bluuebunny/crossref_metadata_2025 huggingface dataset:
Resective surgical treatment of peri-implantitis: an integrative review
Authors: Belasla Smail , Castro Filipe , Dipalma Gianna , Inchingolo Angelo Michele , Vizanski Amiram , Fernandes Juliana Campos Hasse , Fernandes Gustavo
Published: February 2025

Objectives: This review aimed to analyze the resective surgical treatment of peri-implantitis (PI), evaluating whether it is an effective approach.
Methods: An electronic search was done through the PubMed/MedLine and Online Knowledge Library (B-On) databases from 2011 to 2022. The section of studies was guided by reading the title, the abstract, and the full-text reading of the article. It included randomized controlled trials (RCTs), only clinical studies, and articles in the English language addressing the resective surgical treatment of PI, taking into account the respective parameters: probing depth (PD), bleeding on probing (BoP), marginal bone loss (MBL), and microbiological data.
Results: According to the bibliographic research, we found 325 articles; therefore, only seven were included for full-text reading and integrated into this review. Over 401 implants were studied in 221 patients diagnosed with PI and treated with different resective surgical approaches. Two of the studies included had a 24-month follow-up; one had 12 months; two had a duration of 36 months; one of 3 months; and one study had 6-month follow-up. Regarding the mean age of the patients, an average of 59.3 years was found. All studies included both smoking and non-smoking patients, but these did not show any negative effects on surgical resective treatments for PI. There was a large heterogeneity of methods for treating PI: (1) resective surgery with osteoplasty and surface debridement (implantoplasty, IP); (2) the use of medications/antiseptic (0.12% chlorhexidine + 0.05% cetylpyridinium chlorine) or acids (phosphoric acid 35%); and (3) adjunctive use of laser. The best PD reduction result obtained was found in Bianchini et al.’s study, with a 75% PD decrease. The best result for %BoP reduction was present by Papadopoulos et al., with an average reduction of 73% and 67%, respectively, approaching PI with an isolated “open flap” debridement and adding laser. The best result for MBL was obtained by Englezos et al., with a difference of 4.9 mm.
Conclusion: The resective surgical treatment of PI effectively reduced clinical parameters (PD, BoP, MBl, and inflammation) in the tissues affected by PI. More scientific evidence is limited regarding the success of this treatment of PI; however, additional scientific studies with a more significant number of patients and longer follow-ups are necessary.
Clinical limitations of invisible orthodontics and related responsibilities: a case report
Authors: Russomanno Wanda Lelia , Di Vecchio Stefano , Dapei Beatrice , Otria Liliana
Published: February 2025

Invisible orthodontics, primarily represented by clear aligners, has introduced an aesthetic and minimally invasive approach to managing malocclusions. However, complex cases present significant challenges that require careful planning and strict clinical control to achieve optimal results. This report describes three clinical instances in which the exclusive use of clear aligners allowed for addressing complex orthodontic issues. The clinician must take responsibility for surpassing the limits suggested by the technicians who virtually design the clinical case, customizing the treatment to ensure optimal functional and aesthetic outcomes.
One-stage approach to implant placement in the posterior atrophic maxilla: a review of the literature
Authors: Sleman Nadim , Khalil Ali
Published: February 2025

Rehabilitating the posterior atrophic maxilla presents a significant challenge due to the need to create sufficient bone volume for implant placement. The amount of existing bone height is critical in deciding between a one-stage or two-stage lateral sinus lift procedure.  This review investigates the feasibility of implant placement in the atrophic maxilla during simultaneous maxillary sinus floor augmentation, focusing on implant survival rates, particularly when the bone height is less than 5 mm. By analyzing implant survival rates in this specific scenario, this comprehensive review contributes to the understanding of successful implant integration in the posterior atrophic maxilla.
Atypical swallowing treatment with myofunctional devices
Authors: Martelli Mirko , Russomanno Wanda Lelia , Di Vecchio Stefano , Dapei Beatrice , Gargari Marco , Bollero Patrizio , Dolci Alessandro , Ottria Liliana , Gianfreda Francesco
Published: February 2025

The study, conducted on 420 patients at the Orthodontics division of the U.O.C. of Odontostomatology at Fatebenefratelli San Pietro Hospital in Rome, analyzes the physiological mechanisms of swallowing and evaluates the clinical effectiveness of Froggy Mouth. Froggy Mouth is a removable device made of thermoplastic elastomer, available in three sizes and used to stimulate neural circuits for 15 minutes a day during playful activities. The results show significant improvements in tongue posture and spontaneous resolution of dental malocclusions. Patients, particularly those in the physiological developmental age, achieved predictable and lasting results with minimal commitment. Supporting this are studies by Eric Kandel (Nobel Prize winner in 2000) on the physiological bases of memory and learning, which suggest that involuntary and consistent learning can lead to permanent structural changes in neural circuits. This approach is also confirmed by Dr. Patrick Fellus, the device's creator, who emphasizes the importance of stimulating the posterior part of the tongue. Therefore, Froggy Mouth has proven to be an effective device for correcting atypical swallowing with significant and lasting improvements. However, further studies are needed to confirm these results and explore the mechanisms of action. Multidisciplinary collaboration remains crucial in addressing this complex problem.
Hemodynamic evaluation of Norwood aortic arch geometry compared to native arch controls
Authors: Blanch Granada Aloma , LaDisa John , Samyn Margaret , Cava Joseph , Handler Stephanie S. , Gerardin Jennifer F , Goot Benjamin , Maadooliat Mehdi , Hraška Viktor
Published: February 2025

