bluuebunny/crossref_metadata_2025 huggingface dataset:
High CD4+:CD8+ ratios with herpes zoster infections in patients with multiple sclerosis on dimethyl fumarate
Authors: Balshi Alexandra , Saart Emma , Pandeya Sarbesh , Dempsey John , Baber Ursela , Sloane Jacob A
Published: August 2023

Background:

Dimethyl fumarate (DMF) depletes CD8+ and CD4+ T cells, and cases of herpes zoster (HZ) in patients with multiple sclerosis (MS) on DMF have been documented.

Objectives:

To evaluate lymphocyte subsets in patients with MS who developed HZ on DMF (Tecfidera) compared to matched controls who did not develop HZ.

Methods:

We used linear mixed-effects models to test for differences in white blood cell count, lymphocyte percentage, absolute lymphocyte count, CD3+ percentage, absolute CD3+ count, CD4+ percentage, absolute CD4+ count, CD8+ percentage, absolute CD8+ count, and CD4+:CD8+ ratio over time in HZ and non-HZ groups.

Results:

Eighteen patients developed HZ while on DMF. The linear mixed-effects model for CD4+:CD8+ ratio showed a significant difference between the HZ and non-HZ groups ( p = 0.033). CD4+:CD8+ ratio decreased over time in the HZ group and increased over time in the non-HZ group.

Conclusion:

Patients with MS who develop HZ while on DMF have high CD4+:CD8+ ratios, suggesting an imbalance of CD4+ and CD8+ cells that may put a patient at risk for developing HZ while on DMF. This result emphasizes the need for lymphocyte subset monitoring (including CD4+:CD8+ ratios) on DMF, as well as vaccination prior to DMF initiation.
Native languages and aspect-marking in New Englishes: The (im)perfective in Namibian English
Authors: Stell Gerald
Published: August 2023

Aims and objectives/purposes/research questions:

This study investigates how the perfective/imperfective distinction is encoded across various ethnic varieties of Namibian English, with a specific focus on progressive -ing, simple verbal forms, and used to.

Design/methodology/approach:

The sample involves 158 Coloured and White Afrikaans-speaking informants, Damaras (L1: Khoekhoegowab), Hereros (L1: Otjiherero), Ovambos (L1: Oshiwambo). The sample thus includes Bantu, Khoesan, and West Germanic languages. The informants were administered an L1- into-English translation task.

Data and analysis:

The analysis follows two steps. First, the study looks at the distribution of English verbal forms across tenses, event classes, and English verb types. Second, the study looks at the distribution of English verbal forms across aspectual indicators in the informants’ respective native languages.

Findings/conclusions:

Regardless of event classes and verb types, Khoekhoegowab-speakers are the most frequent users of -ing while Afrikaans-speakers are the most frequent users of simple verbal forms. A close look at how English verbal forms are distributed across L1 aspectual indicators possibly reveals hypercorrect L1-pattern avoidance, spearheaded by women. Along with L1-pattern avoidance, one finds overreliance on positively transferable L1-patterns, manifest in the use of used to by Bantu-speakers, who grammatically mark the habitual in their L1s. Finally, one finds instances of English output features that cannot be triggered by L1-patterns. This concerns primarily -ing and used to among Afrikaans-speakers and used to among the Damaras.

Originality:

Unlike most research on aspect in postcolonial English varieties, this study systematically tracks transfers to their linguistic origin.

Significance/implications:

The paper argues that transfers (or their absence) are often better accounted for from the perspective of inter-group relations than as mere ‘interferences’.
Rural–urban and geographical differences in prognosis of atrial fibrillation in Finland: a nationwide cohort study
Authors: Teppo Konsta , Airaksinen K.E. Juhani , Halminen Olli , Jaakkola Jussi , Linna Miika , Haukka Jari , Putaala Jukka , Mustonen Pirjo , Kinnunen Janne , Hartikainen Juha , Lehto Mika
Published: August 2023

Aims:

Rural–urban disparities have been reported in the outcomes of cardiovascular diseases. We assessed whether rural–urban or other geographical disparities exist in the risk of ischemic stroke (IS) and death in patients with atrial fibrillation (AF) in Finland.

Methods:

The registry-based FinACAF cohort study covers all patients with AF from all levels of care in Finland from 2007 to 2018. Patients were divided into rural–urban categories and into hospital districts (HDs) based on their municipality of residence.

Results:

We identified 222,051 patients (50.1% female; mean age 72.8 years; mean follow-up 3.9 years) with new-onset AF, of whom 15,567 (7.0%) patients suffered IS and 72,565 (32.7%) died during follow-up. The crude IS rate was similar between rural and urban areas, whereas the mortality rate was lower in urban areas (incidence rate ratios (IRRs) with 95% confidence intervals (CIs) 0.97 (0.93–1.00) and 0.92 (0.91–0.93), respectively). However, after adjustments, urban residence was associated with slightly higher IS and mortality rates (IRRs with 95% CIs 1.05 (1.01–1.08) and 1.06 (1.04–1.07), respectively). The highest crude IS rate was in the East Savo HD and the lowest in Åland, whereas the highest crude mortality rate was in the Länsi-Pohja HD and the lowest in the North Ostrobothnia HD (IRRs with 95% CIs compared to Helsinki and Uusimaa HD for IS 1.46 (1.28–1.67) and 0.79 (0.62–1.01), and mortality 1.24 (1.16–1.32) and 0.97 (0.93–1.00), respectively.

