bluuebunny/crossref_metadata_2025 huggingface dataset:
Ocular microvascular alteration in Sjögren’s syndrome treated with hydroxychloroquine: an OCTA clinical study
Authors: Yu Chao , Zou Jie , Ge Qian-Min , Liao Xu-Lin , Pan Yi-Cong , Wu Jie-Li , Su Ting , Zhang Li-Juan , Liang Rong-Bin , Shao Yi
Published: April 2023

Background:

Sjögren’s syndrome (SjS) is a rare autoimmune disease, and despite our knowledge of SjS, we still lack effective treatments. Chloroquine drugs used to treat autoimmune diseases are still the primary medicine for SjS but increase the risk of chloroquine retinopathy.

Objectives:

The objective of this study is to use Optical Coherence Tomography Angiography (OCTA) images to monitor the microvascular changes in the fundus of SjS patients after hydroxychloroquine (HCQ) treatment and the feasibility of using them as diagnostic indicators.

Design:

This is a retrospective observational cohort study.

Methods:

Twelve healthy controls (HCs group; 24 eyes), 12 SjS patients (SjS group; 24 eyes), and 12 SjS patients treated with HCQ (HCQ group; 24 eyes) were recruited. Three-dimensional OCTA images of the retina were collected, and microvascular density was calculated for each eye. OCTA image segmentation for analysis was conducted using the central wheel division method (C1–C6), hemisphere segmentation method (SR, SL, IL, and IR), and the early treatment of diabetic retinopathy study method (ETDRS) (R, S, L, and I).

Results:

Retinal microvascular density was significantly lower in the SjS patients compared to the HCs group ( p < 0.05) and much lower in the HCQ group compared to the SjS patients ( p < 0.05). The SjS and HCQ groups differed in the I, R, SR, IL, and IR regions in the superficial and deep retina and the S region in the superficial retina. The ROC curves of the relationship between the HCs and SjS groups and between the SjS and HCQ groups demonstrated good classification accuracy.

Conclusion:

HCQ may contribute significantly to the microvascular alteration in SjS. Microvascular alteration is a potential marker with adjunctive diagnostic value. The MIR and the OCTA images of I, IR, and C1 regions showed high accuracy in minoring the alteration.
Mediation of Inventory Management in the Relationship Between Knowledge and Firm Performance
Authors: Rashid Aamir , Rasheed Rizwana
Published: April 2023

The role of inventory management is pivotal to improving the overall firm performance, but when it comes to the healthcare sector, then it becomes more crucial. This sector often countenances stocks-outs for life-saving drugs and equipment and competent staff that ascent the mortality rate. Thus, the current research aimed to analyze the effect of knowledge on firm performance through inventory management. For this research, a survey questionnaire with a deductive approach was utilized by collecting data from 200 respondents through multistage cluster sampling. IBM SPSS AMOS version 22.0 as a statistical tool was utilized to analyze the measurement model. Results of this research revealed a significant and positive mediation effect on the relationship between knowledge and firm performance. Finally, the results showed that the professionally well-equipped staff, accurate inventories, and stock availability improves the service quality and reduce the cost. Academicians, researchers, provincial healthcare ministries, state-funded organizations, and hospitals will all benefit from this research, which will also add to the current body of knowledge.
Conceptualizing and Developing the Secondary Transition Fidelity Assessment to Support Transition Programming and Practice
Authors: Mazzotti Valerie L. , Morningstar Mary E. , Lombardi Allison , Raley Sheida K. , Rowe Dawn A. , Poppen Marcus , Reardon Kyle , Carlson Sarah R. , Unruh Deanne , Monahan Jessica , Rousey Jessica G. , Vicchio Janie N. , Test David W.
Published: April 2023

In this article, we describe the conceptualization and development of the Secondary Transition Fidelity Assessment (STFA), a measure intended for use by high school leadership teams to examine secondary programs and practices demonstrated by research to lead to meaningful outcomes for secondary students with and without disabilities. We describe our conceptualization and development efforts, which resulted in a measure with six critical features: adolescent engagement, district-level capacity, school-level capacity, community engagement, family engagement, and professional capacity. Based on stakeholder feedback, we revised the STFA and developed an instruction manual and action planning guide to support the self-evaluation of secondary programs and practices using data from the STFA. Recommendations for the field related to research, policy, and practice are provided.
Somali Refugees, Informality, and Self-initiative at Local Integration in Ethiopia and Kenya
Authors: Muhumad Abdirahman A. , Jaji Rose
Published: April 2023

As the number of refugees has continued to grow in post-independence Africa, host governments across the continent have developed stringent refugee policies that are detached from historical transborder relationships in which refugees and host communities interact. The stringent policies are underpinned by the assumption that host communities view refugees from the state-centric perspective of non-citizens as undesirable foreigners or outsiders. Host governments’ insistence that the solution lies in refugees eventually repatriating to their countries of origin drives refugee policies that undermine solutions instead of building and capitalizing on solutions generated at the level of host communities.

