bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for mortality in patients with hypoplastic left heart syndrome after the Norwood procedure
Authors: Selenius Sabina , Ilvesvuo Johanna , Ruotsalainen Hanna , Mattila Ilkka , Pätilä Tommi , Helle Emmi , Ojala Tiina
Published: August 2023

OBJECTIVES

Several studies have reported mortality risk factors associated with hypoplastic left heart syndrome (HLHS). However, these data are ambiguous and mainly focused on the independent effects of these factors. We examined both the independent and the cumulative effects of preoperative risk factors for poor outcome in patients undergoing the Norwood procedure. Moreover, we studied the risk factors associated with prolonged initial hospital stays in these patients.

METHODS

We performed a retrospective national 18-year observational study of preoperative risk factors for 1 year, as well as total follow-up mortality or need for transplant in patients with HLHS (N = 99) born in Finland between 1 January 2004 and 31 December 2021.

RESULTS

Overall, one-year survival was 85.6%. In a multivariable analysis, having a major extracardiac anomaly and being small for gestational age were significant predictors of one-year mortality or the need for a transplant. Aortic atresia was a predictor of total follow-up mortality. An analysis of the cumulative effect indicated that the presence of 2 risk factors was associated with higher mortality.

CONCLUSIONS

HLHS remains the defect with the highest procedural risks for mortality in paediatric cardiac surgery. From a prognostic point of view, recognition of independent preoperative risk factors as well as the cumulative effect of risk factors for mortality is essential.

The results of this study were presented orally at the 55th Annual Meeting of the Association for European Paediatric and Congenital Cardiology, Geneva, Switzerland, 28 May 2022.
Herpes Zoster Reactivation After mRNA and Adenovirus-Vectored Coronavirus Disease 2019 Vaccination: Analysis of National Health Insurance Database
Authors: Yoon Jin Gu , Kim Young-Eun , Choi Min Joo , Choi Won Suk , Seo Yu Bin , Jung Jaehun , Hyun Hak-Jun , Seong Hye , Nham Eliel , Noh Ji Yun , Song Joon Young , Kim Woo Joo , Kim Dong Wook , Cheong Hee Jin
Published: August 2023

Background

Our study aimed to determine the risk of herpes zoster reactivation and coronavirus disease 2019 (COVID-19) vaccination (mRNA vaccine [BNT162b2] and adenovirus-vectored vaccine [ChAdOx1 nCoV-19]).

Methods

This retrospective study analyzed herpes zoster cases diagnosed between 26 February 2021 and 30 June 2021 and registered in the National Health Insurance Service database. A matched case-control study with a 1:3 matching ratio and a propensity score matching (PSM) study with a 1:1 ratio of vaccinated and unvaccinated individuals were performed.

Results

In the matched case control analysis, BNT162b2 was associated with an increased risk of herpes zoster reactivation (first dose adjusted odds ratio [aOR], 1.11; 95% confidence interval [CI], 1.06–1.15; second dose aOR, 1.17; 95% CI, 1.12–1.23). PSM analysis revealed a statistically significant increase in risk within 18 days following any vaccination (adjusted hazard ratio [aHR], 1.09; 95% CI, 1.02–1.16). BNT162b2 was associated with an increased risk at 18 days postvaccination (aHR, 1.65; 95% CI, 1.35–2.02) and second dose (aHR, 1.10; 95% CI, 1.02–1.19). However, the risk did not increase in both analyses of ChAdOx1 vaccination.

Conclusions

mRNA COVID-19 vaccination possibly increases the risk of herpes zoster reactivation, and thus close follow-up for herpes zoster reactivation is required.
Surveillance of antimicrobial resistant Shiga toxin-producing E. coli O157:H7 in England, 2016–2020
Authors: Greig David R , Do Nascimento Vivienne , Olonade Israel , Swift Craig , Nair Satheesh , Jenkins Claire
Published: August 2023

Objectives

Shiga toxin-producing Escherichia coli (STEC) O157:H7 are zoonotic pathogens and transmission to humans occurs via contaminated food or contact with infected animals. The aim of this study was to describe the frequency, and distribution across the phylogeny, of antimicrobial resistance (AMR) determinants in STEC O157:H7 isolated from human cases in England.

Methods

Short-read whole-genome sequencing data from 1473 isolates of STEC O157:H7 from all seven sub-lineages (Ia-Ic, IIa-IIc and I/II) were mapped to genes known to confer phenotypic resistance to 10 different classes of antibiotic. Long-read sequencing was used to determine the location and genomic architecture of the AMR determinants within phylogenetic clusters exhibiting multidrug resistance.

Results

Overall, 216/1473 (14.7%) isolates had at least one AMR determinant, although the proportion of isolates exhibiting AMR varied by sub-lineage. The highest proportion of AMR determinants were detected in sub-lineages Ib (28/64, 43.7%), I/II (18/51, 35.3%) and IIc (122/440, 27.7%). In all sub-lineages, the most commonly detected AMR determinants conferred resistance to the aminoglycosides, tetracyclines and sulphonamides, while AMR determinants conferring resistance to fluroquinolones, macrolides and third-generation cephalosporins were rarely detected. Long-read sequencing analysis showed that the AMR determinants were co-located on the chromosome in sub-lineages Ib and lineage I/II, whereas those associated with sub-lineage IIc were encoded on the chromosome and/or large plasmids.

