bluuebunny/crossref_metadata_2025 huggingface dataset:
The Implications of Acute Anatomic Injury After Percutaneous Renal Intervention
Authors: Cheun Tracy J. , Davies Mark G.
Published: August 2024

Purpose:

Percutaneous renal artery revascularization for hypertension and renal dysfunction remains common. The frequency, cause, and outcomes of anatomic injury associated with renal intervention are poorly delineated. This study aims to determine the frequency of acute anatomic renal injury after renal artery interventions, identify factors associated with anatomic renal injury, and determine whether anatomic renal injury related to renal intervention is associated with late adverse clinical events.

Methods:

A retrospective analysis of patients undergoing renal artery interventions for atherosclerotic renal artery disease between 2002 and 2022 was performed. Acute anatomic renal injury encompassed renal artery dissection, renal artery perforation, acute occlusion, renal parenchymal infarction, and renal parenchymal perforation. Freedom from renal-related morbidity (increase in persistent creatinine >20% of baseline, progression to hemodialysis, death from renal-related causes) and patient survival were measured.

Results:

A total of 968 patients underwent 1309 renal artery interventions: 47% for hypertension, 25% for hypertension associated with chronic renal dysfunction, and 28% for chronic renal dysfunction. An acute anatomic renal injury occurred in 5.9% of the patients. The occurrence of an anatomic injury was associated with a significant decrement in freedom from renal-related morbidity (79±2% vs 55±8%, no-injury vs injury group, mean±standard error of the mean; p=0.003) and markedly decreased survival at 5 year follow-up (78±3% vs 48±8%; p=0.002). No factor was identified that predicted anatomic injury. In those patients with anatomic injury, perforation was associated with decreased survival, while estimated glomerular filtration rate <60, resistive index >0.8, and dissection were associated with a lack of retained renal benefit.

Conclusion:

Acute anatomic renal injury occurs in approximately 6% of patients undergoing percutaneous renal artery intervention and is a negative predictor of survival and is associated with subsequent renal failure, need for dialysis, and death from renal-related causes.

Clinical Impact

Acute anatomic renal injury occurs in approximately 5% of patients undergoing percutaneous renal artery intervention. Modern endovascular interventions allow for the control and remediation of injuries in the majority of cases with an overall low mortality and morbidity. There is a significant early occlusion of renal arteries following the injury within 1 month. In the long term, the occurrence of injury is a negative predictor of survival and is associated with subsequent renal failure, the need for dialysis, and death from renal-related causes.
Influence of balloon type and lesion location on outcomes following fistuloplasty
Authors: Parker Michael , Bennett Philip C , Dhillon Baljeet , Al-Thaher Ahmad , Al-Alwani Zahra , Elzubeir Lee , Cetin Tugce , Elkhawad Maysoon , Ali Tariq
Published: August 2024

Background

There is limited evidence supporting the optimal use of fistuloplasty to maintain vascular access at various lesion sites, despite its critical role in facilitating renal replacement therapy and the overall high failure rates of arteriovenous fistulas (AVFs). This study aims to identify covariates affecting primary and secondary patency following fistuloplasty of native upper limb vascular access AVFs.

Methods

This retrospective study included all patients who underwent fistuloplasty at a tertiary vascular centre over 4 years. Baseline characteristics were recorded, and factors associated with primary and secondary patency rates were analysed.

Results

A total of 206 patients (88 male, 118 female) with a mean age of 68 (±14) years underwent fistuloplasty during the study period. The prevalence of diabetes, ischaemic heart disease and antiplatelet usage were 33%, 21% and 70%, respectively. The median number of fistuloplasties per access during the follow-up period was 2 [1–3]. Fistulas were classified as radiocephalic (65), brachiocephalic (102) and brachiobasilic transposition (39). Recurrent stenosis (RS) was identified in 60 patients who had previous fistuloplasty before the study period, while 146 patients had de novo stenoses (DNS). Stenosis location significantly differed between RS and DNS ( p = .03), with DNS primarily being anastomotic and RS predominantly in central and mixed locations. Younger fistulas were more likely to have anastomotic stenoses compared to those older than 1 year ( p = .001). While no significant differences in primary patency (PP) were observed, secondary patency (SP) varied by stenosis location: Central 32 [13–42] months, Fistula vein 20 [12.5–35.5] months, Mixed 25 [13.5–37.5] months and Anastomotic 19 [7–29.5] months ( p = .012).