The exclusion of local histories and social dynamics in host regions has led to policies that neither hold up to humanitarian standards nor serve their intended non-integration objectives. Some host governments are reluctant to implement local integration and have maintained exclusionary policies for a long period of time when the realities in the host communities show that refugees are included and participate in various community activities. Host governments perpetuate this disjuncture between policy and local practice by assuming or pretending that refugees will wait for repatriation instead of finding solutions in the host countries where some of them have lived for decades. Contrary to the non-integration objectives of official encampment policies and scholarship that assumes that the absence of official integration policies deters integration, many refugees have defied the stereotypical portrayal of refugees as “bare life” which denotes prioritization of mere survival as opposed to the quality of life. They have managed to find solutions and live their lives as active and productive members of their host countries.

This article specifically addresses the situation of Somali refugees in Ethiopia and Kenya. It argues that the absence of local integration policies or reluctance by host governments to implement them where they exist does not automatically mean that refugees are unable to integrate in their host countries. Host government policies against integration are mediated by refugees’ self-initiative and resourcefulness. These characteristics are facilitated by host communities whose ties and mutual dependence with refugees, cultivated pre- and post-flight, play an important role in engendering solidarity and circumventing policies that hamper refugees’ quest for long-term solutions.

Based on the research findings, the paper recommends that host governments pursue policies that are informed by the shared needs and interests between refugee and host communities and that build on the social dynamics and relationships in refugee-hosting regions.
Patterns of Refugees’ Organization Amid Protracted Displacement: An Understanding From Jordan, Lebanon, and Turkey
Authors: El-Abed Oroub , Najdi Watfa , Hoshmand Mustafa
Published: April 2023

In recent years, increasing attention has been paid to the ways refugees in displacement manage to organize themselves and act upon their needs. The growing recognition in the UN system of the importance of localization of aid and the potential role played by local actors has given refugee-led organizations (RLO) a space to grow. In this paper, we analyze refugee agency and solidarity through the organization of the refugee communities in Turkey, Jordan, and Lebanon. In doing so, we examine: (1) the reasons behind the creation of these organizations and their dynamics; (2) the role of host states toward this drive to organize refugee communities; and (3) the patterns, forms, and structures that these organizations take in providing humanitarian services, as well as community support and empowerment.
Linguistic markers of autism spectrum conditions in narratives: A comprehensive analysis
Authors: Schroeder Kristen , Rosselló Joana , Torrades Teresa Ribalta , Hinzen Wolfram
Published: April 2023

Background & Aims: Narratives are regularly elicited as part of standardized assessments for autism spectrum conditions (ASC) such as the ADOS, but have rarely been utilized as linguistic data in their own right. We here aimed for a specific and comprehensive quantitative linguistic profile of such narratives across nominal, verbal, and clausal domains of grammatical organization, and error patterns. Methods: We manually transcribed and annotated narratives elicited from the ADOS from a sample of bilingual autistic Spanish-Catalan children ( n = 18), matched with typically developing controls (n = 18) on vocabulary-based verbal IQ. Results: Results revealed fewer relative clauses and more frequent errors in referential specificity and non-relational content-word choice in ASC. Frequent error types are also discussed qualitatively. Conclusions & Implications: These findings, based on more finegrained linguistically defined variables, help to disentangle previous inconsistencies in the literature, and to better situate language changes in the spectrum of neurocognitive changes in this population.
Complexities of multispecies coexistence: Animal diseases and diverging modes of ordering at the wildlife–livestock interface in Southern Africa
Authors: van Dam Arvid , van Engelen Wisse , Müller-Mahn Detlef , Agha Sheila , Junglen Sandra , Borgemeister Christian , Bollig Michael
Published: April 2023

The transmission of diseases between wildlife and livestock poses a major challenge to both conservation and livestock sectors in Southern Africa. Focusing on the cases of foot and mouth disease and trypanosomiasis in the Kavango–Zambezi Transfrontier Conservation Area, this article explores the complexity of coexistence between humans, livestock, wildlife, vectors and pathogens. Multispecies coexistence, we suggest, is best understood not only through the relations between species, but also as characterized by a collision of modes of ordering. Drawing on expert interviews and a discourse analysis of policy documents and reports, we identify three modes of ordering coexistence: a categorical and increasingly disfavoured mode of species eradication, a territorial mode focused on containment and separation, and an infrastructural mode premised on connectivity between populations, landscapes and ecosystems. Together, these different modes of ordering pose a challenge to scientific knowledge production; where uncertainties present themselves not so much in the form of ignorance or knowledge gaps, but rather in the form of ambiguity: of knowing diseases and species differently. In this view, living with pathogens becomes a matter of recognizing the partiality of knowledge and the positionality of knowledge producers and users, as well as highlighting potential sites of alignment.
Assessment of community pharmacists’ knowledge of the differences between generic drugs and biosimilars: A pilot cross-sectional study
Authors: Awada Sanaa , Sayah Roudy , Mansour Maribelle , Nabhane Cynthia , Hatem Georges
Published: April 2023

Background:

Pharmacists’ knowledge of the differences in the characteristics between generic drugs and biosimilars is essential to ensure good practice and lower pharmaceutical bills.

Objectives:

This study aimed to evaluate community pharmacists’ knowledge and perception of using and substituting biosimilars and generic drugs.

Design:

A pilot cross-sectional study was performed over 2 months (August-September 2022) targeting community pharmacists in their work site.

Method:

Data were collected using a uniform survey given to 75 pharmacists. Afterward, a knowledge score was generated by summing several individual scores of statements regarding generic drugs and biosimilars.