The Norwood procedure creates a reconstructed neo-aorta to provide unobstructed systemic cardiac output (CO) for Hypoplastic Left Heart Syndrome (HLHS) patients. We used patient-specific computational fluid dynamics (CFD) simulations incorporating physiologic boundary conditions to quantify hemodynamics for reconstructed aortic arch geometries versus native aortic arches from a control group of single ventricle patients. We hypothesized that reconstructed arches from Norwood patients (n=5) would experience significant differences in time-averaged wall shear stress normalized to body surface area (TAWSSnBSA), oscillatory shear index (OSI), energy efficiency (Eeff), and energy loss (EL) versus controls (n=3). CFD simulations were conducted using 3T cardiac magnetic resonance imaging, blood flow and pressure data. Simulations incorporated downstream vascular resistance and compliance to replicate patient physiology. TAWSSnBSA and OSI were quantified longitudinally and circumferentially. Global differences in Eeff and EL were compared. Significance was assessed by Mann?Whitney U test. Norwood patients had higher TAWSSnBSA distal to the transverse arch (TA) at locations of residual narrowing presenting following coarctation correction, as well as higher OSI within ascending aorta (AAo) and TA regions (p<005). EL correlated with patient features including cardiac output (r=0.9) and BT-shunt resistance (r=-0.63) but did not correlate with arch measurements or morphology. These results indicate reconstructed arches from Norwood patients are exposed to altered WSS and energy indices linked to cellular proliferation and inefficiency in prior studies. These results may help clinicians further understand what constitutes an optimally reconstructed arch after confirmation in larger studies
Research priorities for the most premature babies born <25 weeks’ gestation: results of an international priority setting partnership
Authors: Peart Stacey , Ray Olivia , Galletta Laura , Bates Amber , Boland Rosemarie Anne , Davis Peter G , Gale Chris , Johnson Samantha , Kinsella Suzannah , Knight Marian , Owen Louise S , Pallot Louise , Prentice Trisha M , Santhanadass Patricia , Stanbury Kayleigh , Tingay David , Whitehead Clare L , Manley Brett James , Roehr Charles C , Hardy Pollyanna
Published: February 2025

Objective

The James Lind Alliance (JLA) Most Premature Babies Priority Setting Partnership aimed to identify the most important areas for research for infants born <25 weeks’ gestation.

Design

Employing standardised JLA methodology, questions for research were sought from stakeholders via an online survey. Summary questions were formed and checked against existing evidence, with unanswered questions compiled into a second shortlisting survey for prioritisation by stakeholders. A stakeholder consensus workshop was held to determine the top 10 research priorities.

Participants

People with lived experience of neonatal intensive care, including parents/carers of preterm infants and adults born preterm, and healthcare professionals caring for preterm infants across Australia, New Zealand and the UK.

Main outcome measure

The top 10 research priorities for infants born <25 weeks’ gestation.

Results

From 844 questions received from the initial survey, 81 summary questions were formed, of which 80 were unanswered and included in the second shortlisting survey. The 19 top-ranked questions were taken to the final prioritisation workshop, where the top 10 research priorities were determined by people with lived experience and healthcare professionals. The most important research question identified was ‘What can be done in the neonatal intensive care unit to improve long-term health and developmental outcomes?’. Other important areas for research included antenatal interventions and neonatal care at birth, preventing intraventricular haemorrhages, managing pain, postnatal corticosteroid treatment and supporting families.

Conclusions

This study identified the most important areas of research for infants born <25 weeks’ gestation, as determined jointly by stakeholders. These findings should be used to guide future research and funding aimed at improving meaningful outcomes for these infants and their families.
Sacral extramedullary haematopoiesis, radiologically mimicking malignancy
Authors: Shruthi M Maivizhi , Sahoo Biswajit , Nayak Manoj Kumar , Sable Mukund
Published: February 2025

Extramedullary haematopoiesis (EMH) refers to ectopic haematopoietic elements outside the bone marrow. Although it frequently occurs in the liver, spleen and lymph nodes, EMH presenting as a destructive lytic lesion of the sacrum with associated presacral soft tissue mass masquerading as malignancy has been scarcely reported. Imaging workup on a pregnant woman suspected of having haemolytic anaemia revealed a lytic destructive lesion involving the sacrum with homogeneously enhancing presacral soft tissue density mass. A preliminary diagnosis of primary sacral malignancy with liver and splenic metastasis was made; however, additional MRI workup revealed the presacral soft tissue component had similar signal intensity to the adjacent bone marrow, suggesting a haematological disorder like EMH. Whenever a sacral lytic lesion with associated soft tissue presacral mass is encountered, the diagnosis of EMH should be considered in addition to common malignancies involving the sacrococcygeal region. Moreover, MRI and biopsy efficiently diagnose atypical EMH and exclude malignancies.
Long-term survival and rehabilitation of an inoperable patient with extensive type A aortic intramural haematoma, haemopericardium and haemomediastinum
Authors: Illum Emma , Nielsen Lene Hüche , Mortensen Stine Broch , Schneider Ida Ransby
Published: February 2025