Conclusions:

Rural–urban differences in prognosis of AF in Finland appear minimal, whereas considerable disparities exist between HDs.
Laparoscopic cholecystectomy versus antibiotic therapy for acute cholecystitis in patients over 75 years: Randomized clinical trial and retrospective cohort study
Authors: Kivivuori Antti , Salminen Paulina , Ukkonen Mika , Ilves Imre , Vihervaara Hanna , Zalevskaja Kristina , Pajari Jenni , Paajanen Hannu , Rantanen Tuomo
Published: August 2023

Background and objective:

The prevalence of acute cholecystitis among elderly patients is increasing. The aim of this study was to compare laparoscopic cholecystectomy (LC) to antibiotics in elderly patients with acute cholecystitis.

Methods:

A randomized multicenter clinical trial including patients over 75 years with acute calculous cholecystitis was conducted in four hospitals in Finland between January 2017 and December 2019. Patients were randomized to undergo LC or antibiotic therapy. Due to patient enrollment challenges, the trial was prematurely terminated in December 2019. To assess all eligible patients, we performed a retrospective cohort study including all patients over 75 years with acute cholecystitis during the study period. The primary outcome was morbidity. Predefined secondary outcomes included mortality, readmission rate, and length of hospital stay.

Results:

Among 42 randomized patients (LC n = 24, antibiotics n = 18, mean age 82 years, 43% women), the complication rate was 17% (n = 4/24) after cholecystectomy and 33% (n = 6/18, 5/6 patients underwent cholecystectomy due to antibiotic treatment failure) after antibiotics (p = 0.209). In the retrospective cohort (n = 630, mean age 83 years, 49% women), 37% (236/630) of the patients were treated with cholecystectomy and 63% (394/630) with antibiotics. Readmissions were less common after surgical treatment compared with antibiotics in both randomized and retrospective cohort patients (8% vs 44%, p < 0.001% and 11 vs 32%, p < 0.001, respectively). There was no 30-day mortality within the randomized trial. In the retrospective patient cohort, overall mortality was 6% (35/630).

Conclusions:

LC may be superior to antibiotic therapy for acute cholecystitis in the selected group of elderly patients with acute cholecystitis.
Incidental graphical perception: How marks and display time influence accuracy
Authors: Moreira João , Mendes Daniel , Gonçalves Daniel
Published: August 2023

Incidental visualizations are meant to be perceived at-a-glance, on-the-go, and during short exposure times, but are not seen on demand. Instead, they appear in people’s fields of view during an ongoing primary task. They differ from glanceable visualizations because the information is not received on demand, and they differ from ambient visualizations because the information is not continuously embedded in the environment. However, current graphical perception guidelines do not consider situations where information is presented at specific moments during brief exposure times without being the user’s primary focus. Therefore, we conducted a crowdsourced user study with 99 participants to understand how accurate people’s incidental graphical perception is. Each participant was tested on one of the three conditions: position of dots, length of lines, and angle of lines. We varied the number of elements for each combination and the display time. During the study, participants were asked to perform reproduction tasks, where they had to recreate a previously shown stimulus in each. Our results indicate that incidental graphical perception can be accurate when using position, length, and angles. Furthermore, we argue that incidental visualizations should be designed for low exposure times (between 300 and 1000 ms).
Broadcasting change: An aerial overview of South African television debates in an age of constant transition
Authors: Loader Reina-Marie
Published: August 2023

This aerial review concentrates on the development of the South African television industry as chronicled and analysed by scholarship. Academic reflections on the evolution of television are categorised into three main periods: First, the advent of South African television, second, the transitional period, and third, a period of stocktaking. The overview aims to provide readers with key academic discussions during these periods and the historical context within which they took shape. Looking at issues ranging from censorship, nation-building, restructuring and globalisation, to event television, edutainment programming and community TV, the South African television environment is shown to be in constant transition.
The hidden cost of dalbavancin: OPAT RN time required in coordination for persons who use drugs
Authors: Douglass Alyse H. , Mayer Heather , Young Kathleen , Sikka Monica K. , Strnad Luke , Makadia Jina , Sukerman Ellie , Lewis James S. , Streifel Amber C.
Published: August 2023

Background:

Serious infections in persons who use drugs (PWUD) are rising. Dalbavancin, due to its extended half-life, offers an alternative treatment for patients in whom standard of care antibiotics are not feasible or practical, allowing for reduced hospital days and the avoidance of central line placement or the use of complex oral regimens.

Objectives:

We aim to describe the time and effort required for coordination of dalbavancin courses by outpatient registered nurses (RNs) and other outpatient parenteral antimicrobial therapy (OPAT) staff.

Design and methods:

We conducted a retrospective review of adult patients with documented substance use who received at least one dose of dalbavancin and quantified the number of interventions required by our OPAT RNs and other OPAT staff for coordination of dalbavancin courses. Additionally, detailed data on time spent per intervention were prospectively collected for a 1-month period.

