bluuebunny/crossref_metadata_2025 huggingface dataset:
BIFURCATION: A CLINICAL CASE IN ACUTE CORONARY SYNDROME
Authors: Ferrarello S , Vinci D , Priolo L , Cangemi S
Published: May 2024

Bifurcation

A clinical case in acute coronary syndrome. Coronary bifurcation lesions are considered one of challenging entities in the field of coronary intervention due to the risk of side branch loss and higher risk of stent thrombosis. There are limited data on the preferred treatment strategy in ST–segment elevation myocardial infarction (STEMI) patients with bifurcation lesions as most dedicated study excluded patients with acute coronary syndrome. In all comers population a 10–20% of STEMI patients had bifurcation culprit lesion. In 2018 guideline suggested a provisional approach by stenting the main vessel and implanting a second stent only if necessary as a bailout strategy. This reccomandation was supported by a large series of study that uniquely documented the superiority of one versus two stent technique. The same message could also be exported in the context of acute patients, as our clinical case, thanks to registry like COBIS 2 including ST–segment elevation patient. But this precious advice cannot be applied in all clinical subsets. Especially when we manage with a relevant side–branch and when the risk of loosing the side branch is very high. In this subgroup of patient, bifurcation lesion may benefit from a 2 stent approach. Different technical option are available. Among these, DK–crush and inverted Main Branch stenting across Side Branch (Invertend Culotte or inverted T technique) could be the best choice. Our patient was a young lady presenting with a lateral STEMI (D1 and aVL). The culprit lesion was a Medina 1.1.1 bifurcation lesion involving left anterior descending and first–diagonal. Since our side branch had thrombus inside, the vessel was relevant by definition. Other anatomical characteristique to take into account: relevant size and covering a large myocardial territory. Planning the strategy to treat our LAD–D1 bifurcation we consider the angle and the difference in size between main and side branch. We decided to proceed with DK–crush and its recent evolution DK–nano crush. In conclusion “do it provisional” guideline message is not always possible, 2 stent technique seems to be the best choice in presence of a relevant side–branch / high risk to loose it. Our take home message is, if the clinical scenario allow it, don’t hesitate to perform a multistep two vessel strategy technique and to try to reconstruct perfect anatomical carina even in STEMI context.
PROSTHETIC GRAFT INFECTION: WHEN ECHOCARDIOGRAPHY IS NOT ENOUGH!
Authors: Pezzi L , Scollo C , Rossi D , D‘Andria R , Benedetti C , Magnano R , D‘Alleva A , Forlani D , Vitulli P , Genovesi E , Gallina S , Di Marco M , Paloscia L
Published: May 2024

A 68–year–old Caucasian male, post–Bentall procedure with a bioprosthetic valve following extensive aortic dissection involving the ascending aorta and aortic arch, presented to the Emergency Department with persistent fever for over a month. During his hospitalization, he experienced ventricular fibrillation in the setting of hypokalemia, successfully managed with Advanced Cardiovascular Life Support (ACLS) and DC shock, leading to the restoration of sinus rhythm. Subsequently, he was admitted to the Cardiovascular Intensive Care Unite. Blood tests revealed neutrophilic leukocytosis with elevated inflammatory markers, anemia, and a troponin curve consistent with myocardial injury in the context of sepsis and anemia. Echocardiography demonstrated a left ventricle of normal dimensions with globally depressed function (EF 45%), attributed to apical akinesia. The prosthetic valve was functioning normally, and there were no signs of endocarditic vegetations or pericardial involvement. A transesophageal echocardiogram confirmed the absence of vegetations. Given echocardiographic signs of myocardial ischemia, coronary angiography was performed, revealing a coronary circulation free from significant stenosis. Cultural exams showed positivity for Enterococcus faecalis. A PET–CT revealed the presence of radioisotope uptake around the vascular prosthesis situated in the aortic arch. An Infectious Disease specialist recommended antibiotic therapy with Piperacillin/Tazobactam and Teicoplanin. At the one–month follow–up, the patient remained asymptomatic, free from new febrile episodes. The follow–up echocardiogram indicated improved global systolic function, and inflammatory markers remained consistently negative. Repeat blood cultures were negative. This case illustrates a suspected endocarditis on a prosthetic valve where both transthoraci and transesophageal echocardiography yielded negative results. The use of PET–CT, on the other hand, revealed the presence of vascular graft infection, proving to be a valuable method in this clinical setting.
INTERATRIAL BLOCK AS A FIRST CLINICAL PRESENTATION OF ATRIAL CARDIOMYOPATHY RELATED TO A NOVEL LMNA VARIANT: A CASE REPORT
Authors: Iavarone M , Covino S , Pettillo R , Russo V
Published: May 2024