We present a case about a man in his 70s who was admitted to the emergency department, haemodynamically unstable and with complaints of chest pain and dyspnoea. A bedside transthoracic echocardiography showed enlargement of the aorta and pericardial effusion, and a subsequent CT of the aorta showed acute type A intramural haematoma (IMH). Emergency surgery was not possible due to comorbidities, and a wait-and-watch strategy (optimal medical therapy, with blood pressure and pain control and repetitive imaging) was selected. He was hospitalised for a total of 16 days, during which his condition stabilised. A 3-month follow-up CT showed complete regression of both the IMH and haemopericardium.
Isolated central nervous system haemophagocytic lymphohistiocytosis with PRF1 gene mutation presenting as fever of unknown origin
Authors: Ganesh Vijay , Mohimen Aneesh , Singh Puneet , Khera Sanjeev
Published: February 2025

Central nervous system (CNS) manifestations are seen in two-thirds cases of familial haemophagocytic lymphohistiocytosis (HLH). Isolated CNS-HLH is described as a rare entity characterised by isolated neuroinflammation without fulfilling diagnostic criteria for evidence of systemic inflammation in mutation-proven familial HLH due to additional genetic modifiers. We describe one such female preschooler who presented to us with the fever of unknown origin spanning over a year and was a diagnostic dilemma. Only two out of the available seven criteria were fulfilled for systemic HLH in the index child. A neuroimaging study done as part of the investigation for seizure led to suspicion of CNS-HLH, and the final diagnosis was established by whole-exome sequencing, which revealed PRF1 mutation. Knowledge about isolated CNS-HLH will help keep it a differential diagnosis in cases where cerebrospinal fluid and neuroimaging findings may suggest a neuroinflammatory disorder. It may lead to early diagnosis and prompt therapy, thereby preventing long-term neurological sequelae.
Implications of an unusual acute leukaemia phenotype on the care of a South African Jehovah’s Witness patient
Authors: van Staden Quintin Andre , van Marle Anne-Cecilia
Published: February 2025

An HIV-negative South African woman in her 50s presented to hospital with fatigue. She had no medical history and is a Jehovah’s Witness. Her full blood count revealed macrocytic anaemia and severe thrombocytopenia. On smear review, there were ±66% blasts with no lineage discerning morphological features. Peripheral blood flow cytometry revealed a blast population that expressed B-cell (CD19 dim, cCD79a dim, CD10 dim, CD22 moderate), T/NK-cell (CD7) and myeloid markers (HLA-DR, CD33, CD117). However, antigen combinations did not fulfil the requirements for specific lineage assignment. The bone marrow aspirate and trephine biopsy were hypercellular with diffuse involvement of blasts. Myeloperoxidase positivity was subsequently confirmed on cytochemistry and immunohistochemistry. The final diagnosis was an acute myeloid leukaemia with expression of aberrant lymphoid markers and monocytic cytochemistry. Delays in lineage assignment can derail timely induction, shake patient confidence and postpone the doctor-patient treatment discussions. This is particularly important in already vulnerable populations.
Diagnosing failure to thrive: 22q11.2 deletion syndrome in identical twins
Authors: Vadakal Siena , Valladares Daniel , Jacobsen Laura
Published: February 2025

22q11.2 deletion syndrome (22q11.2DS) presents with a wide range of clinical manifestations, posing a diagnostic challenge. When cardinal characteristics, such as conotruncal cardiac anomalies or immunodeficiency, are absent, genetic testing may be delayed, postponing interventions to minimise developmental delay. We present a case of monochorionic monoamniotic identical twins diagnosed with de novo 22q11.2DS around 3 months of life, who lacked major characteristics of the disease. Both infants were admitted and discharged multiple times with consistent concerns for failure to thrive (FTT) and aspiration. Twin B was incidentally found to have asymptomatic hypocalcaemia and hypoparathyroidism, leading to a 22q11.2DS diagnosis. Twin A had no symptoms other than FTT and aspiration. This case encourages considering 22q11.2DS in the differential diagnosis for FTT, even when classic symptoms are absent or delayed in presentation. Early recognition allows for timely intervention and better outcomes.
Safe removal of an Allurion swallowable intragastric balloon using an EUS aspiration needle at a non-specialist centre
Authors: Al Tali Merella , Lam Roxane Kiu Yan , Ma Adler Shing Chak , Ochieng Alvin Oduori
Published: February 2025

Intragastric balloons (IGBs) are an increasingly popular management strategy for obesity. The Allurion IGB is a swallowable balloon that spontaneously degrades after residing in the stomach for 4 months. We describe a technique for safe retrieval of an Allurion IGB using endoscopic accessories available at hospitals without a dedicated bariatric service. Nausea and pain are often encountered following IGB insertion. Infrequent but serious adverse events have been noted by NICE. As it does not normally require endoscopic removal, a specific endoscopic kit has not been designed for the Allurion IGB. Devices designed for other types of IGBs have previously been used to extract the Allurion balloon. We achieved a similar outcome using an endoscopic ultrasound (EUS) aspiration needle. Although general anaesthetic for IGB removal remains contentious, we felt this represented the safest strategy given the risk of aspiration as well as the lack of prior experience at our centre.
Concurrent syringocystadenoma papilliferum and basal cell carcinoma arising from nevus sebaceous
Authors: D’Aquila Madeline Laura , Savoie Kate Brackett
Published: February 2025