Results:

A total of 52 patients with 53 dalbavancin courses were included. Most substance use was intravenous. Infectious diagnoses included bone and joint infections (61%) and endocarditis (7%), in addition to skin and soft tissue infections (19%). Infections were most commonly caused by Staphylococcus aureus (62%). RN intervention was required in the coordination of 60% of all courses and in 77% of courses in which at least one outpatient dose was needed. Adverse reactions occurred in one patient (2%) and 90-day readmissions due to infectious complications occurred in two patients (4%). Detailed time analysis was performed for seven consecutive patients, with a total of 179 min spent by OPAT RNs on coordination.

Conclusions:

The ease of dalbavancin administration does not eliminate the need for extensive RN coordination for successful administration of doses in the outpatient setting for PWUD. This need should be accounted for in program staffing to help increase successful dalbavancin course completion.
Effect of unintended short-term 3.0 g/day amoxicillin and probenecid treatment for early syphilis on patients with HIV-1 infection
Authors: Inada Makoto , Ando Naokatsu , Mizushima Daisuke , Kikuchi Yoshimi , Gatanaga Hiroyuki , Oka Shinichi
Published: August 2023

Background:

Standard therapy for early syphilis involves intramuscular injections of penicillin G, which frequently faces shortages in several countries. Fourteen-day amoxicillin therapy has been suggested as an alternative to benzathine penicillin G, but the optimal duration of amoxicillin therapy remains unclear and could theoretically be shortened to less than 14 days. The aim of this study was to explore the effectiveness of short-term amoxicillin therapy for early syphilis.

Methods:

We retrospectively explored the effectiveness of short-term amoxicillin therapy for early syphilis. The treatment data of patients who had received amoxicillin therapy for less than 14 days for unintended reasons were reviewed. Diagnosis was confirmed based on either the physician’s description or clinical presentation. Successful treatment was defined as a fourfold or greater decline in the rapid plasma reagin titer or sero-reversion to negative within 12 months.

Results:

Of 295 patients, 8 received short-term amoxicillin treatment. All were men who had sex with men and people living with human immunodeficiency virus. Their median age, CD4 count, and treatment duration were 34 years (range, 26–40), 258/mL (range, 112–930), and 9.5 days (range, 5–11), respectively. One patient had primary syphilis, six had secondary syphilis, and one had early latent syphilis. All patients, except one who showed reinfection, demonstrated a serological response within 4 months. The median time for serological response was 112 days.

Conclusion:

The results indicate that early syphilis could potentially be treated with 5–11 days of amoxicillin therapy combined with probenecid. This suggests that short-term amoxicillin therapy might be a sufficient treatment for early syphilis instead of the standard 14-day course.
Repair of a multi-subunit defect of the nasal ala, perialar cheek, and apical triangle of the upper lip
Authors: Le Michelle , Nanda Rahul , Khanna Manish
Published: August 2023

A 67-year-old female was treated for a left nasal ala basal cell carcinoma; post-Mohs defect was 1.5 × 1.5 cm and extended to involve the perialar cheek and apical triangle of the upper lip. How would you repair this defect?
Traversing lines of difference: Fostering hospitality and belonging for immigrants in Christian college communities
Authors: DeGraaf Don , Gustat Riley
Published: August 2023

Building on the theoretical framework of social contact theory, this article explores what it means to feel a sense of belonging, and how colleges and universities can equip students to enter a diverse, fractured world with a mindset of hospitality. 12 Christian Colleges and Universities share insights and best practices from creative programs they created and implemented, with grant funding from the Innovation Inclusion Collaborative. These institutional examples provide models for developing college students’ ability to foster inclusive environments in their surrounding communities.
Diagnostic utility of brain MRI in spontaneous intracerebral hemorrhage: A retrospective cohort study and meta-analysis
Authors: Wilson Mitch , Wang Jia-Yi , Andreev Alexander , Katsanos Aristeidis H , Selim Magdy , Lioutas Vasileios-Arsenios
Published: August 2023

Introduction:

The diagnostic yield of brain Magnetic Resonance Imaging (MRI) in spontaneous intracerebral hemorrhage (ICH) is unclear. We performed both an independent single-center retrospective cohort study and a meta-analysis to assess the detection rate of secondary lesions on MRI in patients with spontaneous ICH.

Patients and methods:

In the retrospective cohort study, we examined 856 consecutive patients with spontaneous ICH. Brain MRI scans on admission and follow-up were assessed for secondary lesions. We also examined clinical and CT radiographic variables associated with secondary lesions in univariable analysis. In the meta-analysis we searched PubMed and EMBASE for articles investigating the secondary lesion detection rate on brain MRI in spontaneous ICH.

Results:

Of the 856 patients with ICH, 481 (56%) had at least one brain BRI performed [70 ± 14 years, 270 (56% male)]. 462 (54%) had an admission MRI and 138 (16%) had both admission and follow-up MRIs. The detection rate of secondary lesions on admission MRIs was 24/462 (5.2%). 4/127 (3.1%) patients with a negative admission MRI had a lesion identified on follow-up MRI. No clinical or radiographic variables were associated with a secondary lesion on MRI using univariable analysis. The meta-analysis included five studies total (four identified in the PubMed and EMBASE searches and our cohort study) comprising 1147 patients with spontaneous ICH who underwent brain MRI. The pooled detection rate of secondary lesions was 11% (95% CI: 7–16).