Interatrial block (IAB) is a conduction delay in Bachmann’s bundle with a well–described association with structural heart disease, supraventricular arrhythmias, and cardiovascular events. We report the case of an asymptomatic 35–year–old man in whom the presence of IAB at electrocardiogram led to a comprehensive evaluation including speckle–tracking echocardiography, 24 h Holter monitoring, and genetic testing. Speckle–tracking echocardiography demonstrated a decrease in the longitudinal strain of interventricular septum, a typical feature of LMNA–related cardiomyopathy, and decreased indices of left atrial deformation. A diagnosis of cardiac laminopathy related to the frame shift variant c.1367 (p.Asn456Thrfs*24) of the LMNA gene was made. A dual–chamber implantable cardioverter defibrillator implantation was performed for the high risk of life–threatening ventricular tachyarrhythmias. This case demonstrates that IAB could be a rare presentation of a life–threatening laminopathy. Strain echocardiography is an essential tool to evaluate the deposition of fibrosis tissue in subclinical cardiomyopathies. Our report describes a novel variant of LMNA gene associated with a high risk of sudden cardiac death.
LMNA–RELATED DILATED CARDIOMYOPATHY PRESENTING WITH REGIONAL WALL AKINESIS AND TRANSMURAL LATE GADOLINIUM ENHANCEMENT
Authors: Pongetti G , Lofiego C , Vagnarelli F , Maurizi K , Capodaglio I , Patani F , Matassini M , Battistoni I , Tofoni P , Brugiatelli L , Pietrucci F , Tortora G , Schicchi N , Marini M , Dello Russo A , Perna G
Published: May 2024

A 26–year–old girl was admitted at hospital in December 2022 for a syncopal episode. She referred fatigue and dyspnea in the last 2 months. EKG was markedly abnormal showing peripheral low voltages, poor R wave progression in prechordial leads, negative T waves V4–V6, DII, DIII and aVF, fragmented QRS (Fig.1). Echo showed moderately dilated left ventricle (LV) with apical akinesia and apical aneurysm (no thrombi) and hypo–akinesia and hyperechoic appearance of the middle segments of the infero–posterior and lateral wall (Fig.2a). EF was 38%. There was no family history for sudden cardiac death and cardiomyopathy. Creatine kinase and neurological examination were normal. The diagnostic work–up included: myocardial scintigraphy which showed fixed tracer uptake deficit at apical and posterolateral levels (Fig.2b); cardiac magnetic resonance (CMR): apical aneurysm with extended late gadolinium enhancement (LGE) due to fibrosis, focally transmural, on the left ventricle’s midapical and infero–lateral thinned–hypokinetic myocardial walls (Fig.3a, 3b); Coronary angiography showed no stenosis. Due to myocardial aneurysm in absence of CAD, Chagas disease was excluded. We performed LV endomyocardial biopsy which showed cardiomyopathic changes and replacement fibrosis. Due to fibrosis extension, complex ventricular extrasystoles detected on monitoring and syncope, ICD was implanted. Finally genetic testing showed c.1621C>Tp.Arg541Cys LMNA pathogenetic mutation leading to the diagnosis of LMNA–related LV cardiomyopathy, with extensive fibrosis in multiple areas of left ventricle including the apical segments at a very young age. Patients with LMNA mutation-related heart disease are characterized by conduction abnormalities, ventricular tachyarrhythmias (VA) and high risk of sudden cardiac death with mildly impaired systolic function, often without chamber dilation. About 88% LMNA– cardiomyopathy have typical myocardial fibrosis, predominantly in the mid-myocardium of the basal septum. However, our patient and previous reported cases with the same p.R541 LMNA mutation presents with a specific phenotype including regional LV akinesis, segmental transmural LGE, significant LV dilatation and systolic dysfunction and VA without conduction abnormality. Of note, EKG shows normal A–V conduction but low voltage and negative T waves in precordial and inferior leads. These features are not typical for LMNA–disease and underline the phenotypic variability of cardiomyopathies.
CARDIAC MAGNETIC RESONANCE IN A CASE OF RECURRENT MESALAZINE–INDUCED MYOCARDITIS
Authors: Dicorato M , Caretto P , Colucci C , Colonna P
Published: May 2024

Introduction

Mesalazine represents a key treatment for Intestinal Bowel Diseases (IBD) and only in rare cases produces cardiac toxicity, presenting mainly as myocarditis, with a not completely known mechanism.

Case Report

We report the case of a 25–year–old man in apparent good health status, mild smoker, who accessed our Emergency Department for burning chest pain. In the last month he referred episodes of fever associated with bloody diarrhea and abdominal pain, because of which he underwent colonoscopy, that was not conclusive for IBD. However, therapy with mesalazine was started, with quite alleviation of gastro–intestinal symptoms. After about 2 weeks, the patient accessed our Emergency Department for burning chest pain and fever, with an increase of high–sensitivity cardiac troponin–I at blood tests. The transthoracic echocardiogram evidenced ipocontractility of the inferior and posterior medium left ventricular segments and cardiac magnetic resonance confirmed the suspicion of myocarditis. Antinflammatory and analgesic drugs were started with improvement of patient‘s condition, but mesalazine was not interrupted. 3 weeks after discharge, he came again to our attention for myocarditis recurrence. Auto–immunity and microbiological laboratory tests, including blood cultures, were negative. The patient was evaluated by a multidisciplinary team, that excluded any other possible cause of myocarditis, except for drug–induced form. Thus, we decided to stop treatment with mesalazine and discharged the patient with lifelong ban of assuming this drug. He didn‘t show any recurrence of cardiological impairment at our follow–up (8 months) and is in good health status at now.