Here, we report a case of a female adult patient presenting with fleshy lesions on her scalp who underwent elective excision, and two separate lesions were identified on histopathology. She was found to have an unusual concurrent presentation of syringocystadenoma papilliferum (SCAP) and basal cell carcinoma, emphasising the importance of differential diagnosis in cutaneous lesions. While SCAP is benign, the presence of basal cells necessitates careful monitoring and appropriate treatment. Factors contributing to the simultaneous occurrence of these lesions, such as genetic predisposition or environmental factors, warrant further investigation. Clinicians should be aware of the potential for concurrent skin lesions, particularly in sun-exposed areas. Comprehensive evaluation and management are crucial to ensure appropriate treatment and follow-up for patients presenting with multiple skin tumours.
Alveolar capillary dysplasia in a neonate: emphasising the importance of early recognition and biopsy in refractory pulmonary hypertension
Authors: Chougula Priyadarshini Virupaxi , Suryawanshi Pradeep , Bharadwaj Reena , Malshe Nandini
Published: February 2025

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare congenital condition characterised by abnormal development of the pulmonary vasculature. It manifests as severe, refractory hypoxaemia and persistent pulmonary hypertension of the newborn (PPHN), often resulting in rapid progression to respiratory failure and early death despite aggressive interventions. Diagnosis relies on distinct histological features. We present the case of a term neonate born to parents with a history of third-degree consanguinity. The mother, a primigravida, delivered a male neonate vaginally with meconium-stained amniotic fluid. Despite a normal antenatal course, the neonate developed severe respiratory distress shortly after birth, which progressed rapidly. The baby exhibited severe hypercarbia and progressive hypoxia, with clinical and echocardiographic parameters suggestive of PPHN. Aggressive treatment, including high-frequency oscillatory ventilation, surfactant administration, vasodilators and inotropes, did not improve the condition. Persistent severe respiratory acidosis and worsening hypoxia ensued, ultimately leading to death due to refractory respiratory failure. A lung biopsy performed after the neonate’s death confirmed ACD/MVP as the cause. Initially suspected as PPHN secondary to meconium aspiration syndrome, poor response to treatment redirected focus to congenital lung disease. This case emphasises the importance of recognising ACD/MPV in neonates with severe respiratory distress and pulmonary hypertension unresponsive to standard treatments. Early lung biopsy, despite potential risks, can confirm the diagnosis, guide prognosis and avoid ineffective therapies.
Unilateral vulvar oedema after laparoscopy: aetiology and management of a rare complication
Authors: Silverberg Orli Mihal , Hasan Ahmad , Zhu Amy , Pereira Nigel
Published: February 2025

Laparoscopy is frequently used for the minimally invasive treatment of various gynaecological pathologies. Compared with laparotomy, laparoscopy is associated with faster recovery, better incision cosmesis, shorter hospital stays and lower postoperative pain and complications. Vulvar and/or labial oedema is an exceptionally rare postoperative complication of laparoscopy, and in this context, we present the case of a patient who developed unilateral vulvar oedema several hours after an uncomplicated laparoscopic ovarian cystectomy. The patient was managed expectantly, and she made a full recovery within 24 hours. Postlaparoscopic vulvar oedema occurs most commonly after ovarian cystectomy, although it has been described after laparoscopic presacral neurectomy and bilateral salpingectomy. The exact aetiology of this complication remains unclear; however, proposed mechanisms include a patent canal of Nuck or passage of fluid through the subcutaneous tissue to the most dependent area.
Sociocultural constructs and sensorimotor control: a scoping review examining implications for anterior cruciate injury
Authors: Wilford Katherine F , Mena-Iturriaga Maria Jesus , Wainer-Baracatt Macarena Paz , Vugrin Margaret , Hooper Troy L , Brooks Toby , James C Roger , Kim Shinye , Seeber Gesine H , Sizer Phillip S
Published: February 2025

Objective

There is a need to explore the many factors that may have a more subtle influence on, or relationship with, sensorimotor control as it pertains to anterior cruciate ligament injury risk. Due to well-established sex/gender-related differences in sensorimotor control, a close examination of key sociocultural constructs is warranted. This scoping review examined the connection between sociocultural constructs and sensorimotor control.

Design

Scoping review.

Data sources

The following databases were searched: PubMed, Embase, Scopus, CINAHL Complete, Academic Search Complete, Pre-Prints Database and Rehabilitation Reference Center from inception to September 2023. Additionally, relevant grey literature was identified.

Eligibility criteria for selecting studies

Two blinded reviewers independently performed screening, study selection and data extraction. Original references in English, Spanish and German reporting on sociocultural constructs and motor task performance were included.

Results

Data were extracted from 68 included articles. Stereotype threat, gender and race have been examined more than other sociocultural constructs. Sensorimotor control was assessed in upper and lower quarter tasks and physical activity (PA). Task assessment methods varied, often focusing on task completion or completion speed. It is evident that sociocultural constructs influence sensorimotor control, but the exact mechanism remains unclear.