Conclusion

Stenosis location in AVFs is associated with the age and type of the fistula. Younger fistulas often fail due to anastomotic stenoses, which have lower secondary patency compared to stenoses at other sites. Preliminary data suggest that central stenoses, primarily occurring in older fistulas, exhibit better secondary patency following fistuloplasty than stenoses at other locations.
Common iliac artery aneurysm with narrow inner lumen treated by a novel surgeon-modified inner branch iliac branch device
Authors: Wu Mingwei , Yuan Panpan , Xiong Jiang
Published: August 2024

Objectives

The iliac branch device (IBD) has emerged as the optimal method for endovascular reconstruction of internal iliac artery (IIA). However, due to its high anatomical requirements, the applicability rate among East Asians is limited, especially for common iliac artery aneurysm (CIAA) with narrow inner lumen cases. Here, we report a case with narrow distal inner lumen of the CIAA treated with a novel surgeon-modified inner branch iliac branch device (IIBD).

Methods

This is a case report, and consent for publication was obtained from the patient.

Results

The 1-year follow-up CTA showed that the CIAA regressed without abdominal pain. Right CIA, external iliac artery, and IIA were all patent.

Conclusions

The IIBD technique has lower anatomical requirements for the CIA. Therefore, it may be a feasible option for IIA preservation in cases of CIAA with narrow inner lumen.
Exploring the relationships between potential, performance, and athleticism in elite youth soccer players
Authors: Barraclough Sam , Till Kevin , Kerr Adam , Emmonds Stacey
Published: August 2024

Talent identification of young soccer players is a significant consideration for elite youth soccer organisations, with decisions on players often being made based on the subjective expert opinion of scouts and coaches. Previous research has suggested that scouts and coaches purportedly consider a multitude of factors before arriving at their decisions. However, to date, limited research exists regarding how coaches evaluate player potential within such organisations and how the consideration of further data may influence such evaluations of a player's future potential. Therefore, the aim of this study was to present ratings of perceived potential in an elite youth soccer academy and explore the relationships between a player's perceived potential, athleticism, and perceived level of current match performance. Using 181 player observations, findings demonstrated that ratings of players’ perceived potential decreased within older age groups and were the lowest in the senior academy age group (U18). Furthermore, a mixed effects ordinal regression model suggested that coaches’ perceptions of a player's future potential demonstrated strong relationships with current match performance and athleticism. Increases in a player's mean match rating significantly increased the odds of them being perceived to have higher potential and increases in athleticism also demonstrated a positive relationship with increased perceptions of potential. The findings have implications for youth soccer organisations, providing insight into the distribution of ratings of potential within an elite youth soccer academy, and demonstrating that further data (match performance and athleticism) is related to, and may influence, coaches’ perceptions of player potential.
Course Correction: Navigating Equity in Ninth-Grade Advanced Placement
Authors: Morris Sarah R. , McKenzie Sarah C. , Vernon Miranda G.
Published: August 2024

This robust mixed-methods study examines ninth-grade advanced course placement in Arkansas, revealing disparities rooted in race and socioeconomic status. Utilizing a logit analysis for a five-year pooled sample ( n = 163,616), we find persistent enrollment gaps for Black ninth-grade students after controlling for prior academic achievement, highlighting systemic barriers to access to advanced courses. Socioeconomic divides are also evident in our analysis. Qualitative findings from counselor interviews highlight the importance of parental involvement in course placement decisions, particularly for students from lower socioeconomic backgrounds. Overall, we find through these interviews that districts consider a myriad of factors when considering course placement for ninth-grade courses. We recommend systemic changes for districts, including local norm-based placement systems and automatic enrollment policies to enhance fairness in advanced course placement.
How to Use Continuous Glucose Monitoring Efficiently in Diabetes Management: Opinions and Recommendations by German Experts on the Status and Open Questions
Authors: Thomas Andreas , Haak Thomas , Tombek Astrid , Kulzer Bernhard , Ehrmann Dominic , Kordonouri Olga , Kröger Jens , Schubert-Olesen Oliver , Kolassa Ralf , Siegmund Thorsten , Haller Nicola , Heinemann Lutz
Published: August 2024

Today, continuous glucose monitoring (CGM) is a standard diagnostic option for patients with diabetes, at least for those with type 1 diabetes and those with type 2 diabetes on insulin therapy, according to international guidelines. The switch from spot capillary blood glucose measurement to CGM was driven by the extensive and immediate support and facilitation of diabetes management CGM offers. In patients not using insulin, the benefits of CGM are not so well studied/obvious. In such patients, factors like well-being and biofeedback are driving CGM uptake and outcome. Apps can combine CGM data with data about physical activity and meal consumption for therapy adjustments. Personalized data management and coaching is also more feasible with CGM data. The same holds true for digitalization and telemedicine intervention (“virtual diabetes clinic”). Combining CGM data with Smart Pens (“patient decision support”) helps to avoid missing insulin boluses or insulin miscalculation. Continuous glucose monitoring is a major pillar of all automated insulin delivery systems, which helps substantially to avoid acute complications and achieve more time in the glycemic target range. These options were discussed by a group of German experts to identify concrete gaps in the care structure, with a view to the necessary structural adjustments of the health care system.
Public Critique by Journalists and Politicians as a Process of Democratic Legitimization
Authors: Tant Cédric
Published: August 2024