Results:

Overall, pharmacists had moderate to low knowledge scores, namely, with the statements tackling biosimilars. No significance was reported between these scores and their general characteristics. As regards their substitution, most pharmacists agreed to substitute generic drugs if the brand was not available, while the doctor’s approval was crucial for biosimilar switching. Most participants perceived equal effectiveness of generic drugs but similar to a lower one for biosimilars compared to the reference medication. Pharmacists highlighted the need to include generic drugs and biosimilars in the continuing education program and workshops.

Conclusion:

To promote their use, improving pharmacists’ knowledge can help overcome misconceptions about generic drugs and biosimilars. It is recommended that health care stakeholders focus on fostering good understanding among pharmacists to enhance access to medication.
Identification of novel biomarkers linking depressive disorder and Alzheimer’s disease based on an integrative bioinformatics analysis
Authors: Song Jin , Ma Zilong , Zhang Huishi , Liang Ting , Zhang Jun
Published: April 2023

Background

Previous reports revealed that a history of major depressive disorder (MDD) increased the risk of Alzheimer’s disease (AD). The immune disorder is associated with MDD and AD pathophysiology. We aimed to identify differentially expressed immune-related genes (DEIRGs) that are involved in the pathogenesis of MDD and AD.

Methods

We downloaded mRNA expression profiles (GSE76826 and GSE5281) from the Gene Expression Omnibus (GEO) database. The R software was used to identify DEIRGs for the two diseases separately. Functional enrichment analysis and PPI network of DEIRGs were performed. Finally, the relationship between shared DEIRGs and immune infiltrates of AD and MDD were analyzed, respectively.

Results

A total of 121 DEIRGs linking AD and MDD were identified. These genes were significantly enriched in immune-related pathways, such as the JAK-STAT signaling pathway, regulation of chemotaxis, chemotaxis, cytokine-cytokine receptor interaction, and primary immunodeficiency. Furthermore, three shared DEIRGs (IL1R1, CHGB, and NRG1) were identified. Correlation analysis between DEIRGs and immune cells revealed that IL1R1 and NRG1 had a negative or positive correlation with some immune cells both in AD and MDD.

Conclusion

Both DEIRGs and immune cell infiltrations play a vital role in the pathogenesis of AD and MDD. Our findings indicated that there are common genes and biological processes between MDD and AD, which provides a theoretical basis for the study of the comorbidity of MDD and AD.
Effect of acuity level and patient characteristics on bowel preparation quality: a retrospective cohort study of inpatient colonoscopies
Authors: Kabir Christopher , Salazar Leon Mariani , Ndiaye Cindy , Flicker Michael
Published: April 2023

Background and aims

Colonoscopy is the primary method to detect mucosal abnormalities in the colon, rectum, and terminal ileum. Inadequate bowel preparation is a common problem and can impede successful visualization during colonoscopy. Although studies identified hospitalization as a predictor of inadequate bowel preparation, acuity of care vary greatly within this patient population. The current study aims to examine the effect of patient characteristics and care level predictors on inadequate bowel preparation quality within the inpatient setting.

Methods

This retrospective study was conducted in a single urban level 1 trauma medical center and included adult patients undergoing diagnostic colonoscopy while admitted in the hospital from January 1, 2015 to June 30, 2020. We examined the level of inpatient care between the General Medical Floor (GMF), Intensive Care Units (ICU) and Telemetry Unit (TU) and assessed this association with bowel preparation quality, adjusting for known and unknown predictors.

Results

Of 538 patients undergoing colonoscopy, 47.4% were admitted into TU, 43.7% into GMF and 8.9% into ICU. For the entire sample, 72.7% of patients achieved good or excellent preparation and quality of bowel preparation differed by care level (P = 0.01). Patients from the critical care units were less likely to achieve adequate bowel preparation when compared to GMF (Odds Ratio [OR] 0.36; 95% Confidence Interval [CI] 0.17,0.77), after adjusting for patient characteristics, medications, physical status, and preparation regimen. No significant difference in Bowel Preparation Quality (BPQ) was identified between patients from GMF and TU (OR 0.96; 95%CI 0.61, 1.52). Furthermore, adequate BPQ was associated with withdrawal time and cecal intubation, but not higher adenoma detection rates.

Conclusions

Results suggest the ICU setting is an independent predictor for inadequate bowel preparation and patients with prior opioid and laxative use may be more likely to have inadequate bowel preparation in the hospital. Future interventions should prioritize preprocedural clinician meetings for critical care unit patients, including a more detailed readiness assessment and thorough medication history.
Survival and predictors of mortality after completion of TB treatment among people living with HIV: a 5-year analytical cohort
Authors: Lumu Ivan , Musaazi Joseph , Semeere Aggrey , Handel Ian , Castelnuovo Barbara
Published: April 2023

Background

After completion of TB treatment patients may remain at risk of co-morbidity and mortality. We determined the survival and predictors of all-cause mortality after completing TB treatment among ART-experienced patients.

Methods

This was a retrospective cohort analysis of all ART experienced patients who completed TB treatment at a specialist HIV clinic in Uganda, between 2009 and 2014. The patients were followed for five years after TB treatment. We determined the cumulative probability of death, and predictors of mortality using Kaplan-Meier methods and Cox proportional hazard models, respectively.