Conclusions

AMR genes were unevenly distributed across the different sub-lineages of STEC O157:H7 and between different clades within the same sub-lineage. Long-read sequencing facilitates tracking the transmission of AMR at the pathogen and mobile genetic element level.
Decay kinetics of HIV-1-RNA in seminal plasma with dolutegravir/lamivudine versus dolutegravir plus emtricitabine/tenofovir alafenamide in treatment-naive people living with HIV
Authors: Saborido-Alconchel Abraham , Serna-Gallego Ana , Lopez-Cortes Luis E , Trujillo-Rodriguez María , Praena-Fernandez Juan Manuel , Dominguez-Macias Montserrat , Lozano Carmen , Muñoz-Muela Esperanza , Espinosa Nuria , Roca-Oporto Cristina , Sotomayor Cesar , Herrero Marta , Gutierrez-Valencia Alicia , Lopez-Cortes Luis F
Published: August 2023

Background

This was a substudy of a Phase IV, randomized clinical trial (ClinicalTrials.gov identifier: NCT04295460) aiming to compare the activity of dolutegravir/lamivudine versus dolutegravir plus tenofovir alafenamide/emtricitabine (DTG + TAF/FTC) in the male genital tract.

Methods

Participants were asymptomatic adults without sexually transmitted diseases, treatment-naive people living with HIV (PLWH), with CD4+ T cell counts >200 cells/mm3 and plasma HIV-1-RNA levels >5000 and <500 000 copies/mL, randomized (1:1) to DTG + TAF/FTC or dolutegravir/lamivudine. Blood plasma (BP) and seminal plasma (SP) were collected at baseline and Weeks 4, 8, 12 and 24. HIV-1-RNA was measured in BP and SP using the Cobas 6800 system (Roche Diagnostics) with a lower detection limit of 20 copies/mL. The primary efficacy endpoint was the proportion of subjects with undetectable SP HIV-1-RNA at Week 12 by intention-to-treat analysis.

Results

Fifteen participants in the DTG + TAF/FTC and 16 in the dolutegravir/lamivudine arms were analysed, with basal SP viral load of 4.81 (4.30–5.43) and 4.76 (4.09–5.23), P = 0.469, respectively. At Week 12, only one participant in each treatment arm had a detectable SP HIV-1-RNA (DTG + TAF/FTC, 141 copies/mL; dolutegravir/lamivudine, 61 copies/mL). Based on the estimated means, there was no significant difference in the decay of HIV-1-RNA in both BP and SP over time between the two arms of treatment (F = 0.452, P = 0.662, and F = 1.147, P = 0.185, respectively).

Conclusions

After 12 weeks of treatment, there were no differences in the percentage of undetectable SP HIV-1-RNA in naive PLWH who started dolutegravir/lamivudine compared with DTG + TAF/FTC.
Fine-mesh exclusion netting reduces Drosophila suzukii (Diptera: Drosophilidae) infestation and improves organic fall-bearing raspberry yields
Authors: Kuesel Ryan , Avery Chelsea , Jones Sarah , Gauger Alexis , Scott Delia , Gonthier David
Published: August 2023

The economical production of small fruits has been significantly complicated by the spotted-wing drosophila, Drosophila suzukii Matsumura, throughout its invaded rage. Fall-bearing red raspberries are especially susceptible to D. suzukii, and significant efforts to mitigate their damage are undertaken by growers. Exclusion barriers made from fine-mesh netting has emerged as an organic compliant strategy to mitigate damage from D. suzukii. Identifying less susceptible raspberry cultivars may also alleviate D. suzukii damage. Key pollination complications arise from exclusion-based tactics, but properly timing exclusion establishment may provide a remedy. In a 2-yr-old fall-bearing raspberry planting containing 3 cultivars, exclusion barriers were erected at 2 phenological timings. Spinosad- and pyrethrin-based pesticides were also applied to separate rows throughout harvest and a fourth treatment group matured without management. A subsection of raspberries was harvested and examined for marketability or damage, and D. suzukii adult populations were sampled with baited traps. An exclusion barrier applied early in fruit development was the most effective pest management strategy of those we tested. Its use decreased D. suzukii captures by 75%, decreased D. suzukii-infested fruit weights by 48%, and increased marketable yield by 63% compared to the no management control; however, it also increased pollination deficient fruit weights. Exclusion netting applied later in fruit maturation also decreased D. suzukii captures, infested fruit weights, and the weight of fruits damaged by other arthropod pests but did not significantly increase marketable yield. Our results indicate that netting exclusions may hold promise for the economical production of fall-bearing raspberries.
Computing minimal unsatisfiable core for LTL over finite traces
Authors: Niu Tong , Xiao Shengping , Zhang Xiaoyu , Li Jianwen , Huang Yanhong , Shi Jianqi
Published: August 2023

In this paper, we consider the minimal unsatisfiable core (MUC) problem for linear temporal logic over finite traces (LTL$_{f}$), which nowadays is a popular formal-specification language for AI-related systems. Efficient algorithms to compute such MUCs can help locate the inconsistency rapidly in the written LTL$_{f}$ specification and are very useful for the system designers to amend the flawed requirement. As far as we know, there are no available tools off-the-shelf so far that provide MUC computation for LTL$_{f}$. We present here two generic approaches NaiveMUC and BinaryMUC to compute an MUC for LTL$_{f}$. Moreover, we introduce heuristics that are based on the Boolean unsatisfiable core (UC) technique to accelerate the two approaches, which are named NaiveMUC+UC and BinaryMUC+UC, respectively. In particular, for global LTL$_{f}$ formulas, we show that the MUC computation can be reduced to the pure Boolean MUC computation, which therefore conducts the GlobalMUC approach. Our experiments show that GlobalMUC performs the best to compute an MUC for global formulas, and BinaryMUC+UC is the best for an arbitrary unsatisfiable formula.
A parametrized axiomatization for a large number of restricted second-order logics
Authors: Badia Guillermo , Bell John L
Published: August 2023

By limiting the range of the predicate variables in a second-order language, one may obtain restricted versions of second-order logic such as weak second-order logic or definable subset logic. In this note, we provide an infinitary strongly complete axiomatization for several systems of this kind having the range of the predicate variables as a parameter. The completeness argument uses simple techniques from the theory of Boolean algebras.