This theoretical article takes a fresh look at the relationship between journalists and politicians, based on the public critique they level at each other. It proposes that this critique should be seen not simply as the expression of reproaches between rival actors, but as a meaningful metadiscursive articulation. Public critique means, for example, defining journalism, politics, democracy, or a particular context in which the relationship between journalists and politicians takes place. Above all, public critique is part of a process of legitimization that involves journalists and politicians, who are increasingly mistrustful of institutions. Associated with the public arena, public critique is also a tool for understanding new democratic dynamics driven by noninstitutional actors (citizens’ movements or alternative media) that challenge the legitimacy of journalists and politicians.
Case study on retail investors: Technological innovation and stock market dynamics
Authors: Vinoth Balaji V , Sriram M
Published: August 2024

The emergence of sophisticated trading platforms, mobile applications, and algorithmic trading systems has triggered a transformation in how retail investors engage in stock market investment. This case explores the primary determinants influencing retail investors' adoption of technology-driven trading platforms. It looks at elements including accessibility, convenience, and the availability of real-time market data. Further, this case discusses the impact that online investment communities and social media platforms have on the formation of retail investors' investment decisions. The case study additionally addresses algorithmic trading, high-frequency trading, and market manipulation, as well as ethical concerns associated with the application of technology in stock market trading. In addition, the function of regulatory bodies in accommodating the swift progression of technological innovation to safeguard investors' interests and maintain market integrity is scrutinised. The study offers useful information on prospective trends and obstacles in technology-driven stock market trading for retail investors by examining scholarly literature and industry reports. This underscores the importance for investors to maintain a state of alertness to minimise potential hazards linked to their dependence on technological advances while simultaneously leveraging the prospects offered by developments in trading technology.
Life-threatening hypercalcemia in a child with vitamin D intoxication due to parental self-medication: A case report
Authors: Virú-Loza Manuel André , Alvarado-Gamarra Giancarlo , Zapata-Sequeiros Rocio Ivonne , Flores-Nakandakare Héctor Francisco
Published: August 2024

Vitamin D is essential for bone metabolism and has gained popularity since the general population is now more aware of its benefits. Unfortunately, the availability of unregulated vitamin D formulations without prescription increases the risk of inadvertently ingesting excessive doses of vitamin D. Reports of pediatric cases of vitamin D toxicity are scarce in the world literature. We present the case of a 4-years 9-months old boy from a rural town with vitamin D intoxication secondary to ingestion of seven oral vials containing each of them 600,000 Units of cholecalciferol for a period of 8 months. It is important to educate general population about the risks of ingesting vitamin D without medical prescription. In our patient, the most effective treatment strategy was the use of pamidronate.
Exploring the feasibility of remote administration of speech audiometry: A comparative study of conventional and digital methods
Authors: Yuan Chen
Published: August 2024

Objective

This study investigated the effectiveness of remote administration of speech audiometry, an essential tool for diagnosing hearing loss and determining its severity. Utilizing two software tools for remote testing, the research aimed to compare these digital methods with traditional, in-person speech audiometry to evaluate their feasibility and accuracy.

Design

Participants underwent the Cantonese Hearing in Noise Test (CHINT) under three listening conditions—quiet, noise from the front, and noise from the right side—using three different administration methods: the conventional in-person approach, video conferencing software, and remote access software.

Study Sample

Fifty-six Cantonese-speaking adults residing in Hong Kong participated in this study.

Results

Analysis revealed no significant differences in CHINT scores among the three administration methods, indicating the potential for remote administration to yield results comparable to those of conventional methods.

Conclusions

The findings supported the feasibility of remote speech audiometry using the investigated digital tools. This study paved the way for the wider adoption of tele-audiology practices, particularly in situations where in-person assessments are not possible.
Shifting the Resilience Narrative: A Qualitative Study of Resilience in the Canadian Post-secondary Context
Authors: Thannhauser Jennifer E. , Heintz Madison , Qiao Thomas , Riggin Alex , Dimitropoulos Gina , Dobson Keith S. , Szeto Andrew C. H.
Published: August 2024