Discussion

Mesalazine–induced myocarditis is extremely rare. The diagnosis of this condition can be made only by ruling out other causes of myocarditis (in our case through a multidisciplinary team), and considering 2 main features (both present in our patient): symptoms onset within 2–4 weeks after the first drug intake (differently from IBD–related myocarditis) and improvement of patient’s status only thanks to mesalazine interruption. The peculiarity of this case is also represented by the myocarditis recurrence: since the only effective treatment for this condition is stopping mesalazine, in our patient after the first hospitalization myocarditis has recurred because the drug was continued, further supporting our diagnostic suspicion.
VERY MOBILE LEFT VENTRICULAR PAPILLARY FIBROELASTOMA PRESENTING WITH ISCHEMIC STROKE
Authors: Maffè S , Paffoni P , Facchini E , Bergamasco L , Prenna E , Ariotti S , Ticozzi S , Paino A , Dellavesa P
Published: May 2024

Papillary fibroelastomas are small and pedunculated left side valves associated mass, that frequently causing cerebral embolization; they are composed of collagen and elastic fibers and are usually connected with a pedicle to the endocardial layer. Differential diagnosis with endocarditis can rely on the side of attachement: Papillary fibroelastomas are more frequently found downstream the valves, instead, endocarditis are mostly found upstream the valves. They are mostly located (>80%) on valvular surfaces, more commonly on left side cardiac valves (44% on the aortic valve and 35% on the mitral valve); therefore, in the present knowledge, papillary fibroelastomas arising from left ventricular myiocardial wall are rare and mostly anecdotally descripted. We present the case of a 78–year–old man, diabetic, with no cardiac history, hospitalized with a right capsulo–lenticular stroke. Symptomatic due to left hemiparesis, he did not undergo thrombolysis due to a delay in hospitalization of almost 24 hours. The transthoracic and then transesophageal echocardiogram showed the presence of a hyperechogenic, floating mass of approximately 3 cm at the level of the left ventricle, separate from the mitral valve and attached to the mid–distal anterior septum and the ventricular apex (Figure 1). Cardiac MRI confirmed the presence of a peduncolate left ventricular mass, isointense on cine sequences, without myocardial infiltration, isointense on T1–weighted images and mildy hyperintense on T2–weighted images, with mild uniform late–gadolinium enhancement (Figure 2). The patient underwent surgical removal of the mass: histological analysis showed multiple, branching fronds of paucicellular, avascular fibroelastic tissue lined by a single layer of endocardium, with positive stains at Weigert coloration for elastic fibers (Figure 3). Histomorphological analysis was compatible with papillary fibroelastoma. This is a very atypical case of papillary fibroelastoma, due to the large size of the mass and the intraventricular and not–valvular location, which determined its emboligenicity and which, if not removed, would have exposed the patient to an enormous risk of recurrence of stroke.
MECHANICAL PROSTHETIC MITRAL VALVE THROMBOSIS COMPLICATED BY AN ACUTE CORONARY SYNDROME AFTER SYSTEMIC FIBRINOLYSIS: A CASE REPORT
Authors: Collareta M , Vera–Mondazzi L , Abd Almhmoud Sidiq M , Mohmed Ahmed Ibrahem H , Giovanella E , Portella G , Masini F
Published: May 2024

The annual incidence of blocked mechanical valvular prosthesis (BMVP) is 0.3–5.7%. 78% of cases are due to thrombosis and development of pannus is the second more frequent etiology. The risk of thrombosis is higher for mitral prosthesis, during the 1st year after valve replacement, and for poor INR trend. TEE is the gold standard for diagnoses, but it is seldom required if adequate TTE and cine–fluoroscopy are performed. As therapy, redo surgery is recommended in case of NYHA III–IV patients or in presence of big thrombi: if surgery is contraindicated or too high–risk, systemic thrombolysis is a reasonable option. In less compromised patients, upgrading of the anti–thrombotic therapy can be considered. In our Centre (around 600 valve replacement surgeries/year, mainly high risk patients) we use thrombolysis for BMVP in decompensated patients, choosing between two different protocols: the so called “fast” protocol (alteplase 15 mg iv bolus, then 0.75 mg/kg over 30’ and 0.5 mg/kg over 1h) is provided for NYHA IV patients, while the “slow” protocol (25 mg over 6 h) is the treatment of choice for the NYHA III ones. Many complications, mainly bleeding, are associated to thrombolysis. A 30 years old lady who underwent MVR in 08/2021, already successfully treated with thrombolysis in 11/2021 due to BMVP, presented in 01/2023 due to NYHA IV heart failure. TTE and cine–fluoroscopy showed BMVP (grad. 29/21 mmHg, area 0.7 cm2). The LV was hypekynetic (EF 81%), and severe pulmonary hypertension (calcSPAP 82 mmHg) was present. Fast thrombolysis was performed, with decrease of gradients (11/6 mmHg) and of pulmonary pressure (45 mmHg), and preserved LV function (EF 55%), without acute complications. On the 2nd day, the patient developed generalized seizures and pulsless VT, with ROSC after DC shock (7’ low–flow time). The neurological recovery was complete, but haemodynamic instability developed; new onset LBBB, and progressive worsening of the LV function (EF 40%, then 25%, medioapical hypokinesia) were documented. The coronary angiography showed a thrombus in the proximal LAD, not occluding the vessel, and TIMI 3 downstream flow. Heparin continuous infusion was provided for 48 h with a 1.8–2.3 aPTT ratio target. The patient was eventually discharged home with normal gradients (12/7 mmHg), EF (67%), ECG and pulmonary pressure. Coronary embolism is a possible complication of BMVP, and can follow systemic thrombolysis. Close multimodal clinical monitoring is mandatory.
AORTIC VALVE FIBROELASTOMA PRESENTING WITH MYOCARDIAL INFARCTION WITH NON–OBSTRUCTIVE CORONARY ARTERIES (MINOCA)
Authors: Pepe M , Tritto R , Naccarati M , Quarta S , Marzullo A , Ciccone M
Published: May 2024