This article is dedicated to our friend John N. Crossley on the occasion of his 86th birthday.
Long-term remission of VEXAS syndrome achieved by a single course of CHOP therapy: A case report
Authors: Miyoshi Yuji , Kise Takayasu , Morita Kaoru , Okada Haruka , Imadome Ken-Ichi , Tsuchida Naomi , Maeda Ayaka , Uchiyama Yuri , Kirino Yohei , Matsumoto Naomichi , Yokogawa Naoto
Published: August 2023

We herein describe the case of a 52-year-old male patient who presented with fever, arthritis, and neutrophilic dermatosis in 2013 and subsequently experienced macrophage activation syndrome treated with high-dose glucocorticoid therapy. Due to the persistent symptoms refractory to several immunomodulatory and immunosuppressive (IS) drug therapies with dapsone, methotrexate, tacrolimus, infliximab (IFX), and tocilizumab (TCZ), he received prednisolone (PSL) ≥20 mg/day to suppress disease activity. In 2017, Epstein–Barr virus (EBV)–associated haemophagocytic lymphohistiocytosis (HLH) was diagnosed and initially treated with immunochemotherapy consisting of dexamethasone, cyclosporine (CyA), and etoposide (ET). Because of the suboptimal response to the initial therapy, cytoreduction therapy consisting of CHOP (combination chemotherapy consisting of cyclophosphamide, doxorubicin, vincristine, and PSL) was administered. This regimen improved the EBV-associated HLH. Later, the patient’s condition stabilised with methylprednisolone 1 mg/day and CyA 100 mg/day. In 2022, ubiquitylation-initiating E1 enzyme (UBA1) variant analysis using Sanger sequencing of peripheral blood leukocytes detected a previously reported somatic variant (NM_003334.3: c.118-1G>C), confirming the diagnosis of vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome. The clinical course in the present case suggested the possibility that CHOP could be a potential treatment option for VEXAS syndrome, in the pathophysiology of which the expansion of clones with UBA1 variant seems to play a pivotal role.
Click display: a rapid and efficient in vitro protein display method for directed evolution
Authors: Zeng Yu , Woolley Michael , Chockalingam Karuppiah , Thomas Benjamin , Arora Srishtee , Hook Magnus , Chen Zhilei
Published: August 2023

We describe a novel method for in vitro protein display—click display—that does not depend on maintaining RNA integrity during biopanning and yields covalently linked protein–cDNA complexes from double-stranded input DNA within 2 h. The display is achieved in a one-pot format encompassing transcription, translation and reverse transcription reactions in series. Stable linkage between proteins and the encoding cDNA is mediated by a modified DNA linker—ML—generated via a click chemistry reaction between a puromycin-containing oligo and a cDNA synthesis primer. Biopanning of a click-displayed mock library coupled with next-generation sequencing analysis revealed >600-fold enrichment of target binders within a single round of panning. A synthetic library of Designed Ankyrin Repeat Proteins (DARPins) with ∼1012 individual members was generated using click display in a 25-μl reaction and six rounds of library panning against a model protein yielded a panel of nanomolar binders. This study establishes click display as a powerful tool for protein binder discovery/engineering and provides a convenient platform for in vitro biopanning selection even in RNase-rich environments such as on whole cells.
Crystal structure of a cap-independent translation enhancer RNA
Authors: Lewicka Anna , Roman Christina , Jones Stacey , Disare Michael , Rice Phoebe A , Piccirilli Joseph A
Published: August 2023

In eukaryotic messenger RNAs, the 5′ cap structure binds to the translation initiation factor 4E to facilitate early stages of translation. Although many plant viruses lack the 5′ cap structure, some contain cap-independent translation elements (CITEs) in their 3′ untranslated region. The PTE (Panicum mosaic virus translation element) class of CITEs contains a G-rich asymmetric bulge and a C-rich helical junction that were proposed to interact via formation of a pseudoknot. SHAPE analysis of PTE homologs reveals a highly reactive guanosine residue within the G-rich region proposed to mediate eukaryotic initiation factor 4E (eIF4E) recognition. Here we have obtained the crystal structure of the PTE from Pea enation mosaic virus 2 (PEMV2) RNA in complex with our structural chaperone, Fab BL3–6. The structure reveals that the G-rich and C-rich regions interact through a complex network of interactions distinct from those expected for a pseudoknot. The motif, which contains a short parallel duplex, provides a structural mechanism for how the guanosine is extruded from the core stack to enable eIF4E recognition. Homologous PTE elements harbor a G-rich bulge and a three-way junction and exhibit covariation at crucial positions, suggesting that the PEMV2 tertiary architecture is conserved among these homologs.
Baseline Tumor Size as Prognostic Index in Patients With Advanced Solid Tumors Receiving Experimental Targeted Agents
Authors: Nicolò Eleonora , Tarantino Paolo , D’Ecclesiis Oriana , Antonarelli Gabriele , Boscolo Bielo Luca , Marra Antonio , Gandini Sara , Crimini Edoardo , Giugliano Federica , Zagami Paola , Corti Chiara , Trapani Dario , Morganti Stefania , Criscitiello Carmen , Locatelli Marzia , Belli Carmen , Esposito Angela , Minchella Ida , Cristofanilli Massimo , Tolaney Sara M , Curigliano Giuseppe
Published: August 2023

Background

Baseline tumor size (BTS) has been associated with outcomes in patients with cancer treated with immunotherapy. However, the prognostic impact of BTS on patients receiving targeted therapies (TTs) remains undetermined.