Discussion and conclusion:

No predictors of secondary lesion detection were identified in our cohort study. Prospective studies are required to better understand the diagnostic utility of MRI in spontaneous ICH.
Republication of “Total Ankle Replacement Conversion to Tibiotalocalcaneal Arthrodesis With Bulk Femoral Head Allograft and Pseudoelastic Intramedullary Nail Providing Sustained Joint Compression”
Authors: Conklin Mark Jay , Smith Kathryn Elizabeth , Blair Jeremy Webster , Dupont Kenneth Michael
Published: August 2023

Tibiotalocalcaneal (TTC) arthrodesis is commonly performed to salvage a failed total ankle replacement. These salvage procedures are complicated by significant bone loss from the ankle replacement and are associated with low patient satisfaction. Here, we describe 2 cases of patients who presented with a failed total ankle replacement and underwent arthrodesis using a bulk femoral head allograft and a novel pseudoelastic intramedullary nail. The intramedullary nail contains an internal pseudoelastic element that adapts to bone resorption and settling allowing for compression to be maintained at the arthrodesis sites throughout healing. In the first case, a 65-year-old woman with a failed total ankle replacement underwent TTC arthrodesis. The second case involved an obese 53-year-old woman who had previously undergone 2 total ankle replacement procedures that resulted in unsuccessful outcomes. In both cases, union was demonstrated on computed tomographic scan by 6 months. At 2 years postsurgery, both patients were satisfied with the procedure. These cases provide preliminary evidence that tibiotalocalcaneal arthrodesis with a pseudoelastic IM nail and structural allograft is an appropriate treatment for failed total ankle replacements.

Level of Evidence: Level IV, therapeutic, case series.
Constructive constraints: On the role of chance and complexity in artistic creativity
Authors: Feiten Tim Elmo , Peck Zachary , Holland Kristopher , Chemero Anthony
Published: August 2023

Creativity is sometimes understood as the individual, mental creation of novelty which is then imposed as form onto a material substrate. On this view, constraints would feature only as obstacles in the creative process. In contrast, we support the view that creativity emerges from the interactions between human agents and the material, cultural, and social constraints that comprise a particular situation. In this account, constraints play a key enabling role, scaffolding the space of possibilities in which improvisation and chance give rise to novelty. In this paper, we review experimental work on interpersonal synergies between jazz pianists, which provides a scientific framework from which to approach the complex relationship between chance, constraints, and creativity. We also explore two case studies from the science of complexity and the creative arts in order to substantiate this notion of creative constraints: Anthony Braxton’s musical innovation at the intersection between composition and improvisation, and Marcel Duchamp’s radical interventions in the fields of sculpture and conceptual art.
Observed nonlinear site amplification of vertical ground motion in Taiwan
Authors: Chao Shu-Hsien , Kuo Chun-Hsiang , Lin Che-Min , Huang Jyun-Yan , Rathje Ellen , Abrahamson Norman
Published: August 2023

The objective of this study is to evaluate the possible reason for the observed nonlinear site amplification (NSA) of vertical ground motions in Taiwan. First, we observe that NSA generally occurs simultaneously in both the horizontal and vertical components of a ground-motion record and that the NSA levels are similar between these components. We also observe that most vertical peak ground acceleration (PGA) and vertical peak oscillator spectral acceleration (SA) responses for different periods occur during the shear wave (S-wave) window after S-wave arrival. The differences in the source, path, and site effects on PGA and SA responses occurring during the pressure wave (P-wave) and S-wave windows are evaluated individually through a regression analysis. We determine that NSA is observed only when PGA and SA responses occur during the S-wave window. This evidence demonstrates that the observed NSA of vertical ground motions in Taiwan may result from the hysteresis of the soil layer subjected to S-waves. This study provides physical evidence for the observed NSA of vertical ground motions in Taiwan.
An information-theoretic approach to single cell sequencing analysis
Authors: Casey Michael J. , Fliege Jörg , Sánchez-García Rubén J. , MacArthur Ben D.
Published: August 2023

Background

Single-cell sequencing (sc-Seq) experiments are producing increasingly large data sets. However, large data sets do not necessarily contain large amounts of information.

Results

Here, we formally quantify the information obtained from a sc-Seq experiment and show that it corresponds to an intuitive notion of gene expression heterogeneity. We demonstrate a natural relation between our notion of heterogeneity and that of cell type, decomposing heterogeneity into that component attributable to differential expression between cell types (inter-cluster heterogeneity) and that remaining (intra-cluster heterogeneity). We test our definition of heterogeneity as the objective function of a clustering algorithm, and show that it is a useful descriptor for gene expression patterns associated with different cell types.

Conclusions

Thus, our definition of gene heterogeneity leads to a biologically meaningful notion of cell type, as groups of cells that are statistically equivalent with respect to their patterns of gene expression. Our measure of heterogeneity, and its decomposition into inter- and intra-cluster, is non-parametric, intrinsic, unbiased, and requires no additional assumptions about expression patterns. Based on this theory, we develop an efficient method for the automatic unsupervised clustering of cells from sc-Seq data, and provide an R package implementation.
Structure and ecological function of the soil microbiome associated with ‘Sanghuang’ mushrooms suffering from fungal diseases
Authors: Xu Weifang , Sun Tao , Du Jiahui , Jin Shuqing , Zhang Ying , Bai Guofa , Li Wanyu , Yin Dengke
Published: August 2023

Background

The most serious challenges in medicinal ‘Sanghuang’ mushroom production are the fungal diseases caused by various molds. Application of biological agents has been regarded as a potential crop disease management strategy. Here, the soil microbiome associated with ‘Sanghuang’ mushroom affected by fungal diseases grown under field cultivation (FC) and hanging cultivation (HC) was characterized using culture-dependent and culture-independent methods.