Resilience has been championed as important for mitigating stressors and challenges experienced by students during post-secondary education, as evidenced by the abundance of programs aimed at enhancing student resilience. Despite growing attention to resilience, there continues to be a lack of consensus about the definition or operationalization of the concept. Even less is known about how to foster resilience in the post-secondary context, especially for marginalized or underrepresented students, who are recognized to be at increased risk for negative mental health outcomes during their post-secondary education. To address these gaps, we employed qualitative methodology to explore marginalized or underrepresented students’ perceptions of resilience. Findings demonstrated that resilience arises from a complex and dynamic interplay between personal skills and attitudes and resources available within students’ communities. Post-secondary institutions are called to shift from individual student responsibility to a collective and shared responsibility for students’ wellbeing in the face of adversity.
Prognostic Factors for Multiligament Knee Injury Treated With Multiligament Reconstruction: Functional and Radiological Outcomes at 2 to 8 Years Postoperatively
Authors: Schneebeli Valentine , Philippe Virginie , Laurent Alexis , Applegate Lee Ann , Martin Robin
Published: August 2024

Background:

Multiligament reconstruction (MLR) has become the standard surgical approach for treating multiligament knee injuries (MLKIs).

Purpose:

To identify prognostic factors for patient-reported outcome measures, return to work (RTW), return to sports, and radiographic osteoarthritis (OA) (Kellgren-Lawrence grade ≥2) after MLR for MLKI.

Study Design:

Case-control study; Level of evidence 3.

Methods:

Included were 52 consecutive patients (age, 35.5 ± 11 years; 75% men), with MLKI sustained between 2013 and 2019 and treated with MLR. At a mean follow-up of 3.8 ± 1.6 years, patient-reported outcome measure scores—including the International Knee Documentation Committee (IKDC), the Knee injury and Osteoarthritis Outcome Score (KOOS), the Anterior Cruciate Ligament–Return to Sport after Injury (ACL-RSI), and the 12-Item Short-Form Health Survey—RTW, return to sports, and weightbearing radiographs were obtained. A total of 20 determinants were hypothesized and tested by univariate logistic regression for binary variables or linear regression for continuous variables. Only factors identified as significant ( P < .10) were entered into a multivariate logistic regression model.

Results:

The prevalence of injury severity according to the Schenck knee dislocation (KD) classification was as follows: KD I (44%), KD III (36%), KD IV (10%), and KD V (10%). Increased KD grades resulted in decreased IKDC ( P = .002) and all 5 KOOS subscales ( P≤ .007 for all) scores. Medial meniscectomy (23%) was associated with a worse ACL-RSI score ( P = .007) and RTW failure (odds ratio [OR], 36.8; P = .035). Peroneal nerve palsy (6%) was associated with a worse ACL-RSI score ( P≤ .001). Radiographic OA was observed in 38%, with distribution predominantly patellofemoral (80%) and medial tibiofemoral (45%). Traumatic cartilage damage (Outerbridge grade >2 [37%]) was associated with secondary patellofemoral (OR, 10; P = .012) and medial tibiofemoral (OR, 10; P = .019) OA. Anterior cruciate ligament reconstruction failure (7%) was a risk factor for medial tibiofemoral OA (OR, 25.8; P = .006).

Conclusion:

Increased Schenck KD grade, permanent peroneal nerve palsy, and irreparable medial meniscus lesions were prognostic factors for worse functional outcomes 3.8 years after MLKI was treated with MLR. Traumatic cartilage damage and anterior cruciate ligament failure were associated with the development of early OA.
Power in the Court: Legal Argumentation and the Hierarchy of Credibility in Eviction Hearings
Authors: Hanley Caroline , Howell Kathryn , Teresa Benjamin
Published: August 2024

Existing research shows that tenants are disadvantaged in eviction proceedings, but studies have provided an incomplete account of the way court procedures and practices work together to produce systematic disadvantage. We draw on legal aid attorneys’ accounts of eviction hearings—particularly how courts establish whether and how much rent is owed—to show how hearings routinely result in judgments in favor of plaintiffs even when tenants have a legal defense. We argue that there is a hierarchy of credibility in how courts evaluate landlords’ claims for possession of a rental property due to nonpayment of rent. In demonstrating the way legal claims are embedded within and shaped by wider courthouse practices, the study highlights the importance of legal representation for tenants facing eviction and suggests that courts play a role in the maintenance of exploitative rental markets by failing to penalize landlords for inaccurate charges.
Thermal conductivity variation effects on Marangoni radiative hybridizedAg-ZrO2 and MoS2-ZrO2 nanofluid based-blood with oblique magnetic field
Authors: Mabood Fazle , Eid Mohamed Rabea , Sahar Fareeha , Shehzad Sabir Ali , Badruddin Irfan Anjum
Published: August 2024