Methods

We reviewed data of patients with advanced solid tumors consecutively treated within early-phase clinical trials at our institution from 01/2014 to 04/2021. Treatments were categorized as immunotherapy-based or TT-based (biomarker-matched or not). BTS was calculated as the sum of RECIST1.1 baseline target lesions.

Results

A total of 444 patients were eligible; the median BTS was 69 mm (IQR 40-100). OS was significantly longer for patients with BTS lower versus higher than the median (16.6 vs. 8.2 months, P < .001), including among those receiving immunotherapy (12 vs. 7.5 months, P = .005). Among patients receiving TT, lower BTS was associated with longer PFS (4.7 vs. 3.1 months, P = .002) and OS (20.5 vs. 9.9 months, P < .001) as compared to high BTS. However, such association was only significant among patients receiving biomarker-matched TT, with longer PFS (6.2 vs. 3.3 months, P < .001) and OS (21.2 vs. 6.7 months, P < .001) in the low-BTS subgroup, despite a similar ORR (28% vs. 22%, P = .57). BTS was not prognostic among patients receiving unmatched TT, with similar PFS (3.7 vs. 4.4 months, P = .30), OS (19.3 vs. 11.8 months, P = .20), and ORR (33% vs. 28%, P = .78) in the 2 BTS groups. Multivariate analysis confirmed that BTS was independently associated with PFS (P = .03) and OS (P < .001) but not with ORR (P = .11).

Conclusions

Higher BTS is associated with worse survival outcomes among patients receiving biomarker-matched, but not biomarker-unmatched TT.
KAI2 Can Do: Karrikin Receptor Function in Plant Development and Response to Abiotic and Biotic Factors
Authors: Varshney Kartikye , Gutjahr Caroline
Published: August 2023

The α/β hydrolase KARRIKIN INSENSITIVE 2 (KAI2) functions as a receptor for a yet undiscovered phytohormone, provisionally termed KAI2 ligand (KL). In addition, it perceives karrikin, a butenolide compound found in the smoke of burnt plant material. KAI2-mediated signaling is involved in regulating seed germination and in shaping seedling and adult plant morphology, both above and below ground. It also governs responses to various abiotic stimuli and stresses and shapes biotic interactions. KAI2-mediated signaling is being linked to an elaborate cross-talk with other phytohormone pathways such as auxin, gibberellin, abscisic acid, ethylene and salicylic acid signaling, in addition to light and nutrient starvation signaling. Further connections will likely be revealed in the future. This article summarizes recent advances in unraveling the function of KAI2-mediated signaling and its interaction with other signaling pathways.
Membrane microdomains: Structural and signaling platforms for establishing membrane polarity
Authors: Li Ruili , Zhao Ran , Yang Mei , Zhang Xi , Lin Jinxing
Published: August 2023

Cell polarity results from the asymmetric distribution of cellular structures, molecules, and functions. Polarity is a fundamental cellular trait that can determine the orientation of cell division, the formation of particular cell shapes, and ultimately the development of a multicellular body. To maintain the distinct asymmetric distribution of proteins and lipids in cellular membranes, plant cells have developed complex trafficking and regulatory mechanisms. Major advances have been made in our understanding of how membrane microdomains influence the asymmetric distribution of proteins and lipids. In this review, we first give an overview of cell polarity. Next, we discuss current knowledge concerning membrane microdomains and their roles as structural and signaling platforms to establish and maintain membrane polarity, with a special focus on the asymmetric distribution of proteins and lipids, and advanced microscopy techniques to observe and characterize membrane microdomains. Finally, we review recent advances regarding membrane trafficking in cell polarity establishment and how the balance between exocytosis and endocytosis affects membrane polarity.
A global phylogeny of Elysia Risso, 1818 (Gastropoda: Heterobranchia): molecular systematic insights focusing on European taxa and description of a new species
Authors: Martín-Hervás M Rosario , Carmona Leila , Jensen Kathe R , Krug Patrick J , Vitale Fabio , Cervera Juan Lucas
Published: August 2023

The genus Elysia comprises about one-third of the species richness in Sacoglossa. However, the species diversity in the genus remains poorly characterized in some areas like the north-eastern Atlantic and Mediterranean waters. To clarify the systematics of this genus and to characterize the species diversity in undersampled regions, we performed an integrative study based on a thorough literature review, molecular and morphological analyses, and species delimitation approaches. We conducted phylogenetic analyses of partial sequences of two mitochondrial genes (COI and 16S) and two nuclear genes (H3, 28S) using Bayesian inference and maximum likelihood methods, which confirmed the presence of five of the recognized European Elysia species: Elysia viridis, E. timida, E. flava, E. margaritae, and E. rubeni. Moreover, a new species (Elysia azorica sp. nov.) was identified in the Azores, and E. gordanae, currently considered a junior synonym of E. margaritae, was recovered as a distinct species. In addition, we consider E. hetta as a junior synonym of E. gordanae, and E. translucens as a taxon inquirendum. Finally, the tropical E. evelinae is recorded along European coasts for the first time. Our results demonstrate the value of integrative approaches in resolving taxonomic uncertainty surrounding polymorphism and unravelling potential cases of cryptic or pseudocryptic species complexes.
Duration and Timing of In Utero Opioid Exposure and Incidence of Neonatal Withdrawal Syndrome
Authors: Wang Yi , Berger Lawrence , Durrance Christine , Kirby Russell S. , Kuo Daphne , Pac Jessica , Ehrenthal Deborah B.
Published: August 2023

OBJECTIVE:

To evaluate the association between prenatal prescription opioid analgesic exposure (duration, timing) and neonatal opioid withdrawal syndrome (NOWS).