Results

A total of 12,525 operational taxonomic units (OTUs) and 168 pure cultures were obtained using high-throughput sequencing and a culture-dependent method, respectively. From high-throughput sequencing, we found that HC samples had more OTUs, higher α-diversity, and greater microbial community complexity than FC samples. Analysis of β-diversity divided the soil microbes into two groups according to cultivation mode. Basidiomycota (48.6%) and Ascomycota (46.5%) were the two dominant fungal phyla in FC samples, with the representative genera Trichoderma (56.3%), Coprinellus (29.4%) and Discosia (4.8%), while only the phylum Ascomycota (84.5%) was predominant in HC samples, with the representative genera Discosia (34.0%), Trichoderma (30.2%), Penicillium (14.9%), and Aspergillus (7.8%). Notably, Trichoderma was predominant in both the culture-independent and culture-dependent analyses, with Trichoderma sp. FZ0005 showing high host pathogenicity. Among the 87 culturable bacteria, 15 exhibited varying extents of antifungal activity against Trichoderma sp. FZ0005, with three strains of Bacillus spp. (HX0037, HX0016, and HX0039) showing outstanding antifungal capacity.

Conclusions

Overall, our results suggest that Trichoderma is the major causal agent of ‘Sanghuang’ fungal diseases and that Bacillus strains may be used as biocontrol agents in ‘Sanghuang’ cultivation.
Plant GARDEN: a portal website for cross-searching between different types of genomic and genetic resources in a wide variety of plant species
Authors: Ichihara Hisako , Yamada Manabu , Kohara Mitsuyo , Hirakawa Hideki , Ghelfi Andrea , Tamura Takuro , Nakaya Akihiro , Nakamura Yasukazu , Shirasawa Sachiko , Yamashita Samatchaya , Toda Yosuke , Harada Daijiro , Fujishiro Tsunakazu , Komaki Akiko , Fawcett Jeffrey A. , Sugihara Eiji , Tabata Satoshi , Isobe Sachiko N.
Published: August 2023

Background

Plant genome information is fundamental to plant research and development. Along with the increase in the number of published plant genomes, there is a need for an efficient system to retrieve various kinds of genome-related information from many plant species across plant kingdoms. Various plant databases have been developed, but no public database covers both genomic and genetic resources over a wide range of plant species.

Main body

We have developed a plant genome portal site, Plant GARDEN (Genome And Resource Database Entry: https://plantgarden.jp/en/index), to provide diverse information related to plant genomics and genetics in divergent plant species. Elasticsearch is used as a search engine, and cross-keyword search across species is available. Web-based user interfaces (WUI) for PCs and tablet computers were independently developed to make data searches more convenient. Several types of data are stored in Plant GARDEN: reference genomes, gene sequences, PCR-based DNA markers, trait-linked DNA markers identified in genetic studies, SNPs, and in/dels on publicly available sequence read archives (SRAs). The data registered in Plant GARDEN as of March 2023 included 304 assembled genome sequences, 11,331,614 gene sequences, 419,132 DNA markers, 8,225 QTLs, and 5,934 SNP lists (gvcf files). In addition, we have re-annotated all the genes registered in Plant GARDEN by using a functional annotation tool, Hayai-Annotation, to compare the orthologous relationships among genes.

Conclusion

The aim of Plant GARDEN is to provide plant genome information for use in the fields of plant science as well as for plant-based industries, education, and other relevant areas. Therefore, we have designed a WUI that allows a diverse range of users to access such information in an easy-to-understand manner. Plant GARDEN will eventually include a wide range of plant species for which genome sequences are assembled, and thus the number of plant species in the database will continue to expand. We anticipate that Plant GARDEN will promote the understanding of genomes and gene diversity by facilitating comparisons of the registered sequences.
PRedicting the EVolution of SubjectIvE Cognitive Decline to Alzheimer’s Disease With machine learning: the PREVIEW study protocol
Authors: Mazzeo Salvatore , Lassi Michael , Padiglioni Sonia , Vergani Alberto Arturo , Moschini Valentina , Scarpino Maenia , Giacomucci Giulia , Burali Rachele , Morinelli Carmen , Fabbiani Carlo , Galdo Giulia , Amato Lorenzo Gaetano , Bagnoli Silvia , Emiliani Filippo , Ingannato Assunta , Nacmias Benedetta , Sorbi Sandro , Grippo Antonello , Mazzoni Alberto , Bessi Valentina
Published: August 2023

Background

As disease-modifying therapies (DMTs) for Alzheimer's disease (AD) are becoming a reality, there is an urgent need to select cost-effective tools that can accurately identify patients in the earliest stages of the disease. Subjective Cognitive Decline (SCD) is a condition in which individuals complain of cognitive decline with normal performances on neuropsychological evaluation. Many studies demonstrated a higher prevalence of Alzheimer’s pathology in patients diagnosed with SCD as compared to the general population. Consequently, SCD was suggested as an early symptomatic phase of AD. We will describe the study protocol of a prospective cohort study (PREVIEW) that aim to identify features derived from easily accessible, cost-effective and non-invasive assessment to accurately detect SCD patients who will progress to AD dementia.

