Proposed SSc esophageal endophenotypes are now defined, risk stratification methods are growing, and imaging and functional studies are now employed to guide therapeutic interventions. Additional progress is being made in characterizing the gut microbiome in patients with SSc. Research into the role of the immune response in the pathogenesis of SSc-GI disease is also ongoing, evolving simultaneously with the development of methods to facilitate data collection with real-time capture of diet, exercise, and medication data.

Multidisciplinary teams are working to deepen our understanding of SSc-GI disease pathogenesis, to identify biomarkers for risk stratification and the assessment of disease activity, and to develop and validate outcomes and clinical trial endpoints to pave the way toward effective therapy for SSc-GI disease.
The Price for Delayed Diagnosis of Pediatric Septic Hip: Increased Cost and Poor Outcomes
Authors: Nielsen Ena , Mortimer J. Alexandra , Bompadre Viviana , Yandow Suzanne
Published: August 2024

Background:

Most authors agree that early diagnosis and treatment of pediatric septic hip, within 4 days of onset of symptoms, is crucially important for good outcomes. In healthcare, value is a function of outcome over cost. The purpose of this study was to determine the clinical outcome and cost, therefore value, associated with early versus delayed treatment of pediatric septic arthritis of the hip.

Methods:

A retrospective review was performed at a single pediatric hospital. Hospital records over 6 years (2011 to 2016) were examined to identify patients who had undergone treatment for primary septic arthritis of the hip. Patient demographics, clinical data at presentation, treatment information, and follow-up data were recorded. Hospital charges at account level were calculated and compared between groups.

Results:

Forty-three subjects were identified for analysis. Twelve presented more than 4 days after the onset of symptoms (delayed diagnosis). There was no difference in patient demographics, Kocher criteria, or initial imaging performed between those with early versus delayed diagnosis. The delayed group had significantly longer length of hospital stay (17 vs. 9 d, P=0.003), follow-up needed (56 vs. 19 wk P=0.001), long-term complications (50% vs. 3%, P=0.000), duration of antibiotics (8 vs. 5.5 wk, P=0.043), greater number of I&Ds (2 vs. 1, P=0.04), more tissue cultures and blood draws (6 vs. 2, P=0.002; and 3 vs. 2 P=0.009, respectively) and more radiographs taken as outpatients (4 vs. 2, P=0.001, respectively). The average total hospital charge (inpatient and outpatient) was $102,774 in the early diagnosis group and $243,411 in the delayed group (P=0.012).

Conclusions:

Delayed diagnosis of pediatric septic hip correlated with longer length of hospital stay, duration of follow-up, and more long-term complications. These factors contributed to higher total hospital costs and therefore decreased healthcare value.
Burden of non-communicable diseases in China and its provinces, 1990–2021: Results from the Global Burden of Disease Study 2021
Authors: Liu Hanxiao , Yin Peng , Qi Jinlei , Zhou Maigeng
Published: August 2024

Background:

Non-communicable diseases (NCDs) are the primary causes of disability and death. The aim of this study is to analyze the disease burden of NCDs in China from 1990 to 2021.

Methods:

This study used data on NCDs in China and its provinces from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The study analyzed the disease burden of NCDs in 2021 and its changes from 1990 to 2021 using indicators including deaths and disability-adjusted life years (DALYs).

Results:

Between 1990 and 2021, the NCD burden in China exhibited an upward trend. In 2021, China had 10.6 (95% uncertainty interval [UI]: 9.0–12.2) million deaths and 349.3 (95% UI: 301.5–401.2) million DALYs due to NCDs, accounting for 91.0% (95% UI: 90.4–91.7%) of all deaths and 86.7% (95% UI: 86.0–87.4%) of all DALYs. NCDs caused a lower disease burden in females than in males. Cardiovascular diseases and neoplasms were the main NCD level 2 causes of deaths and DALYs, resulting in 5.1 (95% UI: 4.3–5.9) and 2.8 (95% UI: 2.3–3.4) million deaths and 100.2 (95% UI: 84.6–116.6) million and 71.2 (95% UI: 59.3–85.2) million DALYs in 2021, respectively. Chronic respiratory diseases were the third leading cause of NCD deaths, while musculoskeletal disorders were the third leading cause of NCD DALYs. Qinghai, Xizang, and Heilongjiang had the highest age-standardized mortality rates and age-standardized DALY rates (per 100,000) for NCDs, while Hong Kong Special Administration Region (SAR), Macao SAR, and Shanghai recorded the lowest age-standardized mortality rates and age-standardized DALY rates.