Conclusion

Sociocultural constructs can influence sensorimotor control and PA. Future research should further explore this connection as it relates to biomechanical profiles associated with increased injury risk. Additionally, sociocultural construct inventory scores could be added to existing injury screening programmes to create a more gendered approach to risk mitigation.
Potential role of ChatGPT in simplifying and improving informed consent forms for vaccination: a pilot study conducted in Italy
Authors: Cosma Claudia , Radi Alessio , Cattano Rachele , Zanobini Patrizio , Bonaccorsi Guglielmo , Lorini Chiara , Del Riccio Marco
Published: February 2025

Objectives

Informed consent forms are important for assisting patients in making informed choices regarding medical procedures. Because of their lengthy nature, complexity and specialised terminology, consent forms usually prove challenging for the general public to comprehend. This pilot study aims to use Chat Generative Pretrained Transformer (ChatGPT), a large language model (LLM), to improve the readability and understandability of a consent form for vaccination.

Methods

The study was conducted in Italy, within the Central Tuscany Local Health Unit. Three different consent forms were selected and approved: the standard consent form currently in use (A), a new form totally generated by ChatGPT (B) and a modified version of the standard form created by ChatGPT (C). Healthcare professionals in the vaccination unit were asked to evaluate the consent forms regarding adequacy, comprehensibility and completeness and to give an overall judgement. The Kruskal–Wallis test and Dunn’s test were used to evaluate the median scores of the consent forms across these variables.

Results

Consent forms A and C achieved the top scores in every category; consent form B obtained the lowest score. The median scores were 4.0 for adequacy on consent forms A and C and 3.0 on consent form B. Consent forms A and C received high overall judgement ratings with median scores of 4.0, whereas consent form B received a median score of 3.0.

Conclusions

The findings indicate that LLM tools such as ChatGPT could enhance healthcare communication by improving the clarity and accessibility of consent forms, but the best results are seen when these tools are combined with human knowledge and supervision.
Bladder drugs and risk of dementia: Danish nationwide active comparator study
Authors: Pourhadi Nelsan , Janbek Janet , Gasse Christiane , Laursen Thomas Munk , Meaidi Amani , Jensen-Dahm Christina , Waldemar Gunhild
Published: February 2025

Objective

To assess the association between cumulative use of anticholinergic bladder drugs and risk of all cause dementia compared with non-use and use of the β3 agonist bladder drug, mirabegron.

Design

Danish nationwide active comparator study.

Setting

National Danish registries, 1 January 2000 to 31 December 2022.

Participants

1 29 254 individuals with dementia were matched by age and sex to 646 270 controls without dementia, identified from a cohort of 2.26 million individuals aged 60-75 years between 2000 and 2022 with no previous dementia. Two separate nested case-control populations were studied: the general population and an active comparator population of 58 242 new users of bladder drugs (2198 developed dementia and were matched to 10 990 controls). Information on medication use was based on filled prescriptions and defined daily doses.

Main outcome measures

Conditional logistic regression provided incidence rate ratios for associations between anticholinergic bladder drugs and dementia compared with non-use and mirabegron use adjusted for educational level, cardiovascular disease, diabetes, hypertension, dyslipidaemia, and Charlson Comorbidity Index.

Results

Compared with non-use, ever use of anticholinergic bladder drugs was associated with an increased risk of dementia, with an incidence rate ratio of 1.44 (95% confidence interval (CI) 1.40 to 1.48). The incidence rate ratio increased with increasing cumulative drug use, from 1.31 (95% CI 1.27 to 1.36) for 1-90 defined daily doses to 1.68 (1.59 to 1.76) for >365 defined daily doses. Compared with non-use, all types of anticholinergic bladder drugs were associated with increased incidence rate ratios for dementia: tolterodine 1.43 (95% CI 1.38 to 1.49), solifenacin 1.37 (1.29 to 1.46), trospium 1.52 (1.37 to 1.67), and fesoterodine 1.48 (1.26 to 1.74). The increased risk of dementia with use of anticholinergic bladder drugs was not seen when compared directly with the use of the β3 agonist mirabegron (incidence rate ratio 0.82, 95% CI 0.74 to 0.92), irrespective of the type of anticholinergic drug.

Conclusions

In this study, all types of anticholinergic bladder drugs were associated with an increased risk of dementia compared with non-use, but not when applying the active comparator of the β3 agonist bladder drug mirabegron. These findings highlight the relevance of using an active comparator. Future research should evaluate the risk of cognitive impairment and dementia for both types of bladder drugs.
Time-varying effects of COVID-19 vaccination on symptomatic and asymptomatic infections in a prospective university cohort in the USA
Authors: Robinson Lucy , Feting Anna , Isozaki Isamu , Seyfert-Morgolis Vicki , Jay Mitchell , Kim Edward , Cairns Charles
Published: February 2025

Objectives

Despite widespread vaccination programmes and consensus recommendations, the understanding of the durability of COVID-19 vaccination against ensuing infection and transmission at the individual level is incomplete. The objective of this study was to estimate the effects of time-varying covariates including time since vaccination and symptoms on subsequent positive SARS-CoV-2 test results and assess the stability of these effects between March 2020 and April 2022.

Design

Prospective cohort study.

Setting

Urban university in the USA.

Participants

Drexel University students, faculty, and staff (n=15 527) undergoing mandatory COVID-19 symptom tracking, testing and vaccinations.

Intervention

Systematic symptom tracking and SARS-COV-2 testing starting in September 2020 and mandatory COVID-19 vaccination starting in September 2021.