A 35–year–old woman with known mitral valve prolapse and history of migraine presented to the Emergency Department because of several episodes of chest pain in the previous three days arising at rest and followed by spontaneous relief within few minutes. No electrocardiographic abnormalities were found but an oscillating trend of high sensitivity Cardiac troponin I (hs–cTnI) was reported. After an urgent coronary angiography which showed non obstructive coronary artery disease, the patient was referred to intensive care unit (ICU) with a working diagnosis of myocardial infarction with non–obstructive coronary arteries (MINOCA). Hence, an integrated imaging assessment was performed: trans–thoracic echocardiogram (TTE) and trans–esophageal echocardiogram (TEE) excluded segmental wall motion abnormalities and pericardial effusion but revealed a round–shaped hyperechoic floating mass attached to the aortic valve. Cardiac nuclear magnetic resonance (CMR) allowed to rule out an acute myocarditis and demonstrated on the T1–weightened imaging an isointense mass on the right cusp of the aortic valve. During the assessment of LGE in phase–sensitive inversion recovery (PSIR) the mass appeared hyperintense. The hypothesis of repetitive episodes of myocardial ischemia due to the transient obstruction of the coronary ostium determined by the pedunculated mass was formulated. After successful surgical excision, the histopathological examination of the specimen revealed mesenchymal tissue with the characteristics of cardiac papillary fibroelastoma (CPF).
PERCUTANEOUS EDGE–TO–EDGE REPAIR OF MITRAL REGURGITATION IN CARDIAC AMYLOIDOSIS: DO IT BUT NOT TOO MUCH
Authors: Paparoni F , Tomassoni G , Marrangoni A , Marrone G , Lezzi A , De Remigis F
Published: May 2024

We report the case of a 68 year old man with history of wild type TTR cardiac amyloidosis, treated with tafamidis since 1 year, symptomatic for advanced cardiac failure, already in optimal medical treatment, CRT–D, oral anticoagulation for permanent atrial fibrillation. The patient was hospitalised in our intensive care unit for refractory NYHA IV cardiac failure, anuria, very low ejection fraction combined with severe mitral regurgitation. He was treated with inotropes and diuretics then levosimendan however he remained in very critical state and we discussed the opportunity to reduce the mitral regurgitation by percutaneous edge to edge repair. In this setting of restrictive physiology literature is not unanimous and preload reduction secondary to mitral regurgitation treatment may sometimes be deleterious. We decided to offer our patient edge to edge repair by targeting a moderate reduction of mitral regurgitation and also considering some challenges linked to this pathology as atrial septal involvement with ovalis fossa relevant thickness. The procedure was successful with a reduction of mitral regurgitation grade from severe to mild–to moderate and this allowed the patient to re equilibrate his hemodynamic balance and he was able to be dismissed with a short term follow up program.
A low-carbon multigeneration system based on a solar collector unit, a bio waste gasification process and a water harvesting unit
Authors: Demir Nadir , Shadjou Amir Mohammad , Abdulameer Maha Khalid , Almasoudie Najah Kadum Alian , Mohammed Nerain , Fooladi Hadi
Published: May 2024

In this study, we introduce and examine a novel multigeneration cycle powered by low-carbon bio-waste and integrated with a solar thermal component. This system is designed to convert sewage sludge into a variety of useful products. The cycle utilizes anaerobic digestion and gasification to produce biogas and syngas. Additionally, it incorporates processes for generating water and hydrogen energy, utilizing the atmospheric water harvesting unit and water/gas shift reaction, sequentially. The system employs a Rankine cycle, a Brayton cycle and two organic Rankine cycles (ORCs) for electricity generation. A significant portion of the heat and electricity in this proposed project is sourced from a waste heat recovery system. This innovative project not only presents a new structure and configuration for product generation but also addresses energy, water and environmental challenges concurrently. The energy system’s performance has been thoroughly assessed in terms of thermodynamics, environmental impact and economic feasibility. The proposed plant is capable of producing an estimated 17 920 kW of electric power, 3207.6 kg/h of hydrogen energy and 5.14 × 10−3 L/s of freshwater. Under these design conditions, the energy and exergy efficiencies of the system were determined to be 35.76% and 40.49%, respectively. Additionally, the exergy sustainability factor, the levelized total emitted carbon dioxide and the unit cost of total products were characterized to be 52.28%, 0.2145 kg per kWh and 0.05219 $ per kWh, respectively.
Implementation of improved shuffled frog leaping algorithm for optimum landscape space environment design
Authors: Liu Kaizhu , Su Chen , Gu Chengwei , Jiang Yupeng
Published: May 2024

Landscape design is a complex process, requiring the seamless integration of various elements such as the senses, environment, morphology and optimization techniques. In this study, a new approach called the Interactive Enhanced Shuffled Frog Leaping Algorithm (IISFLA), specifically has been designed to optimize spatial environments in landscape design. The IISFLA is a hybrid optimization method that combines the Shuffled Frog Leaping Algorithm (SFLA), Bacterial Foraging Algorithm and human–computer interaction to address intricate nonlinear challenges. To demonstrate its effectiveness, IISFLA has been applied in the design of a garden community and contrasted with conventional design of landscape methodologies. To tackle the problem at hand, a optimality model of search that is layer-by-layer, which allows us to divide the problem space into manageable subsolution spaces, has been employed. Also, a participatory evaluation strategy has been adopted to assess the impact of the landscape design on different user groups. The results of this study reveal that IISFLA surpasses conventional methods in terms of performance and user satisfaction, making it a versatile and user-friendly tool for landscape designers. The research emphasizes the innovation, significance and implications of our work in the field of landscape design and optimization. Key numerical findings include a 22.6% increase in landscape space evaluation value when using IISFLA compared to traditional methods, a 34.7% reduction in computational time and a 28.9% improvement in user satisfaction rates. These outcomes highlight the effectiveness and potential of IISFLA in enhancing landscape design outcomes.
A meta-analysis of randomized controlled trials comparing breast-conserving surgery and mastectomy in terms of patient survival rate and quality of life in breast cancer
Authors: Li Shuangjian , Li Xin , Li Dan , Zhao Qian , Zhu Liping , Wu Tao
Published: May 2024