Methods

We will include patients who self-referred to our memory clinic and are diagnosed with SCD. Participants will undergo: clinical, neurologic and neuropsychological examination, estimation of cognitive reserve and depression, evaluation of personality traits, APOE and BDNF genotyping, electroencephalography and event-related potential recording, lumbar puncture for measurement of Aβ42, t-tau, and p-tau concentration and Aβ42/Aβ40 ratio. Recruited patients will have follow-up neuropsychological examinations every two years. Collected data will be used to train a machine learning algorithm to define the risk of being carriers of AD and progress to dementia in patients with SCD.

Discussion

This is the first study to investigate the application of machine learning to predict AD in patients with SCD. Since all the features we will consider can be derived from non-invasive and easily accessible assessments, our expected results may provide evidence for defining cost-effective and globally scalable tools to estimate the risk of AD and address the needs of patients with memory complaints. In the era of DMTs, this will have crucial implications for the early identification of patients suitable for treatment in the initial stages of AD.

Trial registration number (TRN)

NCT05569083.
Impact and burden of sickle cell disease in critically ill obstetric patients in a high dependency unit in Sierra Leone—a registry based evaluation
Authors: Mortara Milena , Turay Momoh Sitta , Boyle Sonia , Caracciolo Claudia , Bah Sarjoh , Kargbo Henry , Hanciles Eva , John-Cole Valerie , Scapini Ester , Benoni Roberto , Dissanayake Vishmi , Beane Abi , Haniffa Rashan , Adetunji Adeniji O. , Taylor Williamson , Pisani Luigi
Published: August 2023

Introduction

Sickle cell disease (SCD) in pregnancy is associated with worse maternal and neonatal outcomes. There is limited available data describing the burden and outcomes of critically ill obstetric patients affected by SCD in low-income settings.

Objectives

We aimed to define SCD burden and impact on mortality in critically-ill obstetric patients admitted to an urban referral hospital in Sierra Leone. We hypothesized that SCD burden is high and independently associated with increased mortality.

Methods

We performed a registry-based cross-sectional study from March 2020 to December 2021 in the high-dependency unit (HDU) of Princess Christian Maternity Hospital PCMH, Freetown. Primary endpoints were the proportion of patients identified in the SCD group and HDU mortality. Secondary endpoints included frequency of maternal direct obstetric complications (MDOCs) and the maternal early obstetric warning score (MEOWS).

Results

Out of a total of 497 patients, 25 (5.5%) qualified to be included in the SCD group. MEOWS on admission was not different between patients with and without SCD and SCD patients had also less frequently reported MDOCs. Yet, crude HDU mortality in the SCD group was 36%, compared to 9.5% in the non SCD group (P < 0.01), with an independent association between SCD group exposure and mortality when accounting for severity on admission (hazard ratio 3.40; 95%CI 1.57—7.39; P = 0.002). Patients with SCD had a tendency to longer HDU length of stay.

Conclusions

One out of twenty patients accessing a HDU in Sierra Leone fulfilled criteria for SCD. Despite comparable severity on admission, mortality in SCD patients was four times higher than patients without SCD. Optimization of intermediate and intensive care for this group of patients should be prioritized in low-resource settings with high maternal mortality.
Analysis of factors associated with the umbilical cord pitch value by ultrasound measurement in late pregnancy
Authors: Liang Chen , Xu Youfeng
Published: August 2023

Background

This study aimed to investigate the factors associated with the antenatal umbilical cord pitch value by ultrasound measurement in late pregnancy. We investigated the factors associated with the umbilical cord pitch value under prenatal ultrasound measurement.

Methods

This study included 528 pregnant women who underwent routine antenatal ultrasound examinations in Ningbo Women and Children’s Hospital from December 2020 to August 2021. Their umbilical cord pitch values and diameter, Wharton’s jelly thickness, amniotic fluid indexes, umbilical artery blood flow parameters, and other relevant data, such as ages and gestational ages, were measured. Information about delivery methods, placenta, umbilical cord, and neonatal weight were recorded during follow-up. Statistical analysis was performed on the above data, and the factors associated with the pitch values were analyzed by linear regression.

Results

This study revealed that cord torsion (p < 0.001, 95% confidence interval [CI]=-34.81 to -19.01), cord entanglement (p < 0.001, 95% CI = 10.71 to 20.11), thickening of Wharton’s jelly (p = 0.001, 95% CI = 5.39 to 20.24), and cord edema (p = 0.015, 95%CI = 2.09 to 19.44), gestational age (p = 0.024, 95%CI = 0.14 to 1.89), age of pregnant woman (p = 0.009, 95%CI= -1.15 to -0.16), and neonatal weight (p = 0.011, 95%CI = 0.002 to 0.012) were significantly correlated with the pitch values.