Results

A total 1,287 patients completed TB treatment between 2009 and 2014, of which 1,111 were included in the analysis. At TB treatment completion, the median age was 36 years (IQR: 31–42), 563 (50.7%) were males, and median CD4 cell count was 235 cells/mL (IQR: 139–366). The person-time at risk was 4410.60 person-years. The all-cause mortality rate was 15.42 (95% CI: 12.14–19.59) per 1000 person-years. The probability of death at five years was 6.9% (95%CI: 5.5- 8.8). In the multivariable analysis, CD4 count < 200 cells/mL was a predictor of all-cause mortality (aHR = 1.81, 95%CI:1.06–3.11, p = 0.03) alongside history of retreatment (aHR = 2.12, 95%CI: 1.16–3.85, p = 0.01).

Conclusion

Survival post TB treatment in ART experienced PLHIV is reasonably good. Most deaths occur within two years after TB treatment completion. Patients with a low CD4 count and those with a history of retreatment have an increased risk of mortality which underscores the need for TB prophylaxis, detailed assessment, and close monitoring after completion of TB treatment.
Longitudinal quantification of choriocapillaris flow deficits in persistent placoid maculopathy: a case report
Authors: Li Jianqing , Wu Chris Y. , Shen Mengxi , Bynoe Leon , Nezgoda Joseph , Liu Jeremy , Cheng Yuxuan , Sporysheva Anna , Albini Thomas , Wang Ruikang K. , Gregori Giovanni , Rosenfeld Philip J.
Published: April 2023

Background

Persistent placoid maculopathy (PPM) is a rare idiopathic chorioretinopathy characterized by choriocapillaris (CC) hypoperfusion. In a case of PPM, we quantified CC flow deficits (FDs) over time and observed an increase in CC perfusion as the visual acuity and outer photoreceptor anatomy improved.

Case presentation

A 58-year-old man was diagnosed with PPM in both eyes based on the patient’s clinical presentation and imaging. He presented with sudden-onset central scotomas in both eyes for about two months. On referral, the best corrected visual acuity (BCVA) was 20/20 in the right eye and 20/100 in the left eye. Plaque-like yellowish macular lesions were observed bilaterally and autofluorescence imaging showed bilateral hyperautofluorescent lesions. Fluorescein angiography (FA) revealed early-phase hyper-fluorescent staining that intensified in the late phases, while indocyanine green angiography (ICGA) displayed persistent hypofluorescence in both eyes. Foveal centered swept source optical coherence tomography (SS-OCT) B-scans showed bilateral focal deposits on the level of retinal pigment epithelium (RPE) and disruption of outer photoreceptor bands. The CC FDs were quantified on SS-OCT angiography (SS-OCTA) images using a previously published algorithm that was validated. The CC FD% was 12.52% in the right eye and 14.64% in the left eye within a 5 mm circle centered on the fovea. After 5 months of steroid treatment, BCVA remained 20/20 in the right eye and improved to 20/25 in the left eye. On OCT imaging, the outer photoreceptor bands fully recovered in both eyes, while some focal deposits remained along the RPE in the left eye. The CC perfusion in both eyes improved, with CC FD% decreasing from 12.52% to 9.16% in the right eye and from 14.64% to 9.34% in the left eye.

Conclusions

Significant impairment of macular CC perfusion was detected after the onset of PPM. Improvement in central macular CC perfusion corresponded with improvements in BCVA and outer retinal anatomy. Our findings suggest that imaging and quantification of CC FDs could serve as a valuable imaging strategy for diagnosing PPM and for following disease progression.
Quantitative evaluation of anisometropic amblyopia treatment efficacy by coupling multiple visual functions via CRITIC algorithm
Authors: Zhi Ying , Cai Min , Du Rui , Qiao Ying , Zheng Xiaowei , Xu Guanghua , Yan Li , Wu Dianpeng
Published: April 2023

Background

The evaluation of amblyopia treatment efficacy is essential for amblyopia prevention, control, and rehabilitation.

Methods

To evaluate the amblyopia treatment efficacy more precisely and quantitatively, this study recorded four visual function examination results, i.e., visual acuity, binocular rivalry balance point, perceptual eye position, and stereopsis before and after amblyopia treatment.

Results

We found that all these four results had a significant difference between before and after treatment, and the relationship between visual acuity improvement and the difference of BRBP, PEP, and stereoacuity cannot show a fitting correlation regarding the widely used index of visual acuity as the standard of treatment efficacy. By using the Criteria Importance Through Inter-criteria Correlation (CRITIC) method, a more comprehensive and quantitative index by coupling the selected four indexes with objective weights was obtained for further training efficacy representation, and the validation dataset also showed a good performance.

Conclusions

This study proved that our proposed coupling method based on different visual function examination results via the CRITIC algorithm is a potential means to quantify the amblyopia treatment efficacy.
Epidemiology of mental health disorders in the citizens of Tehran: a report from Tehran Cohort Study
Authors: Bahrami Mahboobe , Jalali Arash , Ayati Aryan , Shafiee Akbar , Alaedini Farshid , Saadat Soheil , Masoudkabir Farzad , Shahmansouri Nazila , Noorbala Ahmadali
Published: April 2023

Background

Mental health disorders (MHD) impose a considerable burden on public health systems. With an increasing worldwide trend in urbanization, urban mental health stressors are affecting a larger population. In this study, we evaluated the epidemiology of mental health disorders in the citizens of Tehran using the Tehran Cohort Study (TeCS) data.