The study aimed to assess the effects of breast-conserving surgery (BCS) versus mastectomy on survival and quality of life in Stages I, II, and III breast cancer, providing solid evidence for clinical decisions. We conducted a meta-analysis of randomized controlled trials on breast cancer treatments, searching databases such as PubMed and the Cochrane Library to compare BCS, and mastectomy’s effects on survival and quality of life. A combined total of 16 734 patients in the control group and 17 435 patients in the experimental group were included in this analysis. This meta-analysis used RevMan 5.3 (Cochrane Collaboration, Copenhagen, Denmark) software for analysis. Our meta-analysis of 34 169 patients from 11 studies showed that BCS significantly reduced the overall recurrence rate at a median follow-up of 29 months, with a mean difference of 1.27 and a 95% confidence interval of 1.19–1.36, strongly supporting its effectiveness (P < .00001). Furthermore, our analysis found no significant increase in 5-year local recurrence rates for BCS versus mastectomy, indicating its long-term effectiveness with a mean difference of 1.13 (95% confidence interval: [1.03, 1.24], P = .01). Additionally, there was a notable decrease in tissue ischaemic necrosis among patients who had received BCS, with a mean difference of 0.37 (95% confidence interval: [0.33, 0.42], P < .00001), underscoring its benefits and long-term viability. BCS resulted in fewer cases of tissue ischaemic necrosis and higher body image scores compared with mastectomy, suggesting that it is a preferable option for better cosmetic outcomes and potentially favourable effects on prognosis and quality of life.
Giving adolescents with cystic fibrosis a voice: Predicting cystic fibrosis nutritional adherence from their decision-making involvement
Authors: Kelleher Jennifer , Durkin Kristine , Fedele David A , Moffett Kathryn , Filigno Stephanie S , Lynn Courtney , Everhart Robin S , Stark Lori J , Duncan Christina L
Published: May 2024

Objective

Suboptimal nutritional adherence in adolescents with cystic fibrosis (awCF) has been associated with lower lung function. AwCF often have more independence in dietary decisions than younger children, yet little research has examined how adolescent decision-making relates to nutritional adherence. This study explored whether components of adolescent decision-making involvement facilitate enzyme and caloric adherence in awCF.

Methods

37 families participated and completed study procedures. AwCF and caregivers completed electronic surveys, including the Decision-Making Involvement Scale (DMIS). The DMIS evaluated awCF behaviors during nutrition-related decision-making/discussions with caregivers using DMIS subscales: Child Seek (asking for help/advice from caregivers), Child Express (awCF stating opinions) and Joint/Options (awCF participating in joint decision-making or caregiver providing options). AwCF completed 2, 24-hr diet recalls via videoconferencing/phone to estimate adherence. Chart reviews collected medical information. DMIS subscales were regressed onto enzyme and caloric adherence.

Results

43% of awCF met calorie recommendations; 48.6% took all enzymes as prescribed. Caloric adherence was positively correlated with adolescent- and parent-reported Child Seek (r = 0.53; r = 0.36) and adolescent-reported Joint/Options (r = 0.41). Per adolescent-report, the caloric adherence regression model was significant, with Child Seek contributing unique variance in caloric adherence (β = .62, p = .03). Parent-reported adolescent-decision-making involvement significantly predicted caloric adherence, but none of the subscales contributed unique variance. No other regressions were significant.

Conclusions

When awCF participated in nutrition-related discussions with a caregiver, especially with questions, caloric adherence was better. Future research should examine whether family factors influence these results. AwCF are encouraged to ask questions in nutrition discussions.
Testing for distributional structural change with unknown breaks: application to pricing crop insurance contracts
Authors: Lu Hanjun , Ker Alan P
Published: May 2024

Agriculture in developed countries is produced under heavily subsidized insurance. The pricing of these insurance contracts, termed premium rates, directly influences farmers profits, their financial solvency, and indirectly, global food security. Changing climate and technology have likely caused significant shifting of mass in crop yield distributions and, if so, has rendered some of the historical yield data irrelevant for estimating premium rates. Insurance is primarily interested in lower tail probabilities and as such the detection of structural change in tail probabilities or higher moments is of great concern for the efficacy of crop insurance programs. We propose a test for structural change with an unknown break(s) which has power against structural change in any moment and can be tailored to a specific range of the underlying distribution. Simulations demonstrate better finite sample performance relative to existing methods and reasonable performance at identifying the break. The asymptotic distribution is shown to follow the Kolmogorov distribution. Our proposed test finds structural change in most major U.S. field crop yields leading to significant premium rate differences. Results of an out-of-sample premium rating game indicate that incorporating structural change in crop yields leads to more accurate premium rates.
ChIP-Atlas 3.0: a data-mining suite to explore chromosome architecture together with large-scale regulome data
Authors: Zou Zhaonan , Ohta Tazro , Oki Shinya
Published: May 2024