Conclusions:

NCDs caused a high disease burden in China and exhibited heterogeneity across sexes and provinces. China needs to focus on addressing key NCDs and implement intervention measures tailored to the disease distribution characteristics to reduce the NCD burden.
The Effect of Laughter Yoga on Vasomotor Symptoms and Sleep Quality in Menopausal Women
Authors: Aksoy-Can Ahu , Güner-Emül Tuba , Değirmenci Filiz , Buldum Aysu , Aksu Aslıhan , Vefikuluçay-Yılmaz Duygu
Published: August 2024

This experimental study aimed to determine the effects of online laughter yoga on the sleep quality and vasomotor symptoms (VMS) of menopausal women through a prospective, randomized controlled trial. About 36 women who attend the Menopause School were randomized into either the laughter yoga (n = 18) or the control group (n = 18). The laughter yoga group participated in eight online laughter yoga sessions, with two sessions per week for four weeks, whereas the control group did not receive any intervention. Data were collected using the Descriptive Characteristics Form, Visual Analog Scale (VAS), and Pittsburgh Sleep Quality Index (PSQI). The laughter yoga group had significantly lower posttest VAS scores compared with the control group in all VMS (P < .05). Furthermore, the posttest PSQI score of the laughter yoga group was significantly lower than that of the control group (P < .05). Although there was no significant difference in the pretest and posttest scores obtained by the control group from the VAS and PSQI (P > .05), the intervention group exhibited a statistically significant difference in their pretest and posttest VAS and PSQI scores (P < .05; P < .001, respectively). The results indicate that laughter yoga is an effective method for reducing VMS and improving sleep quality.
Effectiveness of Auricular Acupressure on Improving Pain and Heart Rate Variability in Patients After Cervical Spine Surgery
Authors: Liu Ying-Yin , Chien Tsui-Wei , Li Chin-Ching
Published: August 2024

Cervical spine surgery is a common neurosurgical procedure; however, postoperative pain remains a problem. This study aimed to examine the effectiveness of auricular acupressure, which is considered a noninvasive, convenient, and safe method for pain reduction and heart rate variability in patients after surgery. A total of 62 patients who underwent cervical spine surgery were randomly divided into experimental (32 patients) and control (30 patients) groups. Both groups received routine care, whereas the experimental group received auricular acupressure three times a day for four days. The Short-Form McGill Pain Questionnaire was administered, and heart rate variability measurements were obtained on the first, second, third, and fourth postoperative days. The results indicated that auricular acupressure was effective in reducing pain (P < .05) and improving heart rate variability (P < .05) in patients. Based on the findings, this study suggests that auricular acupressure can be used as a complementary treatment to reduce pain in patients after cervical spine surgery.
Findings Associated With Prolonged COVID-19 Recovery Among Boston Healthcare Workers
Authors: Zalaquett Nader , Lutchman Kevan , Iliaki Eirini , Buley Jane , Nathan Neetha , Sotos Prieto Mercedes , Kales Stefanos N. , Lan Fan-Yun
Published: August 2024

Objective

This study aimed to evaluate the long-term, symptomatic recovery of healthcare workers from acute COVID-19 infections up to 3 years after the initial COVID-19 outbreak.