METHODS:

We conducted a retrospective cohort study of Wisconsin Medicaid–covered singleton live births from 2011 to 2019. The primary outcome was a NOWS diagnosis in the first 30 days of life. Opioid exposure was identified with any claim for prescription opioid analgesic fills during pregnancy. We measured exposure duration cumulatively in days (1–6, 7–29, 30–89, and 90 or more) and identified timing as early (first two trimesters only) or late (third trimester, regardless of earlier pregnancy use). We used logistic regression modeling to assess NOWS incidence by exposure duration and timing, with and without propensity score matching.

RESULTS:

Overall, 31,456 (14.3%) of 220,570 neonates were exposed to prescription opioid analgesics prenatally. Among exposed neonates, 19,880 (63.2%) had 1–6 days of exposure, 7,694 (24.5%) had 7–29 days, 2,188 (7.0%) had 30–89 days, and 1,694 (5.4%) had 90 or more days of exposure; 15,032 (47.8%) had late exposure. Absolute NOWS incidence among neonates with 1–6 days of exposure was 7.29 per 1,000 neonates (95% CI 6.11–8.48), and incidence increased with longer exposure: 7–29 days (19.63, 95% CI 16.53–22.73); 30–89 days (58.96, 95% CI 49.08–68.84); and 90 or more days (177.10, 95% CI 158.90–195.29). Absolute NOWS incidence for early and late exposures were 11.26 per 1,000 neonates (95% CI 9.65–12.88) and 35.92 per 1,000 neonates (95% CI 32.95–38.90), respectively. When adjusting for confounders including timing of exposure, neonates exposed for 1–6 days had no increased odds of NOWS compared with unexposed neonates, whereas those exposed for 30 or more days had increased odds of NOWS (30–89 days: adjusted odds ratio [aOR] 2.15, 95% CI 1.22–3.79; 90 or more days: 2.80, 95% CI 1.36–5.76). Late exposure was associated with elevated odds of NOWS (aOR 1.57, 95% CI 1.25–1.96) when compared with unexposed after adjustment for exposure duration.

CONCLUSION:

More than 30 days of prenatal prescription opioid exposure was associated with NOWS regardless of exposure timing. Third-trimester opioid exposure, irrespective of exposure duration, was associated with NOWS.
Six years of experience with the nationwide newborn ultrasonographic hip screening program in Turkey: a considerable change in the type of surgical interventions in developmental dysplasia of the hip
Authors: Kapicioğlu Mehmet Ismail Safa , Karataş Ali Fuat , Akkaya Mustafa , Korkusuz Feza , Ömeroğlu Hakan
Published: August 2023

This study aims to assess whether the nationwide newborn ultrasonographic hip screening program has influenced the rate of different types of surgical interventions performed in developmental dysplasia of the hip (DDH) in children in Turkey. A retrospective analysis of the nationwide data obtained from the National Registry System between January 1, 2015, and December 31, 2020, was carried out. The rate of minor and major surgical interventions was calculated by dividing the total number of primary closed/open reductions with or without tenotomies and the total number of primary pelvic or periacetabular osteotomies with or without femoral osteotomies by the total number of live births in the country per year, respectively. The rates of primary minor surgical interventions were found to be 0.47/1000 in 2015, 0.71/1000 in 2016, 1.07/1000 in 2017, 1.00/1000 in 2018, 1.06/1000 in 2019, and 0.89/1000 in 2020. The rates of primary major surgical intervention were found to be 0.74/1000 in 2015, 0.40/1000 in 2016, 0.33/1000 in 2017, 0.31/1000 in 2018, 0.32/1000 in 2019, and 0.21/1000 in 2020. The introduction of the nationwide newborn hip screening program has significantly changed the surgical treatment modalities in children with DDH. A nearly twofold increase in the rate of primary closed/open reduction and hip spica casting and nearly a three-quarter decrease in the rate of primary bony procedures were observed within 6 years.
Community-Dwelling Older Adults Attending a Fire and Falls Health Promotion Program and the Experience of Social Isolation and Loneliness
Authors: Leo Yeona , Compton Roslyn M. , Hubbard Murdoch Natasha , Krahn Dori
Published: August 2023

Many health promotion programs are designed for older adults who live in the community. This research describes a health promotion program called “Remembering When” (a fire and fall prevention program). In 2020, a quality improvement project was developed to examine the effectiveness and impact of Remembering When among community-dwelling older adults. After analyzing the qualitative data collected for the project, an interesting observation of why older adults attended Remembering When emerged. Older adults might attend Remembering When because they experience social isolation and/or loneliness. The concepts of objective and subjective social isolation and loneliness were defined, and the implications of Remembering When around social isolation and loneliness were discussed. Secondary data analysis followed Braun and Clarke's (2006) thematic analysis steps. Four themes were generated: It is about me having choices, Joining the program as an old friend, We all need referrals, and I am housebound. Overall, 2 significant observations were made: (1) some older adults valued the opportunity to interact with Remembering When's team, which might help older adults decrease social isolation and loneliness, and (2) older adults needed more individualized programs to address their emotional and mental health and well-being needs.
Surgical management of uterine fibroids
Authors: Lazaridis Alexandros , Hirsch Martin , Pistofidis George , Odejinmi Funlayo
Published: August 2023

Purpose of review

Fibroids are benign pelvic masses and constitute the most common gynaecological condition. They create a significant health and social burden to many women because of heavy menstrual bleeding and fibroid pressure symptoms. Many women will be faced with the dilemma of surgical management to improve their symptoms at some point of their reproductive age. The aim of this article is to identify current surgical management of fibroids describing the technical steps, advantages, disadvantages and risks of each method.