Methods

We utilized data from the TeCS recruitment phase. A total of 10,247 permanent residents of Tehran metropolitan (aged 15 years and older) were enrolled in the study from March 2016 to 2019 via systematic random sampling from all 22 districts of Tehran. The participant's demographic, socioeconomic, and medical characteristics were evaluated by conducting comprehensive interviews. The standardized Persian version of the General Health Questionnaire version 28 was utilized to assess the mental status of the patients according to four central mental health disorders.

Results

Almost 37.1% of Tehran residents suffered mental health problems (45.0% of women and 28.0% of men). The greatest incidence of MHDs was seen in the 25–34 and over 75 age groups. The most common mental health disorders were depression (43%) and anxiety (40%), followed by somatization (30%) and social dysfunction (8.1%). Mental health disorders were more frequent in the southeast regions of the city.

Conclusions

Tehran residents have a significantly higher rate of mental health disorders compared to nationwide studies, with an estimated 2.7 million citizens requiring mental health care services. Awareness of mental health disorders and identifying vulnerable groups are crucial in developing mental health care programs by public health authorities.
Dietary sodium to potassium ratio is an independent predictor of cardiovascular events: a longitudinal follow-up study
Authors: Mosallanezhad Zahra , Jalali Mohammad , Bahadoran Zahra , Mirmiran Parvin , Azizi Fereidoun
Published: April 2023

Background

The current prospective cohort study aimed to explore the potential associations between dietary sodium (Na), potassium (K), and sodium-to-potassium (Na-to-K) ratio with an incidence risk of cardiovascular disease (CVD) among Iranian adults.

Methods

The participants of the Tehran Lipid and Glucose Study (men and women aged 30–84 years, n = 2050), free of CVD at baseline (2006–2008) were included. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), and incident CVD (i.e., coronary heart disease, stroke, and CVD mortality) were documented up to March 2018. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) regarding the association between dietary Na, K, and Na-to-K ratio with CVD events.

Results

During a median follow-up of 10.6 years, 10.14% of participants experienced CVD outcomes. A 41% increased risk of CVD in relation to each increase in 1000 mg/d of Na intake. In the fully-adjusted model, higher Na intake (> 4143 versus < 3049 mg/d) was significantly related to the increased risk of CVD (HR = 1.99, 95% CI = 1.06–3.74). Independent of the well-known risk factors, a 56% reduced risk of CVD was observed in the participants with a higher dietary K intake (HR = 0.44, 95% CI = 0.20–0.94). A Higher Na-to-K ratio was associated with an increased risk of CVD (HR = 1.99, 95% CI = 1.13–3.52).

Conclusion

Our study showed that the Na-to-K ratio might independently predict future risk of CVD events in adults.
Can transbronchial lung cryobiopsy benefit adaptive treatment strategies in connective tissue disease-associated interstitial lung disease?
Authors: Yamakawa Hideaki , Takemura Tamiko , Sato Shintaro , Takatsuka Makiko , Ohta Hiroki , Nishizawa Tomotaka , Oba Tomohiro , Kawabe Rie , Akasaka Keiichi , Horikoshi Masanobu , Amano Masako , Kuwano Kazuyoshi , Matsushima Hidekazu
Published: April 2023

Background

Some patients with connective tissue disease (CTD)-associated interstitial lung disease (ILD) progress to pulmonary fibrosis over their disease course despite initial improvement, potentially indicating a poor prognosis. Transbronchial lung cryobiopsy (TBLC) is a new bioptic approach used in diffuse parenchymal lung diseases. This study of CTD-ILD assessed the utility of TBLC in determining therapeutic decision-making strategies.

Methods

We analyzed medical records of 31 consecutive CTD-ILD patients who underwent TBLC focusing on radio-pathological correlation and disease course. A TBLC-based usual interstitial pneumonia (UIP) score was used that assessed three morphologic descriptors: i) patchy fibrosis, ii) fibroblastic foci, and iii) honeycombing.

Results

Among the patients with CTD-ILD, 3 had rheumatoid arthritis, 2 systemic sclerosis, 5 polymyositis/dermatomyositis, 8 anti-synthetase syndrome, 6 Sjögren’s syndrome, and 5 had microscopic polyangiitis. Pulmonary function test results showed a mean %FVC of 82.4% and %DLCO of 67.7%. Among the 10 CTD patients and TBLC-proven pathological UIP, 3 patients had prominent inflammatory cells in addition to a framework of UIP, and pulmonary function of most patients improved with anti-inflammatory agents. Six (40%) of 15 patients with TBLC-based UIP score ≥ 1 had a progressive disease course during follow-up, of whom 4 patients received anti-fibrotic agents.

Conclusions

TBLC in patients with CTD-ILD can help determine an appropriate medication strategy, particularly when UIP-like lesions are present. TBLC may be useful when judging which agents to prioritize, anti-inflammatory or anti-fibrotic, is difficult. Moreover, additional information from TBLC may be beneficial when considering early intervention with anti-fibrotic agents in clinical practice.
The association of rod curvature with postoperative outcomes in patients undergoing posterior lumbar interbody fusion for spinal stenosis: a retrospective case–control study
Authors: Han Lin , Ma Hongdao , Li Qisheng , Yuan Jincan , Yang Haisong , Qin Yuchen , Lu Xuhua
Published: April 2023

Background

Restoration of sagittal balance is a crucial consideration in posterior lumbar interbody fusion (PLIF) surgery and adverse postoperative outcomes are associated with inadequate restoration of sagittal alignment. However, there remains a shortage of substantial evidence regarding the effect of rod curvature on both sagittal spinopelvic radiographic parameters and clinical outcomes.