Conclusion

The umbilical cord pitch value significantly correlated with cord entanglement, cord torsion, cord edema, Wharton’s jelly thickening, gestational age, age of the pregnant woman, and neonatal weight. Notably, the pitch value by prenatal ultrasound measurement is predictive of cord morphological abnormalities such as cord entanglement, cord torsion, cord edema, and Wharton’s jelly thickening.
Treatment with anticancer drugs for advanced pancreatic cancer: a systematic review
Authors: Salazar Josefina , Bracchiglione Javier , Savall-Esteve Olga , Antequera Alba , Bottaro-Parra David , Gutiérrez-Valencia Marta , Martínez-Peralta Susana , Pericay Carles , Tibau Ariadna , Bonfill Xavier ,   Appropriateness of Systemic Oncological Treatments for Advanced Cancer (ASTAC) Research Group, Acosta-Dighero Roberto , Auladell-Rispau Ariadna , Cantero-Fortiz Yahveth , Hernandez Edgar , Irassar Juan , Meade Adriana-G , Meinardi Pamela , Merchán-Galvis Angela , Meza Nicolas , Quintana María Jesús , Requeijo Carolina , Rodriguez-Grijalva Gerardo , Salas-Gama Karla , Santero Marilina , Savall-Esteve Olga , Selva Anna , Solà Ivan , Urrútia Gerard
Published: August 2023

Background

Patients with advanced pancreatic cancer have a poor prognosis and high burden of cancer-related symptoms. It is necessary to assess the trade-off of clinical benefits and possible harms of treatments with anticancer drugs (TAD). This systematic review aims to compare the effectiveness of TAD versus supportive care or no treatment, considering all patient-important outcomes.

Methods

We searched PubMed, Embase, Cochrane Library, and Epistemonikos. Two reviewers performed selection, data extraction and risk of bias assessment. We assessed certainty of the evidence using the GRADE approach.

Results

We included 14 randomised controlled trials. Chemotherapy may result in a slight increase in overall survival (MD: 2.97 months (95%CI 1.23, 4.70)) and fewer hospital days (MD: -6.7 (-8.3, -5.1)), however, the evidence is very uncertain about its effect on symptoms, quality of life, functional status, and adverse events. Targeted/biological therapy may result in little to no difference in overall survival and a slight increment in progression-free survival (HR: 0.83 (95%CI 0.63, 1.10)), but probably results in more adverse events (RR: 5.54 (95%CI 1.24, 23.97)). The evidence is very uncertain about the effect of immunotherapy in overall survival and functional status.

Conclusions

The evidence is very uncertain about whether the benefits of using treatment with anticancer drugs outweigh their risks for patients with advanced pancreatic cancer. This uncertainty is further highlighted when considering immunotherapy or a second line of chemotherapy and thus, best supportive care would be an appropriate alternative. Future studies should assess their impact on all patient-important outcomes to inform patients in setting their goals of care.
Evaluating the effect of the COVID-19 pandemic on hypertension and diabetes care in South Korea: an interrupted time series analysis
Authors: Sim Boram , Kim Sunmi , Nam Eun Woo
Published: August 2023

Background

Access to healthcare services is important, especially for patients with chronic diseases. We evaluated the effect of the COVID-19 pandemic on outpatient visits and medication for patients with hypertension and diabetes in South Korea.

Methods

Nationwide claims data were extracted for patients with hypertension and diabetes from January 2019 to July 2020. We used an interrupted time series (ITS) analysis to evaluate the pandemic’s impact on outpatient care using the number of outpatient visits and days of medication supplied per visit. We identified the change in the continuity of care in medication, a consequence of the change in outpatient care, using the Medication Possession Ratio (MPR).

Results

The number of outpatient visits for diabetes significantly declined in February 2020, when community transmission began. However, when high-intensity social distancing was relaxed in April 2020, outpatient visits for hypertension and diabetes rebounded significantly. Moreover, when the outpatient visits declined, the number of days of medication supplied per visit increased. Consequently, the average MPRs significantly increased compared to 2019, increasing the ratio of patients with appropriate medication supply (MPR ≥ 0.8).

Conclusions

Outpatient visits decreased immediately when COVID-19 spread to local communities. However, the number of days of medication supplied per visit increased to compensate for the longer intervals between visits. Rather, the change in the continuity of care in medication improved; thus, the temporary decrease in outpatient visits might have had a limited negative impact on health outcomes.
Effect of multiple chronic conditions on family doctor contracting in the elderly in China: the moderating role of socioeconomic status
Authors: Lv Bo , Zhang Ling , Meng Kai
Published: August 2023

Background

China's family doctor contracting service is an important part of deepening the reform of the healthcare systems, aiming to further develop chronic disease management services, enhance the capacity of primary health care services and improve the health of residents. The purpose of this study was to explore the influence of multiple chronic conditions in the elderly on family doctor contracting and whether socioeconomic status played a moderating role.

Methods

A cross-sectional survey was conducted in Beijing, China. A total of 1814 elderly people over 60 years old were included in this study using a whole-group sampling method. The univariate analysis and logistic regression analysis was used to analyze the data.

Results

21.72% of the elderly signed up with family doctors. The multiple chronic conditions was a factor influencing the elderly to sign up with family doctors (OR = 1.44, 95%CI = 1.28–1.61), and the higher the degree of multiple chronic conditions, the stronger willingness to sign up. Socioeconomic status positively moderates the effect of multiple chronic conditions on signing. Also, physical activity intensity (OR = 1.25, 95%CI = 1.03–1.54) and willingness to first visit primary care facilities (OR = 1.38, 95%CI = 1.25–1.54) influenced the elderly to sign up with family doctors.