Recent findings

The surgical management of fibroids remains challenging, as the overall prevalence, the clinical experience and the patient awareness is increasing because of an upgrade in our sonographic and magnetic resonance diagnostic tools. Unfortunately not every patient is able to benefit from tailor-made surgery that holistically evaluates individual needs including fertility aspirations.

This article provides the most current synopsis of every available surgical modality for fibroid management. Large prospective multicentre cohort studies are needed to definitely determine the most suitable operation for any individual suffering with fibroids; and perhaps artificial intelligence may offer a valuable tool in the future data analysis.
Family history of hypertension and its relation to other variables in hypertensive patients: a cross-sectional study from a tertiary care hospital
Authors: KC Kanchan , Katwal Srijana , Yadav Gopal K. , Adhikari Alisha , Thapa Raj Kumar , Jha Saroj Kumar , Sharma Arun , Rijal Thaneshwar , Giri Santoshi , Khadka Sitaram
Published: August 2023

Background:

Hypertension, a key determinant of cardiovascular disease, is one of the major public health burdens worldwide. Family history is a known nonmodifiable risk factor for hypertension. This study aims to identify the family history of hypertension in terms of its prevalence and its association with various risk factors.

Methods:

A descriptive cross-sectional study was conducted among 423 hypertensive patients visiting the general outpatient department of Shree Birendra Hospital using a simple random sampling method. The data were collected using a preformed questionnaire through a face-to-face interview approach. Data were entered into Microsoft Excel 2019 v16.0 and were analyzed using Statistical Packages for Social Sciences version 21.

Results:

Out of 423 hypertensive individuals, 131 (30.97%) had a family history of hypertension, with grandparents having the greatest frequency (56.49%). In the multivariable model, the participants with age 60 years or older [adjusted odds ratio (AOR): 2.54, 95% CI: 1.60–4.02,P< 0.001], female (AOR: 2.11, 95% CI: 1.35–3.29,P= 0.001), and participants with government or private jobs, including farming (AOR: 2.63, 95% CI: 1.59–4.35,P<0.001), were significantly associated with a family history of hypertension.

Conclusions:

Family history is an influencing factor in hypertension. Thus, it is possible to target people who have a family history of hypertension to identify undiagnosed hypertension cases in the community, as well as to modify risk factors and provide necessary interventions.
Contrast-enhanced ultrasound liver imaging reporting and data system: clinical validation in a prospective multinational study in North America and Europe
Authors: Lyshchik Andrej , Wessner Corinne E. , Bradigan Kristen , Eisenbrey John R. , Forsberg Flemming , Yi Misung , Keith Scott W. , Kono Yuko , Wilson Stephanie R. , Medellin Alexandra , Rodgers Shuchi K. , Planz Virginia , Kamaya Aya , Finch Lisa , Fetzer David T. , Berzigotti Annalisa , Sidhu Paul S. , Piscaglia Fabio ,   CEUS LI-RADS Trial Group
Published: August 2023

Background and Aims:

The objective of this study is to determine the diagnostic accuracy of the American College of Radiology Contrast-Enhanced Ultrasound (CEUS) Liver Imaging Reporting and Data System LR-5 characterization for HCC diagnosis in North American or European patients.

Approach and Results:

A prospective multinational cohort study was performed from January 2018 through November 2022 at 11 academic and nonacademic centers in North America and Europe. Patients at risk for HCC with at least 1 liver observation not previously treated, identified on ultrasound (US), or multiphase CT or MRI performed as a part of standard clinical care were eligible for the study. All participants were examined with CEUS of the liver within 4 weeks of CT/MRI or tissue diagnosis to characterize up to 2 liver nodules per participant using ACR CEUS Liver Imaging Reporting and Data System. Definite HCC diagnosis on the initial CT/MRI, imaging follow-up, or histology for CT/MRI-indeterminate nodules were used as reference standards. A total of 545 nodules had confirmed reference standards in 480 patients, 73.8% were HCC, 5.5% were other malignancies, and 20.7% were nonmalignant. The specificity of CEUS LR-5 for HCC was 95.1% (95% CI 90.1%–97.7%), sensitivity 62.9% (95% CI 57.9%–67.7%), positive predictive value 97.3% (95% CI 94.5%–98.7%), and negative predictive value 47.7% (95% CI 41.7%–53.8%). In addition, benign CEUS characterization (LR-1 or LR-2) had 100% specificity and 100% positive predictive value for nonmalignant liver nodules.

Conclusions:

CEUS Liver Imaging Reporting and Data System provides an accurate categorization of liver nodules in participants at risk for HCC.
Investigation of the Radiographic Imaging Volume and Occupational Dose of Radiologic Technologists before and during the COVID-19 Pandemic
Authors: Shubayr Nasser
Published: August 2023