Method

A retrospective case–control study was conducted in this study. Patient demographics (age, gender, height, weight and BMI), surgical characteristics (number of fused levels, surgical time, blood loss and hospital stay) and radiographic parameters (lumbar lordosis [LL], sacral slope [SS], pelvic incidence [PI], pelvic tilt [PT], PI-LL, Cobb angle of fused segments [Cobb], rod curvature [RC], Posterior tangent angle of fused segments [PTA] and RC-PTA) were analyzed.

Results

Patients in the abnormal group had older mean age and suffered more blood loss than those in the normal group. In addition, RC and RC-PTA were significantly lower in the abnormal group compared to the normal group. Multivariate regression analysis revealed that lower age (OR = 0.94; 95% CI: 0.89–0.99; P = 0.0187), lower PTA (OR = 0.91; 95% CI: 0.85–0.96; P = 0.0015) and higher RC (OR = 1.35; 95% CI: 1.20–1.51; P < 0.0001) were related to higher odds of better surgical outcomes. The receiver operating characteristic curve analysis showed that the ROC curve (AUC) for predicting outcomes of surgery by RC classifier was 0.851 (0.769–0.932).

Conclusions

In patients who underwent PLIF surgery for lumbar spinal stenosis, those who had a satisfactory postoperative outcome tended to be younger, had lower blood loss, and higher values of RC and RC-PTA compared to those who had poor recovery and required revision surgery. Additionally, RC was found to be a reliable predictor of postoperative outcomes.
Gender differences in illness perceptions and disease management in patients with gout, results from a questionnaire study in Western Sweden
Authors: Bergsten Ulrika , Dehlin Mats , Klingberg Eva , Landgren Anton J. , Jacobsson Lennart T. H.
Published: April 2023

Background

Aims were to examine gender differences in patients with gout with regard to a) self-reported gout severity, b) illness perceptions (IP), c) impact on daily activities and Quality of Life (QoL), d) advice from healthcare professionals, e) having changed dietary- or alcohol habits.

Methods

Adult patients with gout identified in primary and secondary care in Sweden between 2015 and 2017 (n = 1589) were sent a questionnaire about demographics, gout disease severity, IP (using the Brief Illness Perception Questionnaire, (B-IPQ)) and disease management. T-tests, Chi square tests, ANalysis Of VAriance (ANOVA) and linear regression models were used for gender comparisons.

Results

Eight hundred sixty-eight patients responded to the questionnaire. Women, n = 177 (20%), experienced more severe gout symptoms (p = 0.011), albeit similar frequencies of flares compared to men. Women experienced modest but significantly worse IP with regard to consequences, identity, concerns and emotional response (p < 0.05) as well as daily activities such as sleeping (p < 0.001) and walking (p = 0.042) and QoL (p = 0.004). Despite this and a higher frequency of obesity in women (38 vs 21%, P < 0.001) and alcohol consumption in men (p < 0.001), obese women had received significantly less advice regarding weight reduction (47 vs 65%, p = 0.041) compared to obese men. On the other hand, women reported having acted on dietary advice to a larger degree.

Conclusions

Despite only modestly worse gout severity and perception, women appear to have been given less information regarding self-management than men. These gender differences should be given attention and addressed in clinical care.
Consistency of serial ultrasonographic joint tissue measurements by the Joint tissueActivity and Damage Exam (JADE) protocol in relation to hemophilic joint health parameters
Authors: Barnes Richard F. W. , Aguero Peter , Hanacek Cris , Flores Andres , Steiner Bruno , Bailey Cindy , Quon Doris V. , Kruse-Jarres Rebecca , von Drygalski Annette
Published: April 2023

Objectives

The Joint tissueActivity and Damage Exam (JADE) is a point-of-care (POC) musculoskeletal ultrasound (MSKUS) protocol for non-radiologists to evaluate hemophilic arthopathy. Our aim was to determine the consistency of cross-sectional analyses of direct tissue measurements (JADE protocol) and clinical Hemophilia Joint Health Score [HJHS] and functional joint assessments (arc) at three clinic visits.

Methods

We prospectively studied adults (n = 44) with hemophilia (A or B) of any severity and arthropathy at 3 North American sites. We assessed HJHS, total arc, and JADE parameters (bilateral elbows, ankles, and knees) at study entry, at ≈12–18 months, and at ≈24–36 months, and used MSKUS to evaluate painful episodes between study visits. JADE measurements included osteochondral alterations, cartilage thickness, and soft tissue expansion at sentinel positions. Associations between joint HJHS and total arc with each JADE variable were examined with random intercept models.

Results

At each visit increasing HJHS and decreasing total arc were associated in the expected direction with increasing length of OAs and soft tissue expansion in all joints, and decreasing cartilage thickness in the knee. However, HJHS associations with cartilage thickness were U-shaped for elbow and ankle (i.e. cartilage thinning and thickening). Associations between total arc and cartilage thickness followed a similar curve. (Near) normal levels of both joint parameters (HJHS and total arc) were associated with normal ranges of cartilage thickness. JADE views were also helpful to detect hemarthrosis in association with joint pains.