The objective of this examination is to explore the mathematical modeling of a hybridized nanofluid flowing, which involves the transference of biologically fluid via a stretchable sheet. The nanofluid contains of pure blood as the conventional fluid, and it is combined with two nanomolecules. The flow occurs through a porosity stretchable surface. This simulation has potential applications in drugs delivery. The present study relies on the Marangoni condition and the injection/suction properties of two hybrid nanofluids (Ag-ZrO2/blood and MoS2-ZrO2/blood) to explain the time-independent and incompressible flow and transport of energy. Adding magnetic and radiation terms helps develop the issue. Similarity variables are used to define the mathematical phenomena. By using the Fehlberg approach, the reorganized nonlinear model may be carried out. Displaying and elaborating on the roles performed by restrictions in determining engineering physical quantities. The key characteristics of the current analysis are the bigger speed profiles and lower temperatures that emerge in response to the tightening stretching limit. Declining trends in the solid volume percentage have been attributed to the skin friction factor, whereas rising temperatures have had the opposite effect. Nusselt numbers for volume fraction and radiation are the polar opposite of one another. Nusselt number values are also lower for blowing than they are for suction.
Laser-induced protruded bioinspired texturing of Ti-6Al-4V for controlled wettability in biomedical application
Authors: Yadav Chitaranjan Kumar , Samuel G. L. , Pratap Tej
Published: August 2024

Bioinspired protruded textures with variable surface morphology and characteristics are getting worldwide popularity due to their wider applications. Among them controlled wettability for different materials through bioinspired textures is very essential to reduce the adhesion, bacterial contamination and growth, and drug delivery application. Even, identification and efficient fabrication of favorable bioinspired protrusions with optimum parameters are comparatively complex from normal textures through any material processing methods due to their complex shapes, form accuracy and dimensions. Therefore, this work targets the fabrication of four different types of protruded bioinspired textures namely, fish scale, protruded square, protruded circular, Python scale (snake) textured surface on biomedical grade Ti-6Al-4V titanium alloy for controlling the wettability using femtosecond laser surface texturing (LST). The optimum process parameters for the machining of Ti-6Al-4V were set as a temporal width of 350 fs, output power of 5.5 W, wavelength of 1030 nm, scanning speed of 100 mm/s and pulse rate of 500 KHz and three repetitions for all the texture types. To examine the effect of texture type, perimeter of all the fabricated textures was kept constant. Further, effect of varying perimeters was also analyzed for perimeter ranges from 300 to 500 µm. Surface morphology and characteristics were also analyzed for the measurement of texture consistency, dimensions and composition which was also related to the wettability results examined by static contact angle of the sessile drop method. Wetting of fish scale texture is decreased with increasing perimeter whereas of all other textures, wettability is going to be improved significantly.
Patient Education and Community Outreach in Diagnostic Medical Sonography Programs
Authors: Tilson Elwin R. , Sharma Archana More , Clark Kevin R.
Published: August 2024

Objective:

A research project was conducted to determine what patient education skills, community health education skills, and community outreach activities are included in the US-accredited diagnostic medical sonography (DMS) programs.

Materials and Methods:

A quantitative, cross-sectional research survey was sent via email to DMS program directors of 245 accredited programs, resulting in 118 (48.2%) completed surveys returned. Written informed consent was obtained from all subjects before the study. The survey assessed the inclusion of 13 specific patient education skills, eight community education skills, and nine community health/outreach activities in DMS programs.

Results:

Of the 12 patient education skills, 11 were routinely included in 90% of programs. The remaining skill of patient negotiation was included in 75.1% of programs. For patient education skills, 69.4% were required by programs, and 30.6% were encouraged by programs. Community education skills were less commonly included in DMS programs, with 27.4% to 51.3% inclusion rates. The most common community education skill was tailoring messages to intended public audiences. Community outreach activity inclusion in programs ranged from 32.5% to 66.7%, with 77.5% only encouraging participation. Health fairs, health screenings, and self-care education were the most common activities. Incorporating community-related skills into the curriculum was listed as a “good idea” by 72.6% of program directors.