This study aimed to assess occupational radiation doses for radiologic technologists (RTs) in Saudi Arabia shortly before and during the COVID-19 pandemic, considering changes in imaging volume during that time. This retrospective study included the imaging volume data and the RTs’ occupational dose records from a central hospital for 2019 and 2020. The occupational dose—in terms of annual and quarterly mean effective doses (AMEDs and QMEDs)—was estimated for 115 RTs using thermoluminescent dosimeter records. There was a 22% increase in the AMED in 2020 compared with 2019, though the overall imaging volume decreased by 9% in 2020. The percentage changes in AMEDs between 2019 and 2020 for general radiography (GR), computed tomography (CT), interventional radiology (IR), nuclear medicine (NM), and mammography (MG) were 45%, 56%, 9%, 18% and −2%, respectively. The highest contribution to AMEDs in 2020 for modalities was due to GR and CT procedures, accounting for 0.50 mSv and 0.58 mSv, respectively. The percentage change in imaging volumes between 2019 and 2020 depicted a slight decrease in Q2 (−1%) and a substantial decrease in Q1 (−10%), Q3 (−12%), and Q4 (−11%) for 2020. The overall percentage changes in imaging volumes in 2020 for GR (conventional and mobile), CT, IR, NM, and MG were −7% (−19% and 48%), −11%, 13%, −26%, and −46%, respectively. Investigating the changes in 2020 by comparing Q1 of 2020 (before the pandemic restrictions) with Q2 (during the pandemic restrictions and changes in workflow) revealed that the QMED during Q2 increased by 5% with a 17.4% decrease in the imaging volume. However, CT procedures were increased by 11.1% during the pandemic restrictions in Q2 of 2020, with an increase in the corresponding QMED of 66%. Moreover, mobile GR procedures increased by 21% in Q2 of 2020 compared to Q1. This study indicated the impact of the COVID-19 pandemic on imaging volume and occupational dose. Overall, the study observed a decrease in the imaging volume and an increase in RTs’ effective doses by 2020. However, there was an increase in mobile GR and CT examinations during the COVID-19 pandemic restrictions in 2020. This study suggested that the increased mobile GR and CT examinations contributed to greater effective doses for RTs in 2020.
Effectiveness of repetitive influenza vaccination against SARS-CoV-2 infection among a cohort of health care workers in Portugal
Authors: Sá Silva Susana , Severo Milton , Norton Pedro , Moreira André
Published: August 2023

Vaccination for influenza has been essential over the years to protect the most vulnerable populations. Moreover, it was recently suggested that influenza vaccination might confer some nonspecific immunity to other viruses and be associated with a lower risk for coronavirus disease 2019 (COVID-19) morbidity and mortality. Therefore, we aimed to assess the effectiveness of repetitive influenza vaccination against SARS-CoV-2 infection in a cohort of health care workers (HCWs). This study was conducted among HCWs at São João University Hospital Center (CHUSJ), Porto, Portugal, a tertiary reference hospital for diagnosis and therapy, one of the largest hospitals in the country with approximately 6000 HCWs. We analyzed databases for influenza vaccination conducted between 2012 and 2019 and COVID-19 laboratory testing retrieved from the first and last registered positive COVID test date before HCW's COVID-19 vaccination started. The study outcome was the incidence of the first SARS-CoV-2 infection, as determined by reverse transcription polymerase chain reaction (RT-PCR). Age and sex were considered potential confounders. We used multivariable Cox regression to estimate odds ratios. Neither the absolute number nor the proportion of influenza shots influenced the risk of getting infected by SARS-CoV-2 (adjusted odds ratio 1.02, 95% CI: 0.9–1.06 and 1.17 95% CI: 0.86–1.58, respectively). Similar findings were observed in most cases when the analysis was restricted by year. The findings from our retrospective observational analysis of a HCWs cohort failed to support any protective effect between repetitive influenza vaccination and SARS-CoV-2 infection.
Palliative Care Utilization in Patients Requiring Extracorporeal Membrane Oxygenation: An Observational Study
Authors: Peeler Anna , Davidson Patricia M. , Gleason Kelly T. , Stephens R. Scott , Ferrell Betty , Kim Bo Soo , Cho Sung-Min
Published: August 2023

Palliative care (PC) is a model of care centered around improving the quality of life for individuals with life-limiting illnesses. Few studies have examined its impact in patients on extracorporeal membrane oxygenation (ECMO). We aimed to describe demographics, clinical characteristics, and complications associated with PC consultation in adult patients requiring ECMO support. We analyzed data from an ECMO registry, including patients aged 18 years and older who have received either venoarterial (VA)- or venovenous (VV)-ECMO support between July 2016 and September 2021. We used analysis of variance and Fisher exact tests to identify factors associated with PC consultation. Of 256, 177 patients (69.1%) received VA-ECMO support and 79 (30.9%) received VV-ECMO support. Overall, 115 patients (44.9%) received PC consultation while on ECMO. Patients receiving PC consultation were more likely to be non-white (47% vs. 53%, p = 0.016), have an attending physician from a medical versus surgical specialty (65.3% vs. 39.6%), have VV-ECMO (77.2% vs. 30.5%, p < 0.001), and have longer ECMO duration (6.2 vs. 23.0, p < 0.001). Patients were seen by the PC team on an average of 7.6 times (range, 1–35), with those who died having significantly more visits (11.2 vs. 5.6, p < 0.001) despite the shorter hospital stay. The average time from cannulation to the first PC visit was 5.3 ± 5 days. Congestive heart failure in VA-ECMO, coronavirus disease 2019 infection in VV-ECMO, and non-white race and longer ECMO duration for all patients were associated with PC consultation. We found that despite the benefits of PC, it is underused in this population.
Transesophageal Ultrasound-Guided Normothermic Regional Perfusion in Controlled Donors After Cardiocirculatory Determination of Death
Authors: Antonini Marta Velia , Viola Lorenzo , Circelli Alessandro , Bianchin Matteo , Bolondi Giuliano , Nanni Andrea , Agnoletti Vanni
Published: August 2023