ChIP-Atlas (https://chip-atlas.org/) presents a suite of data-mining tools for analyzing epigenomic landscapes, powered by the comprehensive integration of over 376 000 public ChIP-seq, ATAC-seq, DNase-seq and Bisulfite-seq experiments from six representative model organisms. To unravel the intricacies of chromatin architecture that mediates the regulome-initiated generation of transcriptional and phenotypic diversity within cells, we report ChIP-Atlas 3.0 that enhances clarity by incorporating additional tracks for genomic and epigenomic features within a newly consolidated ‘annotation track’ section. The tracks include chromosomal conformation (Hi-C and eQTL datasets), transcriptional regulatory elements (ChromHMM and FANTOM5 enhancers), and genomic variants associated with diseases and phenotypes (GWAS SNPs and ClinVar variants). These annotation tracks are easily accessible alongside other experimental tracks, facilitating better elucidation of chromatin architecture underlying the diversification of transcriptional and phenotypic traits. Furthermore, ‘Diff Analysis,’ a new online tool, compares the query epigenome data to identify differentially bound, accessible, and methylated regions using ChIP-seq, ATAC-seq and DNase-seq, and Bisulfite-seq datasets, respectively. The integration of annotation tracks and the Diff Analysis tool, coupled with continuous data expansion, renders ChIP-Atlas 3.0 a robust resource for mining the landscape of transcriptional regulatory mechanisms, thereby offering valuable perspectives, particularly for genetic disease research and drug discovery.
Accuracy of chest x-ray screening of silica-exposed miners for tuberculosis
Authors: Maboso B , Ehrlich R I
Published: May 2024

Background

The World Health Organization recommends systematic chest X-ray (CXR) screening for tuberculosis (TB) in silica-exposed workers. However, evidence on the accuracy of CXR screening in such populations is lacking.

Aims

To measure the accuracy of CXR screening for active TB in silica-exposed miners, in a population with a high prevalence of silicosis, post-TB lung disease and HIV.

Methods

A secondary analysis of data from a miner screening programme in Lesotho was undertaken. We measured the performance of CXR (in participants with and without cough) for ‘abnormalities suggestive of TB’ against Xpert MTB/RIF (Xpert). The sample size was 2572 and positive Xpert prevalence was 3%.

Results

CXR alone had high sensitivity (0.93, 95% confidence interval [CI] 0.87–0.99), but low specificity (0.41, 95% CI 0.39–0.42). Requiring cough and a positive CXR increased specificity (0.79, 95% CI 0.77–0.81), resulting in reduced sensitivity (0.41, 95% CI 0.30–0.52). There was no difference in CXR accuracy by HIV status. However, specificity was markedly reduced in the presence of silicosis (from 0.70, 95% CI 0.68–0.72, to 0.03, 95% CI 0.02–0.04) or past TB history (from 0.59, 95% CI 0.56–0.62 to 0.27, 95% CI 0.25–0.29). Throughout, positive predictive value remained very low (5%) and negative predictive value very high (99%).

Conclusions

CXR screening accurately identifies TB-negative CXRs in this population, but post-TB lung disease and silicosis would result in a high proportion of Xpert-negative referrals and an increased risk of unneeded empirical treatment. Adapted screening algorithms, practitioner training and digital access to previous mining CXRs are needed.
Dialetheism and the A-theory
Authors: Baron Sam
Published: May 2024

According to dialetheism, there are some true contradictions. According to the A-theory, the passage of time is a mind-independent feature of reality. On some A-theories, the passage of time involves the movement of the present. I show that by appealing to dialetheism, one can explain why the present moves. I then argue that A-theorists should adopt this explanation. To do this, I defend two claims. First, that the dialetheic explanation is an improvement on the only other explanation available for why the present moves and, second, that adopting the explanation is better than leaving the motion of the present unexplained. Assuming that A-theorists should adopt the best available version of their view, it follows that they should adopt a dialetheic explanation of why time passes.
IL-24 promotes atopic dermatitis-like inflammation through driving MRSA-induced allergic responses
Authors: Qian Xinmin , Tong Meiyi , Zhang Tianqing , Li Qingqing , Hua Meng , Zhou Nan , Zeng Wenwen
Published: May 2024

Atopic dermatitis (AD) is a prevalent inflammatory skin disorder in which patients experience recurrent eczematous lesions and intense itching. The colonization of Staphylococcus aureus (S. aureus) is correlated with the severity of the disease, but its role in AD development remains elusive. Using single-cell RNA sequencing, we uncovered that keratinocytes activate a distinct immune response characterized by induction of Il24 when exposed to methicillin-resistant S. aureus (MRSA). Further experiments using animal models showed that the administration of recombinant IL-24 protein worsened AD-like pathology. Genetic ablation of Il24 or the receptor Il20rb in keratinocytes alleviated allergic inflammation and atopic march. Mechanistically, IL-24 acted through its heterodimeric receptors on keratinocytes and augmented the production of IL-33, which in turn aggravated type 2 immunity and AD-like skin conditions. Overall, these findings establish IL-24 as a critical factor for onset and progression of AD and a compelling therapeutic target.
Effect of bimekizumab on patient-reported disease impact in patients with psoriatic arthritis: 1-year results from two phase 3 studies
Authors: Gossec Laure , Orbai Ana-Maria , de Wit Maarten , Coates Laura C , Ogdie Alexis , Ink Barbara , Coarse Jason , Lambert Jérémy , Taieb Vanessa , Gladman Dafna D
Published: May 2024

Objectives

To evaluate 1-year bimekizumab efficacy in PsA from the patient perspective using the 12-item PsA Impact of Disease (PsAID-12) questionnaire.