Methods

A cross-sectional study was performed among employees of a community-based healthcare system in Massachusetts who had a recorded positive COVID-19 test. Survey responses were collected between September 2022 and January 2023. The survey included validated questionnaires: WHOQOL-BREF, EQ-5D-5 L, DASS-21, FCV-19S, K6+, and the Insomnia Severity Index. We compared the long-COVID (ie, symptoms lasting >28 days) and non–long-COVID groups.

Results

Among the 280 respondents (15.2% response rate), those with long COVID (73.4%) reported significantly worse quality of life and greater levels of depression, anxiety, and stress metrics. However, no significant difference was found between the two groups' fear of COVID-19.

Conclusions

Targeted support for healthcare workers with prolonged symptoms after COVID-19 is warranted.
‘Personalized medicine’: phenotyping pediatric obstructive sleep apnea
Authors: Duong-Quy Sy , Nguyen-Ngoc-Quynh Le , Nguyen-Huu Hoang
Published: August 2024

Purpose of review

Obstructive sleep apnea (OSA) is common in children. Phenotyping pediatric OSA has a crucial role in personalized diagnosis and treatment to improve outcomes for this population. This review sets forth a clinical approach that allows for phenotyping pediatric OSA.

Recent findings

The emerging concept of phenotyping pediatric OSA is based on identifying a primary cause, which leads to a more precise understanding of the pathogenesis in any individual patient. Phenotyping enables treatment focusing on the primary cause, but does not exclude the need for supplemental management strategies based on other recognizable traits. The identification of pediatric OSA phenotypes (POP) relies on observable characteristics with significant prevalence. This review will concentrate on the most important phenotypes seen in clinical practice: pediatric OSA with craniofacial abnormalities (POPCA); OSA with upper airway disease (POPUAD); OSA with obesity (POPO), and OSA associated with neuromuscular disease (POPNED).

Phenotyping pediatric OSA is a form of personalized medicine. By identifying clinical subtypes, individualized treatment plans can be devised in order to choose therapies that are associated with predictable responses. Moreover, it is rare that a therapeutic modality is devoid of possible complications; knowledge of the phenotype being treated can enable early intervention should those occur. Finally, all of the aforementioned phenotypes require personalized support incorporating individualized care plans so as to optimize the quality of life and overall sleep health of children with OSA.
Describing Medical Aid-in-Dying and Nursing “Leave-the-Room” Policies in California
Authors: Sobeck Karin , Strand Gianna R. , Hoffman David N.
Published: August 2024

Transparent patient-centered communication is essential to providing quality hospice care for patients at the end of life. This study aimed to determine and describe the current state of aid-in-dying policies in California and their effect on hospice nursing in response to narratives about leave-the-room policies presenting professional and moral challenges. In total, 97 hospice program policies were analyzed with a focus on the role of nurses at the bedside and intent to discharge patients who pursue medical aid-in-dying. It is necessary to clarify the important role of hospice nurses who care for terminally ill patients pursuing their legal right to assisted dying. The results of this study underscore the need for improved policy transparency and organizational support to enhance hospice engagement, particularly by nurses, with their patients at the end of life.
Improving Patient-Centered Care for End-Stage Renal Disease Patients at a Community Palliative Setting
Authors: Rouhi Behdokht , Collins-Fulea Catherine
Published: August 2024

End-stage renal disease (ESRD) is a complex medical condition growing fastest in Americans 65 years and older. Despite its chronic nature, fewer than 10% of these patients have had advanced care planning. A chart audit (n = 20) of the palliative patients at a community palliative program revealed that no patient had a conversation about prognostication, 10% (n = 2) about the burden of kidney disease, 30% (n = 6) had coordination of care with the nephrologist, and 35% (n = 7) had engaged in end-of-life planning. This project aimed to increase patient-centered care for ESRD patients to 80% in 90 days. The project utilized the Plan-Do-Study-Act quality improvement model in four 2-week rapid cycles with 2 focus improvement areas. The 2 core interventions were patient screening for preferences and values and providing the right care for palliative management utilizing a checklist. At the end of the project, patient-centered right care for ESRD increased from a baseline of 24% to 94%. Patient engagement scores increased from a baseline of 3.2 to 4.9 on a 5-point Likert scale, with 5 being the highest supporting a shared decision model of care in improving patient-centered right care.
Audiovestibular Involvement in Patients With Systemic Sclerosis
Authors: Mazeda Carolina , Silva Susana P. , Romão José , Matias Daniela , Azevedo Luísa , Barcelos Anabela
Published: August 2024