Programs of donation after cardiocirculatory determination of death (DCD) are increasingly established in many countries to increase the availability of organs for transplantation. The use of abdominal normothermic regional reperfusion (A-NRP), shortening total warm ischemia time (tWIT), has been recently recommended by the European Society for Organ Transplantation (ESOT) to decrease the risk potentially associated with transplantation of grafts from DCD donors. We aimed to describe our transesophageal ultrasound (TEU)–guided technique to implement A-NRP in controlled DCD (cDCD) donors through femorofemoral venoarterial extracorporeal support, preventing coronary and cerebral reperfusion occluding the aorta with a balloon. After assessment of the central vascular structures, the use of TEU in real time guides the insertion of the guidewires and the balloon. Moreover, TEU allows us to verify the proper positioning of a venous cannula and aortic balloon. The entire procedure may be performed without the need for fluoroscopic or radiographic evaluation, or limiting the need for fluoroscopic or radiology assistance to a selected scenario of difficult or expected difficult cannulation and/or balloon insertion. The distribution of interventions as antemortem and postmortem reflects the scenario imposed by Italian laws regulating organ procurement in DCD donors.
Extracorporeal Life Support for Cardiogenic Shock in Adult Congenital Heart Disease—An ELSO Registry Analysis
Authors: Rali Aniket S. , Garry Jonah D. , Dieter Raymond A. , Schlendorf Kelly H. , Bacchetta Matthew D. , Zalawadiya Sandip K. , Mishra Kelly , Trahanas John , Frischhertz Benjamin P. , Lindenfeld Joann , Olson Taylor L. , Cedars Ari M. , Anders Marc M. , Tonna Joseph E. , Dolgner Steven J. , Alvis Bret D. , Menachem Jonathan N.
Published: August 2023

There are minimal data on the use of venoarterial extracorporeal membrane life support (VA-ECLS) in adult congenital heart disease (ACHD) patients presenting with cardiogenic shock (CS). This study sought to describe the population of ACHD patients with CS who received VA-ECLS in the Extracorporeal Life Support Organization (ELSO) Registry. This was a retrospective analysis of adult patients with diagnoses of ACHD and CS in ELSO from 2009–2021. Anatomic complexity was categorized using the American College of Cardiology/American Heart Association 2018 guidelines. We described patient characteristics, complications, and outcomes, as well as trends in mortality and VA-ECLS utilization. Of 528 patients who met inclusion criteria, there were 32 patients with high-complexity anatomy, 196 with moderate-complexity anatomy, and 300 with low-complexity anatomy. The median age was 59.6 years (interquartile range, 45.8–68.2). The number of VA-ECLS implants increased from five implants in 2010 to 81 implants in 2021. Overall mortality was 58.3% and decreased year-by-year (β= –2.03 [95% confidence interval, –3.36 to –0.70], p = 0.007). Six patients (1.1%) were bridged to heart transplantation and 21 (4.0%) to durable ventricular assist device. Complications included cardiac arrhythmia/tamponade (21.6%), surgical site bleeding (17.6%), cannula site bleeding (11.4%), limb ischemia (7.4%), and stroke (8.7%). Utilization of VA-ECLS for CS in ACHD patients has increased over time with a trend toward improvement in survival to discharge.
Effect of Hematocrit and Elevated Beat Rate on the 12cc Penn State Pediatric Ventricular Assist Device
Authors: Ponnaluri Sailahari V. , Houtz Brady L. , Raich Emma C. , Good Bryan C. , Deutsch Steven , Weiss William J. , Manning Keefe B.
Published: August 2023

Congenital heart disease affects approximately 40,000 infants annually in the United States with 25% requiring invasive treatment. Due to limited number of donor hearts and treatment options available for children, pediatric ventricular assist devices (PVADs) are used as a bridge to transplant. The 12cc pneumatic Penn State PVAD is optimized to prevent platelet adhesion and thrombus formation at patient nominal conditions; however, children demonstrate variable blood hematocrit and elevated heart rates. Therefore, with pediatric patients exhibiting greater variability, particle image velocimetry is used to evaluate the PVAD with three non-Newtonian hematocrit blood analogs (20%, 40%, and 60%) and at two beat rates (75 and 120 bpm) to understand the device’s performance. The flow fields demonstrate a strong inlet jet that transitions to a solid body rotation during diastole. During systole, the rotation dissipates and reorganizes into an outlet jet. This flow field is consistent across all hematocrits and beat rates but at a higher velocity magnitude during 120 bpm. There are also minor differences in flow field timing and surface washing due to hematocrit. Therefore, despite patient differences in hematocrit or required pumping output, thorough surface washing can be achieved in the PVAD by altering operating conditions, thus reducing platelet adhesion potential.
Inflammation and bone marrow fibrosis: novel immunotherapeutic targets
Authors: Calledda Francesca Rossella , Malara Alessandro , Balduini Alessandra
Published: August 2023

Purpose of review

Myelofibrosis (MF) is primarily driven by constitutive activation of the Janus kinase/signal transducer of activators of transcription (JAK/STAT) pathway. While JAK inhibitors have shown to alleviate disease symptoms, their disease-modifying effects in MF are limited. The only curative treatment remains allogeneic stem cell transplantation, which can be applied to a minority of patients. As a result, there is a need to explore novel targets in MF to facilitate appropriate drug development and therapeutic pathways.

Recent findings

Recent research has focused on identifying novel signals that contribute to the abnormal cross-talk between hematopoietic and stromal cells, which promotes MF and disease progression. Inflammation and immune dysregulation have emerged as key drivers of both the initiation and progression of MF. A growing number of actionable targets has been identified, including cytokines, transcription factors, signalling networks and cell surface-associated molecules. These targets exhibit dysfunctions in malignant and nonmalignant hematopoietic cells, but also in nonhematopoietic cells of the bone marrow. The study of these inflammation-related molecules, in preclinical models and MF patient's samples, is providing novel therapeutic targets.

The identification of immunotherapeutic targets is expanding the therapeutic landscape of MF. This review provides a summary of the most recent advancements in the study of immunotherapeutic targets in MF.