Conclusion:

Patient education skills are routinely required or encouraged in almost all responding educational programs. However, most DMS programs do not require or encourage community education skills. Community outreach activities are not generally required or encouraged by DMS programs, with health fairs and screenings being the most common. Time constraints are the most cited reason for not including community-related content or activities in the programs.
Feasibility and Favorable Responses Following Investigational CAR T-Cell Therapy for Relapsed and Refractory Infant ALL
Authors: Annesley Colleen , Lamble Adam J. , Summers Corinne , Pulsipher Michael A , Wayne Alan S. , Rivers Julie , Huang Wenjun , Wilson Ashley , Wu Qian , Seidel Kristy D. , Mgebroff Stephanie , Brown Christopher T , Lindgren Catherine , Park Julie R , Jensen Michael C , Gardner Rebecca A
Published: August 2024

Infants with B-cell acute lymphoblastic leukemia (B-ALL) continue to have significantly worse outcomes compared to older children with B-ALL, and those with relapsed or refractory (R/R) infant ALL have especially dismal outcomes with conventional treatment. CD19-targeting chimeric antigen receptor (CAR) T-cell therapy has demonstrated remarkable success in the treatment of R/R childhood B-ALL, though the majority of reports have been in non-infant patients. Barriers to the successful implementation of CAR T-cell therapy in infant B-ALL include challenges related to apheresis, product manufacturing and disease-specific considerations such as lineage switch. We describe our experience utilizing two experimental CD19-CAR T-cell products, SCRI-CAR19 or SCRI-CAR19x22, for 19 patients with R/R infant B-ALL enrolled on three clinical trials. CAR T-cell products were successfully manufactured in 18/19 (94.7%) patients, with a median age of 22.5 months at enrollment (range, 14.5-40.1 months). Sixteen of 17 (94.1%) treated patients achieved a complete remission without detectable minimal residual disease. The 1-year leukemia free survival was 75% and 1-year overall survival was 76.5%, with a median follow up time of 35.8 months (range, 1.7-83.6 months). Cytokine release syndrome (CRS) occurred in 14/17 (82.4%) patients, with only 1 patient experiencing Grade 3 CRS. Neurotoxicity occurred in 2/17 (11.8%) patients with all events ≤ Grade 2. With the successful early clinical experience of CAR T-cell therapy in this population, more systematic evaluation specific to infant ALL is warranted.
External Validation of the Charlson Comorbidity Index-based Model for Survival Prediction in Thai Patients Diagnosed with Dementia
Authors: Buawangpong Nida , Phinyo Phichayut , Angkurawaranon Chaisiri , Soontornpun Atiwat , Jiraporncharoen Wichuda , Sirikul Wachiranun , Pinyopornpanish Kanokporn
Published: August 2024

Background

The Charlson Comorbidity Index (CCI) is commonly employed for predicting mortality. Nonetheless, its performance has rarely been evaluated in patients with dementia. This study aimed to examine the predictive capability of the CCI-based model for survival prediction in Thai patients diagnosed with dementia.

Methods

An external validation study was conducted using retrospective data from adults with dementia who had visited the outpatient departments at Maharaj Nakorn Chiang Mai Hospital between 2006 and 2012. The data obtained from electronic medical records included age, gender, date of dementia diagnosis and death, types of dementia, and comorbidities at the time of dementia diagnosis. The discriminative ability and calibration of the CCI-based model were estimated using Harrell’s C Discrimination Index and visualized with calibration plot. As the initial performance did not meet satisfaction, model updating and recalibration were performed.

Results

Of 702 patients, 56.9% were female. The mean age at dementia diagnosis was 75.22 (SD 9.75) year-old. During external validation, Harrell's C-statistic of the CCI-based model was 0.58 (95% CI, 0.54–0.61). The model showed poor external calibration. Model updating was subsequently performed. All updated models demonstrated a modest increase in Harrell's C-statistic. Temporal recalibration did not significantly improve the calibration of any of the updated models.

Conclusion

The CCI-based model exhibited fair discriminative ability and poor calibration for predicting survival in Thai patients diagnosed with dementia. Despite attempts at model updating, significant improvements were not achieved. Therefore, it is important to consider the incorporation of other influential prognostic factors.
Partial (incomplete) removal of granulation tissue using modified minimally invasive surgical technique in treatment of infrabony defects (randomized control clinical trial)
Authors: Ibrahim Ahmed Adel , Tawfik Omnia Khaled , ElNahass Hani
Published: August 2024

Aim

This study aims to compare the clinical and radiographic outcomes after complete versus incomplete removal of granulation tissue (GT) during modified minimally invasive surgical technique (M-MIST) for management of periodontitis patients with deep pockets associated with infra-bony defects.

Methodology

Ten patients with a total of 14 deep non-resolving pockets (≥ 5 mm) associated with a vertical infra-bony defect were recruited for this study. They were randomized into 2 groups; a test group with incomplete removal of GT and a control group with complete removal of GT. Clinical parameters of clinical attachment level (CAL), residual probing depth (rPD) and buccal recession (Rec.) were recorded every 3 months. Radiographic periapicals were taken at baseline, 6 and 9 months. The significance level was set to 0.05.