Introduction

Audiovestibular dysfunction has been reported in many autoimmune connective tissue diseases, including systemic sclerosis (SSc).

Objective

To assess the prevalence and features of audiological and vestibular disturbances in SSc patients and evaluate their relationship with disease duration, clinical features, nailfold videocapillaroscopy pattern, and immunologic profiles.

Method

A matched case-control study was conducted in a rheumatology clinic of a second-level hospital over 24 months. All patients underwent a detailed ear, nose, and throat examination, as well as audiometric and vestibular assessments, including pure tone audiometry, speech audiometry, immittance tests, and the Video Head Impulse Test.

Results

Thirty-five SSc patients and 24 healthy controls were included in the study. In the SSc group, subjective hearing loss was reported by 17.1% of patients, vertigo by 14.3%, tinnitus by 11.4%, and dizziness by 5.7%. Sensorineural hearing loss was identified in 42.9% of SSc patients, significantly higher than in the control group (p = 0.013). There was no correlation between audiological manifestations and clinical symptoms, organ involvement, immunologic characteristics, and treatment. Vestibular dysfunction was detected in 60% of SSc patients, significantly higher than the control group (p = 0.05). A significant correlation was found between abnormal Video Head Impulse Test and the presence of anti-RNA polymerase III and anti-Th/To antibodies (p = 0.05 and p = 0.034, respectively).

Conclusion

Our study revealed an increased prevalence of sensorineural hearing loss and vestibulopathy in SSc patients.
Nivolumab and Cabozantinib Immunotherapy Induced Thyroid Dysfunction Detected on 18F-FDG PET/CT in Renal Cell Carcinoma
Authors: Reddy Moulish , Ravina Mudalsha , Goyal Harish , Kumar Amit , Kote Rutuja
Published: August 2024

Targeted immunotherapy became the most advanced approach for cancer treatment. Programmed death-1 (PD-1) expressed on activated T cells can reverse immune suppression and cause T-cell activation. Nivolumab, a PD-1 immune checkpoint inhibitor antibody that is a fully human immunoglobulin G4, blocks PD-1 and promotes antitumor immunity. Cabozantinib (tyrosine kinase inhibitor) inhibits the tyrosine kinase activity of vascular endothelial growth factor receptors 1, 2, and 3. As a result of enhancing immune response in normal tissues, immune-related adverse events can occur. Thyroid dysfunction is a common form of immune-related adverse event and seen on 18F-FDG PET/CT scans post therapy.
Hot Hearts on Bone Scintigraphy Are Not All Amyloidosis
Authors: Wang Ya-Wen , Xie Yan-Ting , Sun Xiao-Xin
Published: August 2024

A 54-year-old woman with a history of end-stage renal disease was found to have infiltrative cardiomyopathy by echocardiography. 99mTc-pyrophosphate (99mTc-PYP) scintigraphy was positive with a remarkable myocardial uptake. Gene test found a mutation of AGXT, confirming a final diagnosis of primary hyperoxaluria. Radiotracer uptake was due to high myocardial oxalate deposition. This case illustrates false positivity of the 99mTc-PYP scan caused by hyperoxaluria-associated cardiomyopathy, which raises awareness for other conditions apart from amyloid cardiomyopathy.
Incidental Uptake of 68Ga-DOTA-IBA in Prostate Adenocarcinoma
Authors: Liu Huipan , Liu Yuhong , Xiang Feifan , Zhang Jianwen , Chen Yue
Published: August 2024