Conclusions

The elderly with a high degree of multiple chronic conditions, high activity intensity, and a strong willingness to first visit primary care facilities were more likely to sign up with family doctors. The health literacy of the elderly should be further improved, and publicity on the family doctor contracting service policies for the elderly with lower socioeconomic status should be strengthened to guide them to sign up with family doctors. At the same time, the service capacity of primary care facilities should be further improved to meet the health needs of the elderly.
Clustering of lifestyle behaviors and adiposity in early adolescents in Spain: findings from the SI! Program for Secondary Schools
Authors: Bodega Patricia , Santos-Beneit Gloria , de Cos-Gandoy Amaya , Moreno Luis A. , de Miguel Mercedes , Orrit Xavier , Tresserra-Rimbau Anna , Martínez-Gómez Jesús , Ramírez-Garza Sonia L. , Laveriano-Santos Emily P. , Arancibia-Riveros Camila , Estruch Ramón , Lamuela-Raventós Rosa M. , Fernández-Jiménez Rodrigo , Fernández-Alvira Juan M.
Published: August 2023

Background

Several unhealthy lifestyle behaviors in adolescence are often linked to overweight/obesity. Some of them may be present simultaneously, leading to combined effects on health. Therefore, the clustering of several unhealthy behaviors in adolescents might be associated with adiposity excess.

Purpose

To identify lifestyle patterns and analyze their association with adiposity in early adolescents.

Methods

A cross-sectional cluster analysis was performed in 1183 adolescents (50.5% girls) with a mean age of 12.5 (0.4) years included in the SI! Program for Secondary Schools in Spain to identify lifestyle patterns based on healthy diet, step counts, sleep time, and leisure screen time. Generalized mixed models were applied to estimate the association between lifestyle patterns and adiposity indices.

Results

Four lifestyle patterns were derived: Cluster 1-higher screen time and poorer diet (n = 213), Cluster 2-lower activity and longer sleepers (n = 388), Cluster 3-active and shorter sleepers (n = 280), and Cluster 4-healthiest (n = 302). Except for the number of steps (12,008 (2357) day), the lifestyle behaviors in our sample presented levels far below the recommendations, especially for sleep duration. Cluster 4 included the largest proportion of adolescents from high socioeconomic status families (47.7%) and the lowest prevalence of overweight/obesity (23.1%). Compared to Cluster 4-healthiest, adolescents in the remaining clusters presented a higher prevalence of overweight/obesity and central obesity, showing Cluster 3 the highest prevalences (PR:1.31 [95%CI: 1.31, 1.31] and PR:1.40 [95%CI: 1.33, 1.47]).

Conclusions

Clustering of lifestyle patterns in early adolescence allows the identification of individuals with excess adiposity, in whom health promotion strategies should be stressed, especially in socioeconomically disadvantaged groups.

Trial registration

Clinical Trial Registry, NCT03504059. Registered 20/04/2018—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03504059.
Prevalence and risk factors of anemia in the mother–child population from a region of the Colombian Caribbean
Authors: Del Castillo Lisetta , Cardona-Castro Nora , Whelan Denis R. , Builes John Paul , Serrano-Coll Héctor , Arboleda Margarita , Leon Juan S.
Published: August 2023

Background

Despite Colombia's robust well-child visits program, Colombian children and mothers still suffer from anemia, especially in populations of lower socioeconomic status. In this study, we aimed to quantify the prevalence and risk factors among mothers and their children attending their well-child visits in Apartadó, a municipality in the Urabá region of the Colombian Caribbean.

Methods

There were 100 mother–child pairs enrolled in this secondary data-analysis study from a health facility in the municipality of Apartadó, Urabá, Colombia, during well-child visits. Self-reported data included child illnesses in the past two weeks (diarrheal, fever, or respiratory symptoms), child feeding practices (breastfeeding, complementary feeding), child vaccinations, and demographic characteristics (mother’s and child’s age, mother’s education, marital status, race, and child sex) and socioeconomic status. Mother and child anthropometry data were collected via standardized weight and height measurements. Mother or child anemia status was collected via a blood test. Chi-squared tests and multivariable logistic regression were used to assess associations between risk factors and anemia.

Result

The anemia prevalence in children (74%) and mothers (47%) was higher than the Colombian national prevalence. Reported child comorbidities in the preceding two weeks were not significantly associated with child anemia and included respiratory illnesses (60%), fever (46%), and diarrhea (30%). Stunting (8%) was not significantly associated with anemia. Wasting (0%) was not observed in this study. Reported child breastfeeding and complementary feeding were also not significantly associated with child anemia. In adjusted models, the child's significant risk factors for anemia included the mother's "Mestiza" race (OR: 4.681; 95% CI: 1.258, 17.421) versus the Afro-Colombian race. Older children (25–60 months) were less likely to develop anemia than younger (6–24 months) children (OR: 0.073; 95% CI: 0.015, 0.360).

Conclusions

The finding of high anemia prevalence in this study advances our understanding of child and maternal anemia in populations of low socioeconomic status where health care is regularly accessed through well-child programs.