Results

None of the results showed statistical significance between the 2 groups (p > 0.05). The test group showed less CAL gain (2 ± 0.87 mm, p = 0.062), more reduction in rPD (3.1 ± 0.96 mm, p = 0.017) and more recession (0.857 ± 0.26 mm, p = 0.017) than control group CAL gain (2.4 ± 0.58 mm, p = 0.009), rPD reduction (2.9 ± 0.3 mm, p = 0.001) and recession (0.5 ± 0.34 mm, p = 0.203) respectively. Control group had linear reduction in depth defect (DD) (0.68 ± 0.287, p = 0.064) compared to an increase in DD in test group (-0.59 ± 0.5, p = 0.914).

Conclusions

No statistical significance were observed in healing parameters between complete removal of GT in M-MIST and incomplete (partial) removal of GT of deep pockets with infra-bony defects both clinically and radiographically. Further studies with larger samples are needed to confirm the results.
Synergistic intravesical instillation for bladder cancer: CRISPR-Cas13a and fenbendazole combination therapy
Authors: Liang Mingkang , Wang Yongqiang , Liu Lisha , Deng Dashi , Yan Zeqin , Feng Lida , Kong Chenfan , Li Chenchen , Li Yuqing , Li Guangzhi
Published: August 2024

Background

CRISPR-Cas13a is renowned for its precise and potent RNA editing capabilities in cancer therapy. While various material systems have demonstrated efficacy in supporting CRISPR-Cas13a to execute cellular functions in vitro efficiently and specifically, the development of CRISPR-Cas13a-based therapeutic agents for intravesical instillation in bladder cancer (BCa) remains unexplored.

Methods

In this study, we introduce a CRISPR-Cas13a nanoplatform, which effectively inhibits PDL1 expression following intravesical instillation. This system utilizes a fusion protein CAST, created through the genetic fusion of CRISPR-Cas13 and the transmembrane peptide TAT. CAST acts as a potent transmembrane RNA editor and is assembled with the transepithelial delivery carrier fluorinated chitosan (FCS). Upon intravesical administration into the bladder, the CAST-crRNAa/FCS nanoparticles (NPs) exhibit remarkable transepithelial capabilities, significantly suppressing PDL1 expression in tumor tissues.To augment immune activation within the tumor microenvironment, we integrated a fenbendazole (FBZ) intravesical system (FBZ@BSA/FCS NPs). This system is formulated through BSA encapsulation followed by FCS coating, positioning FBZ as a powerful chemo-immunological agent.

Results

In an orthotropic BCa model, the FBZ@BSA/FCS NPs demonstrated pronounced tumor cell apoptosis, synergistically reduced PDL1 expression, and restructured the immune microenvironment. This culminated in an enhanced synergistic intravesical instillation approach for BCa. Consequently, our study unveils a novel RNA editor nanoagent formulation and proposes a potential synergistic therapeutic strategy. This approach significantly bolsters therapeutic efficacy, holding promise for the clinical translation of CRISPR-Cas13-based cancer perfusion treatments.
Health care utilization of patients with acute abdominal pain before and after emergency department visits
Authors: Verleger Katharina , Fischer-Rosinsky Antje , Möckel Martin , Schneider Anna , Slagman Anna , Keil Thomas , Schenk Liane ,   the INDEED Research Group, Baier Natalie , Busse Reinhard , Brammen Dominik , Drepper Johannes , Dröge Patrik , Greiner Felix , Henschke Cornelia , Kuhlmann Stella , Kreye Björn , Lüpkes Christian , Reinhold Thomas , Riens Burgi , Rosenbusch Marie-Luise , Staeps Felix , Schmieder Kristin , Schreiber Daniel , von Stillfried Dominik , Below Maike , Röhrig Rainer , Roll Stephanie , Ruhnke Thomas , Walcher Felix , Zimmermann Grit , King Ryan
Published: August 2024

Background

Acute abdominal pain (AAP) is a major driver for capacity-use in emergency departments (EDs) worldwide. Yet, the health care utilization of patients with AAP before and after the ED remains unclear. The primary objective of this study was to describe adult patients presenting to the ED with AAP and their outpatient care (OC) use before and after the ED. Secondary objectives included description of hospitalization rates, in-hospital mortality, ED re-visits, and exploration of potential risk factors for hospitalization and ED re-visits.

Methods

For the analysis, we combined routine hospital data from patients who visited 15 EDs in Germany in 2016 with their statutory health insurance OC claims data from 2014 to 2017. Adult patients were included based on a chief complaint or an ED diagnosis indicating unspecific AAP or the Manchester Triage System indicator “Abdominal pain in adults”. Baseline characteristics, ED diagnosis, frequency and reason of hospitalization, frequency and type of prior-OC (prOC) use up to 3 days before and of post-OC use up to 30 days after the ED visit.