68Ga-labeled DOTA-ibandronic acid (68Ga-DOTA-IBA) is a novel PET agent developed for bone tumors. In addition, 68Ga-DOTA-IBA uptake in nonosseous findings has also been reported. Herein, we present a case of 68Ga-DOTA-IBA uptake in primary prostate adenocarcinoma.
Timely Access for Orofacial Cleft Repairs in a Brazilian Amazon Center
Authors: Rocha Franklin , Lopes Salomão Sarah , Gerk Ayla , Kim Ana , Telles Luiza , Laus Pereira Lima Beatriz , Melo de Carvalho Monica , Martins Rocha Cynthia , Alonso Nivaldo
Published: August 2024

Orofacial clefts are the most common congenital craniofacial anomalies worldwide, and if not managed in a timely manner, can lead to significant complications. We aim to examine surgical timing at one of the few cleft care centers in the North region of Brazil since its foundation in 2016. This retrospective, descriptive study analyzed medical records from 2016 to 2023. We calculated the age at surgery for each time period and each primary surgery performed. We also evaluated the number of procedures performed outside the recommended age. Of the 1439 procedures performed from 2016 to 2023, 713 procedures met our inclusion criteria. Among these, 66.67% (n=188) of primary cheiloplasties, 67.80% (n=40) of primary lip adhesions, and 54.57% (n=203) of palatoplasties were performed outside the recommended time frame. Of the surgeries performed, 45.16% (n=322) were between 2016 and 2019, while 54.84% (n=391) were from 2020 to 2023. Considering procedures performed within the ideal recommended age groups, only 32.92% (n=106) were done between 2016 and 2019, in contrast to 45.01% (n=176) between 2020 and 2023. In conclusion, since the inception of the specialized center, there has been an increase in surgical volume and an improvement in their timing. However, many surgeries are still being conducted outside the recommended time frame.
CRITICAL NOREPINEPHRINE DOSE TO PREDICT EARLY MORTALITY DURING CIRCULATORY SHOCK IN INTENSIVE CARE: A RETROSPECTIVE STUDY IN 3423 ICU PATIENTS OVER 4-YEAR PERIOD
Authors: Ceausu Dimitri , Boulet Nicolas , Roger Claire , Alonso Sandrine , Lefrant Jean-Yves , Boisson Christophe , Mura Thibault , Muller Laurent
Published: August 2024

Introduction: The maximal norepinephrine (NE) dose >1 μg/kg/min during circulatory shock apparently is associated with higher mortality, but this threshold needs confirmation. This study aimed at investigating whether NE infusion at a dose >1 μg/kg/min could predict early intensive care unit (ICU) mortality (first 5 days). The secondary objective was to assess the day-by-day relationship between NE dose during the first 4 days of ICU stay and subsequent mortality. Methods: We conducted a retrospective analysis of data from ICU patients receiving NE for circulatory shock at the Nimes University Hospital (France) from January 2016 to December 2019. Results: A total of 5,735 patients were admitted, 3,693 were screened, and 3,423 were analyzed. NE infusion at a dose >1 μg/kg/min was associated with day-5 mortality (hazards ratio: 7.40, P < 0.0001). The area under the receiver operating characteristic was 0.79 to predict day-5 mortality in ICU for maximal NE >1 μg/kg/min. The calculated threshold of 1.13 μg/kg/min for maximal NE was the best prognostic value (sensitivity: 67%, specificity: 80%, positive predictive value: 45%). When the 1.2 μg/kg/min threshold was crossed either on the first, second, third, or fourth day of ICU stay, the probability of subsequent death was 47%, 49%, 60%, and 40%, respectively. Along the first 4 days of ICU stay, the risk of death increased with increasing NE infusion dose. Conclusions: An NE infusion rate >1.13 μg/kg/min predicts day-5 mortality in ICU patients with circulatory shock. The time to reach maximal NE infusion rate was shorter in survivors than in nonsurvivors.