Main outcomes and measures

COVID-19 vaccine effectiveness modified by time since vaccination and symptoms.

Results

Using fit-for-purpose digitally based symptom and vaccine tracking and mandatory comprehensive testing for SARS-CoV-2 infection, we estimate the time-dependent effects of vaccination, symptoms and covariates on the risk of infection with a Cox proportional hazards model based on calendar time scale. We found a strong protective effect of vaccination against symptomatic infection. However, there was strong evidence of a protective effect against infection only in the first 90 days after completed vaccination, and only against symptomatic versus asymptomatic infection. The overall estimated effect of vaccination within 30 days, including asymptomatic infections, was 37.3% (95% CI 26%, 47%). Vaccine effect modification by reported symptoms and time period was estimated, revealing the protective effect of vaccination within 90 days against symptomatic infection that varied from 90% (95% CI 84%, 94%) to 49%(95% CI −77%, 85%) across time periods.

Conclusions

This study is among the first to prospectively capture complete COVID-19 symptom, testing and vaccination data over a multiyear period. Overall effectiveness of the COVID-19 vaccine against subsequent infection, including transmissible asymptomatic infections, is modest and wanes after 90 days. Vaccination policies may need to take these issues into account.
Association between clinical and pulmonary function features and diagnosis of cough variant asthma: a case–control study
Authors: Ni Kaiwen , Wang Sujie , Zhang Xinlei , Liu Shan , Zhang Ying , Li Yan , Wang Yiting , Yang Junchao
Published: February 2025

Objectives

To compare physical information, such as age, sex, height, weight, body mass index (BMI) and pulmonary function test (PFT) results, between cough variant asthma (CVA) and chronic cough (CC) and establish a diagnostic model of CVA.

Design

A case–control study of patients with suspected CVA enrolled at The First Affiliated Hospital of Zhejiang Chinese Medical University.

Setting

One leader unit of the National Key Specialised Pulmonary Disease Cooperation Group in China.

Participants

Enrolled 545 patients who underwent PFT and bronchial provocation tests.

Outcome measures

We obtained physical information and pulmonary test data and established the model using logistic regression analysis. The Hosmer-Lemeshow goodness-of-fit test, area under the receiver operating characteristic curve (AUC), calibration plot and decision curve analysis were used to evaluate this model. All data were analysed using SPSS V.27 and RStudio software.

Results

The CVA group had more female patients (%) (68.12% vs 51.48%, p value<0.001) and lower height (m) (1.61 (0.40) vs 1.65 (3.26), p value<0.001), weight (kg) (60 (56) vs 63 (85), p value<0.001) and BMI (kg/m2) (22.59 (17.91) vs 23.28 (21.81), p value=0.016) than the CC group. Differences between CVA and CC in forced vital capacity (FVC) in percent predicted values (FVC% pred)(94.4 (57.3) vs 91.60 (94.10), p value=0.006), forced expiratory volume in 1 s/FVC (FEV1/FVC) (%) (84.65±6.82 vs 86.91±6.71, p value<0.001), peak expiratory flow in per cent predicted values (PEF% pred) (93.00 (81.10) vs 98.00 (108.00), p value=0.005), maximal mid-expiratory flow in percent predicted values (MMEF% pred) (74.50 (100.60) vs 90.85 (170.30), p value<0.001), forced expiratory flow (FEF) at 50% of FVC in per cent predicted values (FEF50%pred) (78.9(113.50) vs 93.10(169.80), p value<0.001) and FEF at 75% of FVC in per cent predicted values (FEF75%pred) (69.70 (137.60) vs 85.60 (225.80), p value<0.001) were significant. Patients with CVA were more in number compared with patients with CC at a lower degree (<65%) of MMEF% pred (32.37% vs 14.50%, p value<0.001), FEF50%pred (26.09% vs 13.02%, p value<0.001) and FEF75%pred (39.13% vs 23.67%, p value<0.001). FVC% pred, FEV1/FVC, BMI and MMEF% pred aided in establishing a model with an AUC of 0.733 (95% CI: 0.6829 to 0.7831). The model was tested using internal and external data (p value=0.2865 and p value=0.3197, respectively).

Conclusion

BMI, FVC% pred, FEV1/FVC (%) and MMEF% pred were used to establish the diagnostic model. Our model potentially indicates CVA.

Trial registration number

NCT06199830.
Medication adherence of patients with peripheral arterial disease to antithrombotic therapy: a systematic review
Authors: Wegerif Emilien CJ , Mol Barend M , Ünlü Çağdaş , de Borst Gert J
Published: February 2025

Objectives

Antithrombotic therapy (ATT) prevents atherothrombotic events (AE) in patients with peripheral arterial disease (PAD). However, the benefit may be compromised by poor medication adherence (MA). Therefore, our primary objective was the proportion of patients with PAD with poor MA in literature following patient-reported, pharmacy-reported or laboratory-reported outcome measurements. Poor MA is a combined outcome of primary non-adherence (inability to initiate a prescription), secondary non-adherence (incorrect daily intake) and non-persistence (discontinuation of daily intake).

Design

Systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Data sources

PubMed, EMBASE and Cochrane Library were searched from 2000 to June 2023.

Eligibility criteria

Publications with a (sub)cohort of patients with PAD that reported on patients’ MA to ATT were included.