Methods

BE OPTIMAL (NCT03895203; biologic DMARD [bDMARD]-naïve), BE COMPLETE (NCT03896581; inadequate response/intolerance to TNF inhibitors [TNFi-IR]) and BE VITAL (NCT04009499; open-label extension) assessed bimekizumab 160 mg every 4 weeks in patients with PsA. Post hoc analyses of patient-reported disease impact, assessed by the PsAID-12 questionnaire, are reported to 1 year (collected to Week 40 in BE COMPLETE).

Results

Overall, 1,112 total patients were included (698 bimekizumab, 414 placebo). Rapid improvements observed with bimekizumab treatment at Week 4 continued to Week 16 and were sustained to 1 year. At 1 year, mean (SE) change from baseline in PsAID-12 total score was comparable between bimekizumab-randomized patients and patients who switched to bimekizumab at Week 16 (bDMARD-naïve bimekizumab –2.3 [0.1], placebo/bimekizumab –2.2 [0.1]; TNFi-IR bimekizumab –2.5 [0.1], placebo/bimekizumab –2.2 [0.2]). Proportions of bimekizumab-randomized patients achieving clinically meaningful within-patient improvement (≥3-point decrease from baseline) at Week 16 were sustained to 1 year (bDMARD-naïve 49.0%; TNFi-IR 48.5%) and were similar for placebo/bimekizumab patients (bDMARD-naïve 44.4%; TNFi-IR 40.6%). Across studies and arms, 35.3% to 47.8% of patients had minimal or no symptom impact at 1 year. Improvements were observed to 1 year across all single-item domains, including pain, fatigue and skin problems.

Conclusion

Bimekizumab treatment resulted in rapid and sustained clinically meaningful improvements in disease impact up to 1 year in bDMARD-naïve and TNFi-IR patients with PsA.

Trial registration

BE OPTIMAL: NCT03895203; BE COMPLETE: NCT03896581; BE VITAL: NCT04009499 (ClinicalTrials.gov)
Understanding the Risk Factors for Overdose in Pregnant and Postpartum Patients With Opioid Use Disorder: A Scoping Review [ID 2683381]
Authors: Campbell Kelly A. , Wilson Anna L. , Torres Marilyn , Dantuluri Neha , Fryer Kimberly
Published: May 2024

INTRODUCTION:

The rise in pregnant patients with opioid use disorder (OUD) has led to increased rates of pregnancy-associated deaths due to opioid-related overdoses. The aim of this scoping review is to describe the risk factors of opioid-related overdose in pregnant and postpartum patients.

METHODS:

We searched PubMed, CIANHL, EMBASE, Web of Science, Scopus, clinicaltrials.gov, and PsycINFO. We included studies that identified pregnant and/or postpartum patients with OUD and differentiated between those who experienced overdose and those who did not. Studies were screened by their title and abstract, and then by full text. Each study was independently screened by two researchers and conflicts were resolved by a group of three researchers.

RESULTS:

Of the 1,060 articles identified, eight met our criteria. These studies examined 90,860 pregnant and postpartum patients with evidence of OUD. The most frequently identified factor that reduced the risk of overdose was the consistent use of medications for OUD during pregnancy and the postpartum period. Other risk factors found included being houseless, incarcerated, young in age, unmarried, postpartum, publicly insured; not graduating high school; co-occurring substance use disorders; living in a state with punitive prenatal substance use policies; inadequate prenatal care; and complications in pregnancy. There was inconsistent information regarding the effect of race and co-occurring psychiatric disorders.

CONCLUSION:

This scoping review highlights risk factors for opioid overdose in pregnant and postpartum patients. The review indicates opportunities for future research and calls for the screening and provision of judgment-free services for high-risk individuals.
The Effect of Urine Drug Screening for No Prenatal Care on the Parent–Neonatal Dyad [ID 2683382]
Authors: Kravitz Elizabeth , Mulugeta-Gordon Lakeisha , Bhadra-Heintz Nia , Antonacci Caroline E. , Sonalkar Sarita , James Abike
Published: May 2024

INTRODUCTION:

Urine drug screens (UDS) during pregnancy can perpetuate racial disparities that extend far past medical outcomes and into the autonomy of birthing persons and their family unit.

METHODS:

This retrospective cohort study compared pregnant patients admitted to the labor floor from September 1, 2020 to June 1, 2022, with UDS collected for no prenatal care (“NPNC”) to those collected for all other indications including altered mental status, use of nonprescribed substances, medications for opioid use disorder, suspicion of abruption, unexplained hypertension, or fetal demise (“Other Cohort”). Chi-squared analysis and Student's t-test were used for statistical analyses.

RESULTS:

Of 7,022 births, 127 (2%) had UDS collected. Patients who identified as Black were significantly more likely to have UDS collected (P<.0001). Of 127 UDS, 29 were sent for NPNC alone, and 98 were sent for other indications. There was no difference in age, race, or insurance status between the two groups. Among the NPNC cohort, 8 were positive for marijuana alone (28%), 3 (10%) for opioids (two provided by the care team), 1 for benzodiazepine (provided by the care team), and the rest were negative (59%). Significantly more patients were positive for opioids or other substances (not marijuana alone) in the “other cohort” compared to the NPNC cohort (P=.002).