Conclusions

POC MSKUS applying direct tissue measurements using the JADE protocol provided reproducible cross-sectional associations with joint health outcomes on three visits. These findings advance protocol validation and enable iterative adaptations resulting in JADE protocol version 2.
The comparison of the Effect of double reverse traction repositor (DRTR) and traction table assisted Anterograde Intramedullary nail in treatment of femoral shaft fractures
Authors: Song Wei , Wang Yueying , Chen Weihao , Zhang Zhenqian , Liu Xuzhou , Ou Guoji , Cheng Benqiang , Lin Hongsheng
Published: April 2023

Objective

The objective of this study was to compare the clinical efficacy of DRTR (Double Reverse Traction Repositor, DRTR)and traction table in the treatment of femoral shaft fractures with the aid of AN-IMN (Antegrade intramedullary nailing).

Patients and Methods

In this study, patients with femoral shaft fractures admitted to the Department of Orthopedics at Zhaoqing First People’s Hospital from May 2018 to October 2022 were recruited. All patients were treated with anterograde intramedullary nailing, with 23 patients in the DRTR-assisted group and 21 patients in the traction table-assisted group. The demographic characteristics, fracture classification, intraoperative data, postoperative data, and prognostic indicators of the two groups were recorded and analyzed retrospectively. All procedures were performed by the same team of experienced physicians.

Results

All the patients in the two groups were followed up for more than 12 months. Both traction methods could provide stable traction for the operator during AN-IMN, and there was no significant difference in demographic characteristics and fracture classification. The intraoperative fluoroscopy times and opening reduction rate of the DRTR group were lower than those of the traction table group (P < 0.05), and the postoperative Harris Hip Score, as well as the Lyshol Lysholm knee function Score of the DRTR group, were significantly higher than the traction table group members (P < 0.05). Postoperative complications such as perineal soft tissue injury and lateral femoral cutaneous nerve injury occurred in the traction table group, but not in the DRTR group.

Conclusion

DRTR can safely and effectively provide continuous and stable traction in the femoral shaft fractures surgery, and outperforms the traction table in the number of intraoperative fluoroscopy, opening reduction rate, reduction of complications, and postoperative joint function score.
Identification and susceptibility testing of oral candidiasis in advanced cancer patients
Authors: Monsen Ragnhild Elisabeth , Kristoffersen Anne Karin , Gay Caryl L. , Herlofson Bente Brokstad , Fjeld Katrine Gahre , Hove Lene Hystad , Nordgarden Hilde , Tollisen Anita , Lerdal Anners , Enersen Morten
Published: April 2023

Background

Patients with advanced cancer are prone to develop different opportunistic oral infection due to anti-cancer treatment or the malignancies themselves. Studies of oral fungal samples show an increased prevalence of non-Candida albicans species in mixed oral infections with Candida albicans. Non-C. albicans and C. albicans are associated with varying degrees of resistance to azoles, which may have implications for treatment. This study aimed to assess the diversity and antifungal susceptibility of Candida species detected in the oral cavity.

Methods

An observational study with microbiological analysis was conducted. Clinical fungal isolates were collected from patients in a hospice unit in 2014–2016. Isolates were re-grown on chromID® Candida plates in 2020. Single colony of each species was re-cultivated and prepared for biochemical identification with a VITEK2® system and verified by gene sequencing. Etest was performed on RPMI agar, and the antifungals fluconazole, amphotericin B, anidulafungin and nystatin were applied.

Results

Fifty-six isolates from 45 patients were identified. Seven different Candida species and one Saccharomyces species were detected. The results of biochemical identification were confirmed with sequencing analysis. Thirty-six patients had mono infection, and nine out of 45 patients had 2–3 different species detected. Of C. albicans strains, 39 out of 40 were susceptible to fluconazole. Two non-C. albicans species were resistant to fluconazole, one to amphotericin B and three to anidulafungin.

Conclusion

C. albicans was the predominant species, with a high susceptibility to antifungal agents. Different Candida species occur in both mono and mixed infections. Identification and susceptibility testing may therefore lead to more effective treatment and may prevent the development of resistance among patients with advanced cancer.

Trail registration

The study Oral Health in Advanced Cancer was registered at ClinicalTrials.gov (#NCT02067572) in 20/02/2014.
Development and validation of the Chinese version of the self-management support scale for kidney transplant recipients
Authors: Lin Keke , Wei Changyun , Li Jiaqi , Guo Xuejie , Gao Fengli , Zhao Peiyu , Liu Hongxia
Published: April 2023

Background

Providing self-management support to kidney transplant recipients is essential. However, a scale to identify the self-management support they have received is lacking. The purpose of this study is to develop a Self-management Support Scale for Kidney Transplant Recipients (SMSSKTR) and test its psychometric properties.

Methods

This is an instrument development and validation study, which has a three-stage cross-sectional design. In Stage 1, a preliminary item pool was formed using a literature review, semi-structured interviews, and the Delphi method. In Stage 2, six experts were invited to assess content validity. A convenience sample of 313 participants was used to explore the factor structure by using exploratory factor analysis. The test-retest reliability was assessed using the intra-class correlation coefficient (ICC). In Stage 3, two hundred and sixty-five participants were recruited to validate the factor structure by using confirmatory factor analysis. Convergent validity was examined using Spearman’s correlation coefficient. Cronbach’s alpha coefficient and corrected item-total correlation coefficient were used to test the reliability of the entire scale and its dimensions. The study was reported according to the STARD and GRRAS checklists.