Data extraction and synthesis

All articles were reviewed on eligibility and methodological quality by two independent researchers. The data were retrieved and collected in Review Manager Web and the percentages were calculated per subgroup. The risk of bias was assessed by using the Cochrane risk-of-bias tool for randomised controlled trials (RCT) and the methodological index for non-randomised studies score for non-RCTs.

Results

We identified 274 potential records of which 10 studies (32 628 patients) were included. Six studies were RCTs and two prospective and two retrospective studies. Most studies scored a moderate risk of bias and had heterogeneous study designs. Poor MA rates ranged between 2% and 45%. Higher rates of poor MA were found in studies with longer follow-ups, pharmacy-reported outcome measurements and registry-based cohorts.

Conclusion

Heterogeneous study designs create a wide dispersion in the proportions. However, poor MA to ATT was found in approximately one-third of the patients with PAD and seemed to increase with longer therapy duration, which highlights the magnitude of this societal challenge. Enhancing patients’ MA to ATT might be a key element in reducing the risk of AE, and therefore, more attention to MA in clinical and research settings is warranted.

PROSPERO registration number

CRD42023431803.
Exploring data security risks associated with trauma medical data within hospitals in China: a qualitative study
Authors: Jin Feifei , Wang Bin , Liao Xiwen , Wang Kai , Huang Wei , Wang Tianbing
Published: February 2025

Objectives

To explore data security risks associated with trauma medical data within hospitals in China, identify and explore the potential underlying factors contributing to these risks and collect suggestions from different stakeholders.

Design

This is a qualitative study involving two types of hospital personnel. Data analysis was performed using thematic analysis.

Setting

The study was conducted in 21 tertiary hospitals from 12 provinces in China, distributed across the eastern, central and western regions of the country. The interviews were conducted between April and August 2022.

Participants

A total of 27 respondents (7 department heads and 20 doctors) were interviewed through stratified purposive sampling.

Results

Data security risks associated with trauma medical data might arise from trauma physicians’ inadequate management of trauma data, the absence of trauma data administrators and data management systems and the lack of security measures for trauma databases. Feasible suggestions included training trauma physicians, establishing a trauma data administrator and a trauma data management system and improving basic data security protection measures.

Conclusions

Determining the risks of trauma medical data security and providing tailored suggestions contribute to the development of healthcare data governance in China. This research establishes a foundation for addressing the current risks related to trauma medical data security and could contribute to efforts to improve the overall capacity of trauma data management in China.
Comparative effectiveness and safety of nifedipine and magnesium sulfate as treatment options for preterm birth: a systematic review and meta-analysis
Authors: Fan Jianing , Lu Qianqian , Chen Jie , Lin Pingping , Fan Chong , Lyv Juan , Zhang Yuhan , Wang Xinyan
Published: February 2025

Objectives

Preterm birth (PTB) is a major cause of neonatal morbidity and mortality worldwide. Effective use of tocolytic agents may improve perinatal outcomes. This study aims to compare the effectiveness and safety of nifedipine and magnesium sulfate in the treatment of PTB.

Design

A systematic review and meta-analysis.

Data sources

China National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, PubMed, Embase, Web of Science and Cochrane were searched from inception to 1 December 2024.

Eligibility criteria

We included randomised controlled trials (RCTs) and cohort studies that compare the efficacy and safety of magnesium sulfate versus nifedipine in treating PTB.

Data extraction and synthesis

Two researchers independently screened studies and extracted data. Risk of bias was assessed using the Cochrane risk-of-bias assessment tool for RCTs and the modified Newcastle-Ottawa Scale for non-randomised studies. Meta-analysis was conducted using Review Manager V.5.4.

Results

In all, 50 articles were included in this review, comprising 6072 cases (n=3014 for the magnesium sulfate group; n=3058 for the nifedipine group). Compared with the magnesium sulfate group, the nifedipine group was more favourable in terms of time to onset of action and prolongation of days of gestation, as well as higher neonatal 1 min Apgar scores. The use of magnesium sulfate was associated with a higher incidence of maternal side effects, specifically tachycardia, flushing, palpitations, dizziness and nausea. In addition, the magnesium sulfate group also showed a higher incidence of neonatal respiratory distress syndrome than the nifedipine group.

Conclusion

Compared with magnesium sulfate, nifedipine is more effective with a faster onset of action and a longer prolonging pregnancy. Additionally, nifedipine may be safer for fewer maternal side effects and better neonatal outcomes. Further studies are needed to confirm the long-term safety and efficacy of these treatments.
Clinical features of overweight in acute-phase hospitalised major depressive disorder with comorbid anxiety: a cross-sectional study
Authors: Zhang Hong , Ma Jun , Wang Jing , Zhu Wenting , Liu Xuebing
Published: February 2025

Objective

This study aimed to investigate the incidence of overweight in patients with major depressive disorder (MDD) comorbid anxiety during the acute phase and to explore associated factors.

Design

Cross-sectional study.

Setting

Wuhan Mental Health Center, China, from July 2017 to August 2022.

Participants

737 hospitalised patients diagnosed with MDD in the acute phase with comorbid anxiety symptoms.

Primary outcome measures

Incidence and clinical correlations of overweight (body mass index (BMI) ≥ 24).