CONCLUSION:

The majority of UDS for NPNC were negative, or positive for marijuana alone. Our findings show potential for harm, and no added utility, when using NPNC as an indication for collecting a UDS as reporting marijuana alone to government agencies may have disproportionately negative effects for Black patients.
Barriers and Facilitators to Telemedicine Contraception Among Patients Who Speak Spanish: A Qualitative Study [ID 2692431]
Authors: Meurice Marielle , Kully Gennifer , Averbach Sarah , Marengo Antoinette , Nodorac Jesse , Mody Sheila K.
Published: May 2024

INTRODUCTION:

The objective of this study was to evaluate the barriers and facilitators of telemedicine for contraception care among patients who speak Spanish using a community-based participatory research approach.

METHODS:

We interviewed 20 patients after telemedicine and in-person contraception visits conducted in Spanish at Planned Parenthood of the Pacific Southwest in Southern California. Two coders analyzed the data using content analysis.

RESULTS:

Most participants had some college education (14, 65%) and public insurance (18, 90%). Most chose a short-acting contraceptive method (11, 55%). Five key themes were identified. 1) Participants reported less comfort with video technology and a preference to not be seen during the appointment, therefore preferring audio-only for telemedicine visits. 2) Participants did not report difficulty with Spanish interpreters using telemedicine. 3) Telemedicine has conveniences related to time, work, childcare, and transportation but may have inconveniences related to method receipt. 4) Preference for comprehensive care with physical examination and familiarity of the in-clinic model motivated people who sought in-person care rather than technology barriers with telemedicine. 5) There is trust in the privacy and confidentiality of the visits, but privacy at home for the individual may affect choice for in-person care.

CONCLUSION:

Many patients who speak Spanish preferred audio-only technology for telemedicine contraception visits. Use of interpreters and technology were not perceived barriers for care. There is a need for prospective studies comparing the quality of telemedicine among patients who speak Spanish for contraception care.
A Qualitative Study of Transgender and Nonbinary Perspectives Regarding the Desired Properties of a Peer Support Intervention for the Initiation of Gender-Affirming Hormone Therapy [ID 2683451]
Authors: Kinnear Hadrian M. , Hosea Forrest , Reynolds Jayne , Stroumsa Daphna
Published: May 2024

INTRODUCTION:

Transgender and nonbinary (TNB) people experience significant mental health disparities and challenges accessing gender-affirming care. Peer support interventions have been shown to improve mental health in other populations and contexts but have not been uniquely tailored to the initiation of gender-affirming hormones. This study aims to identify the desired properties of a peer support intervention for TNB people initiating gender-affirming hormones.

METHODS:

We conducted semistructured interviews with TNB adults who had initiated or attempted to initiate gender-affirming hormones (IRB: HUM00203630: approved/exempt; gender-affirmation: off-label). Participants were selected by snowball and purposive sampling methods. Interview questions focused on the participants' experiences with peer support and their vision for ideal peer support while initiating hormones. Interviews were transcribed and analyzed using reflective thematic analysis with inductive and deductive coding. A TNB community advisory board collaborated in the study design and interviews were conducted by TNB research team members.

RESULTS:

The ages of the participants ranged from 20 to 52 years (mean=32); 8/18 identified as men or trans men; 4/18 identified as nonbinary; 3/18 identified as women or trans women; 3/18 identified as genderqueer or genderfluid; 10/18 identified as a person of color. Themes include the importance of 1) trans community knowledge in guiding hormone therapy decisions, 2) having support structures attend to intersectional identities, and 3) recognizing barriers to peer engagement, including anxieties about fitting in and internalized transphobia.

CONCLUSION:

Centering TNB voices is essential in designing a peer support intervention for hormone initiation. Our participants offered nuanced approaches for how to share information about hormones, attend to intersectional identities, and navigate barriers to peer engagement.
Patient Perceptions on the Use of Gender-Inclusive Language in Obstetrics and Gynecology: A Qualitative Study [ID 2683479]
Authors: Dinelli John , Govindarajan Preethi , Piatelli Alissa , Margolis Benjamin
Published: May 2024

INTRODUCTION:

This qualitative study explored how gender-inclusive language affects patients receiving care from obstetrician–gynecologists.

METHODS:

Purposive sampling was used to ensure a diverse population of participants. Semistructured video interviews were used to explore perceptions of gender-inclusive language. Interviews were transcribed, coded, and analyzed via ATLAS.ti.

RESULTS:

Fourteen interviews were completed. Fifty-seven percent of participants were 18–30 years old. Fourteen percent of participants were over 50 years old. Twenty-nine percent of participants identified as a gender other than female. Terms including “maternity,” “women's health,” and “chestfeeding,” elicited varied responses. Gender inclusivity statements made by national obstetrics and gynecology organizations were variably perceived as either appropriate, needing revision, or harmful to gender-diverse patients. Predominant themes include the following: 1) affirming language and inclusiveness are critical, “it could definitely … save somebody's life just by making them comfortable”; 2) varied patient experiences within health care should be respected; 3) there is a preference towards individualized language over neutral language, “It's good to be more inclusive in a way that doesn't diminish the importance of the individual person”; 4) perceived threats of inclusive language include medicalization of language, lack of recognition of women's rights efforts, and alienation of conservative individuals who may disagree with language changes, “I don't want … care that mostly affects cis-women to become … obscured or … diminished.”

CONCLUSION:

The transition towards gender-inclusive language in obstetrics and gynecology health care is pivotal. Balancing inclusivity, individuality, and historical terminology is a complex task that requires thoughtful input from diverse populations.