Results

An initial 40-item scale was developed in Stage 1. In Stage 2, three factors with 22 items emerged from the exploratory factor analysis: instrumental support, psychosocial support, and relational support. The content validity index of the scale was 0.97. The intra-class correlation coefficient for the entire scale and the subscales were 0.915, 0.771, 0.896, and 0.832, respectively. In Stage 3, the confirmatory factor analysis indicated that the three-factor model had a good fit. The score of the scale was positively associated with that of the Self-Management Scale of Renal Transplant Recipients (r = 0.532). Cronbach’s alpha was 0.959 for the entire scale and 0.956–0.958 for the three subscales. The corrected item-total correlation coefficient ranged from 0.62 to 0.82.

Conclusion

The 22-item SMSSKTR has sufficient psychometric properties to assess the self-management support they have received, which has not been measured before.
Population genomic analysis provides evidence of the past success and future potential of South China tiger captive conservation
Authors: Wang Chen , Wu Dong-Dong , Yuan Yao-Hua , Yao Meng-Cheng , Han Jian-Lin , Wu Ya-Jiang , Shan Fen , Li Wan-Ping , Zhai Jun-Qiong , Huang Mian , Peng Shi-Ming , Cai Qin-Hui , Yu Jian-Yi , Liu Qun-Xiu , Liu Zhao-Yang , Li Lin-Xiang , Teng Ming-Sheng , Huang Wei , Zhou Jun-Ying , Zhang Chi , Chen Wu , Tu Xiao-Long
Published: April 2023

Background

Among six extant tiger subspecies, the South China tiger (Panthera tigris amoyensis) once was widely distributed but is now the rarest one and extinct in the wild. All living South China tigers are descendants of only two male and four female wild-caught tigers and they survive solely in zoos after 60 years of effective conservation efforts. Inbreeding depression and hybridization with other tiger subspecies were believed to have occurred within the small, captive South China tiger population. It is therefore urgently needed to examine the genomic landscape of existing genetic variation among the South China tigers.

Results

In this study, we assembled a high-quality chromosome-level genome using long-read sequences and re-sequenced 29 high-depth genomes of the South China tigers. By combining and comparing our data with the other 40 genomes of six tiger subspecies, we identified two significantly differentiated genomic lineages among the South China tigers, which harbored some rare genetic variants introgressed from other tiger subspecies and thus maintained a moderate genetic diversity. We noticed that the South China tiger had higher FROH values for longer runs of homozygosity (ROH > 1 Mb), an indication of recent inbreeding/founder events. We also observed that the South China tiger had the least frequent homozygous genotypes of both high- and moderate-impact deleterious mutations, and lower mutation loads than both Amur and Sumatran tigers. Altogether, our analyses indicated an effective genetic purging of deleterious mutations in homozygous states from the South China tiger, following its population contraction with a controlled increase in inbreeding based on its pedigree records.

Conclusions

The identification of two unique founder/genomic lineages coupled with active genetic purging of deleterious mutations in homozygous states and the genomic resources generated in our study pave the way for a genomics-informed conservation, following the real-time monitoring and rational exchange of reproductive South China tigers among zoos.
Clinical prediction models for serious infections in children: external validation in ambulatory care
Authors: Bos David A. G. , De Burghgraeve Tine , De Sutter An , Buntinx Frank , Verbakel Jan Y.
Published: April 2023

Background

Early distinction between mild and serious infections (SI) is challenging in children in ambulatory care. Clinical prediction models (CPMs), developed to aid physicians in clinical decision-making, require broad external validation before clinical use. We aimed to externally validate four CPMs, developed in emergency departments, in ambulatory care.

Methods

We applied the CPMs in a prospective cohort of acutely ill children presenting to general practices, outpatient paediatric practices or emergency departments in Flanders, Belgium. For two multinomial regression models, Feverkidstool and Craig model, discriminative ability and calibration were assessed, and a model update was performed by re-estimation of coefficients with correction for overfitting. For two risk scores, the SBI score and PAWS, the diagnostic test accuracy was assessed.

Results

A total of 8211 children were included, comprising 498 SI and 276 serious bacterial infections (SBI). Feverkidstool had a C-statistic of 0.80 (95% confidence interval 0.77–0.84) with good calibration for pneumonia and 0.74 (0.70–0.79) with poor calibration for other SBI. The Craig model had a C-statistic of 0.80 (0.77–0.83) for pneumonia, 0.75 (0.70–0.80) for complicated urinary tract infections and 0.63 (0.39–0.88) for bacteraemia, with poor calibration. The model update resulted in improved C-statistics for all outcomes and good overall calibration for Feverkidstool and the Craig model. SBI score and PAWS performed extremely weak with sensitivities of 0.12 (0.09–0.15) and 0.32 (0.28–0.37).

Conclusions

Feverkidstool and the Craig model show good discriminative ability for predicting SBI and a potential for early recognition of SBI, confirming good external validity in a low prevalence setting of SBI. The SBI score and PAWS showed poor diagnostic performance.

Trial registration

ClinicalTrials.gov, NCT02024282. Registered on 31 December 2013.