Results

Among the study population, 55.63% were classified as overweight. Binary logistic regression analysis revealed that being married (B=0.28, p value=0.018, OR=1.10), thyroid-stimulating hormone (TSH) levels (B=0.10, p value=0.001, OR=1.10) and low-density lipoprotein cholesterol (LDL-C) levels (B=1.61, p value=0.045, OR=1.18) were significant positive predictors of overweight. Additionally, multiple linear regression indicated that TSH levels (B=0.16, t=3.17, p value=0.002) were positively associated with higher BMI values.

Conclusion

Over half of the hospitalised MDD patients with comorbid anxiety are overweight. Thyroid function emerges as a crucial clinical factor for overweight in this population. Targeted interventions focusing on thyroid function may be a promising approach for managing overweight in these patients.
Characteristics of patients with COVID-19 and smell and/or taste disorders depending on different virus strains: a cross-sectional study in Hiroshima, Japan
Authors: Ota Yumeka , Yumiya Yui , Chimed-Ochir Odgerel , Hasegawa Aya , Yoshida Takahito , Nagata Tatsuhiro , Tanaka Junko , Ohge Hiroki , Kuwabara Masao , Kubo Tatsuhiko
Published: February 2025

Objective

The purpose of the study is to compare the prevalence and associated risk factors of smell and/or taste disorders depending on different virus strains in Hiroshima, Japan.

Design

A cross-sectional design was used.

Setting and participants

Data were collected for all COVID-19-confirmed inpatients admitted to 27 hospitals in Hiroshima prefecture, Japan, between 8 April 2020 and 31 January 2023.

Main outcome measures

Smell and/or taste disorders were indicated by physicians on Hiroshima prefecture COVID-19 version J-SPEED forms completed at discharge.

Results

The COVID-19 data from this period corresponds to the following four strains: Wild-dominant, Alpha-dominant, Delta-dominant and Omicron-dominant. A total of 11 353 confirmed cases were analysed and 1261 cases (11.11%) were reported for smell and/or taste disorders.

Among patients with Wild-dominant, 241 out of 1141 cases (21.12%) exhibited smell and/or taste disorders. For Alpha, 223 out of 1265 cases (17.63%), for Delta, 480 out of 1516 cases (31.66%) and for Omicron, 317 out of 7431 cases (4.27%) presented with smell and/or taste disorders. For all four variants, age<65 (Wild: adjusted odds ratio [aOR]=2.66, 95% confidence interval [CI]:1.82–3.88; Alpha:aOR=2.00, 95%CI:1.39–2.88; Delta: aOR=2.42, 95%CI:1.54–3.81; Omicron: aOR=1.84, 95%CI:1.40–2.42) were related to smell and/or taste disorders. For the Wild and Delta variants, higher odds of reporting smell and/or taste disorders were found among wmen (Wild:aOR=1.63, 95%CI:1.20–2.22; Delta: aOR=1.41, 95%CI:1.10– 1.80).

Conclusions

The proportion of patients with smell and/or taste disorders varied significantly depending on the virus strain. Our findings indicate that the Delta-dominant period had the highest number of patients with these disorders, while the Omicron-dominant period had the lowest. Moreover, our study identified risk factors for smell and/or taste disorders for each variant.
Effect of vestibular rehabilitation treatment (VRT) on patients with unsteadiness after intratympanic gentamicin in Menière’s disease: protocol for a randomised controlled trial
Authors: Tong Qiling , Zhou Yue , Wu Peixia , Yu Huiqian
Published: February 2025

Introduction

Menière’s disease (MD) is a multifactorial disease characterised by recurring vertigo, tinnitus and fluctuating sensorineural hearing loss as typical clinical symptoms. For patients with MD with poor response to non-invasive treatments, it is recommended to use intratympanic gentamicin treatment. The destruction of vestibular organs by gentamicin may cause residual vestibular symptoms, notably unsteadiness. However, most previous clinical studies paid little attention to this issue. Currently, vestibular rehabilitation treatment (VRT) has been proven to be an effective method for controlling vestibular symptoms and has been applied to patients with various vestibular diseases. The aim of this study is to investigate the efficacy of VRT versus usual care in MD patients who experience persistent unsteadiness for 1 month after intratympanic gentamicin treatment, in order to understand whether VRT has a positive impact on balance maintenance and vertigo control in patients with MD.

Methods and analysis

Randomised, assessor-blinded, controlled clinical trials will be used to compare the efficacy of balance function before and after VRT. Patients with MD who experience chronic unsteadiness for 1 month after intratympanic gentamicin treatment will be recruited and receive VRT, mainly including gaze stability training, gait rehabilitation, vestibular habituation training, etc. The outcomes assessments will be conducted at baseline and at eighth week and sixth month post-randomisation. The primary outcome will be the improvements in vestibular function quantified through the Functional Gait Assessment. The secondary outcomes will include sensory organisation test, vestibular laboratory tests (video head impulse test, caloric test and vestibular evoked myogenic potentials), Menière’s disease outcomes questionnaire, visual vertigo analogue scale and vestibular activities and participation measure.

Ethics and dissemination

This trial received ethical approval from the Institutional Review Board of Eye and ENT Hospital of Fudan University (reference number 2024020). The study results will be disseminated via peer-reviewed journals and conferences.

Trial registration number

NCT06143462.