Main results

We identified 28,085 adults aged ≥ 20 years with AAP. 39.8% were hospitalized, 33.9% sought prOC before the ED visit (48.6% of them were hospitalized) and 62.7% sought post-OC up to 30 days after the ED visit. Hospitalization was significantly more likely for elderly patients (aged 65 and above vs. younger; adjusted OR 3.05 [95% CI 2.87; 3.25]), prOC users (1.71 [1.61; 1.90]) and men (1.44 [1.37; 1.52]). In-hospital mortality rate was 3.1% overall. Re-visiting the ED within 30 days was more likely for elderly patients (1.32 [1.13; 1.55) and less likely for those with prOC use (0.37 [0.31; 0.44]).

Conclusions

prOC use was associated with more frequent hospitalizations but fewer ED re-visits. ED visits by prOC patients without subsequent hospitalization may indicate difficulties of OC resources to meet the complex diagnostic requirements and expectations of this patient population. Fewer ED re-visits in prOC users indicate effective care in this subgroup.
Civilians under missile attack: post-traumatic stress disorder among the Jewish and Bedouin population of Southern Israel
Authors: Shvartsur Rachel , Savitsky Bella
Published: August 2024

Background

Over the past 20 years, Jewish and Bedouin civilians in southern Israel have faced the ongoing threat of missile attacks from Gaza, with possible mental health consequences. This study aimed to assess the prevalence of post-traumatic stress disorder (PTSD) among Jewish and Bedouin adult civilians in southern Israel in a period with few missile attacks from Gaza, and no military operations.

Methods

The study population included 389 participants (246 Jews, 143 Bedouins) living within 40 km/25 mi from Gaza for at least 2 years and interviewed between January and March 2023 (before the ongoing war that started on October 7th, 2023). The PTSD Checklist (PCL-5) was used, with a score of 33 as a cutoff point for the presence of PTSD.

Results

Compared to Jews, a significantly lower proportion of Bedouins reported accessibility to bomb shelters and siren warning systems. Overall, 20.3% of the respondents exhibited PTSD. Multivariate analysis revealed that after adjustment for demographic and household characteristics, Bedouins had a six-fold significantly higher probability of PTSD in comparison to Jews (OR 5.6, 95%CI 2.8–10.8). Compared to participants with high socioeconomic status (SES), participants with low SES had a six-fold significantly higher probability of PTSD (OR 6.0, 95%CI 2.2–16.5). Participants who did not have an alarm system had more than two-fold odds for PTSD (OR 2.3, 95%CI 1.1–5.5). Being single, living in urban areas, or having a disability significantly increased the probability of PTSD.

Conclusions

The findings of this study demonstrate a significantly higher prevalence of PTSD among the Bedouin population of Southern Israel. Several sociodemographic characteristics were associated with the increased prevalence of PTSD, the most prominent of which was low SES. Healthcare professionals and authorities should be proactive in screening for PTSD, and provide tailored treatment and support, taking into account ethnical and cultural background. Authorities should address the disparity in bomb shelter access and siren warning coverage between Bedouin and Jewish communities.
Heart–Lungs interactions: the basics and clinical implications
Authors: Jozwiak Mathieu , Teboul Jean-Louis
Published: August 2024

Heart–lungs interactions are related to the interplay between the cardiovascular and the respiratory system. They result from the respiratory-induced changes in intrathoracic pressure, which are transmitted to the cardiac cavities and to the changes in alveolar pressure, which may impact the lung microvessels. In spontaneously breathing patients, consequences of heart–lungs interactions are during inspiration an increase in right ventricular preload and afterload, a decrease in left ventricular preload and an increase in left ventricular afterload. In mechanically ventilated patients, consequences of heart–lungs interactions are during mechanical insufflation a decrease in right ventricular preload, an increase in right ventricular afterload, an increase in left ventricular preload and a decrease in left ventricular afterload. Physiologically and during normal breathing, heart–lungs interactions do not lead to significant hemodynamic consequences. Nevertheless, in some clinical settings such as acute exacerbation of chronic obstructive pulmonary disease, acute left heart failure or acute respiratory distress syndrome, heart–lungs interactions may lead to significant hemodynamic consequences. These are linked to complex pathophysiological mechanisms, including a marked inspiratory negativity of intrathoracic pressure, a marked inspiratory increase in transpulmonary pressure and an increase in intra-abdominal pressure. The most recent application of heart–lungs interactions is the prediction of fluid responsiveness in mechanically ventilated patients. The first test to be developed using heart–lungs interactions was the respiratory variation of pulse pressure. Subsequently, many other dynamic fluid responsiveness tests using heart–lungs interactions have been developed, such as the respiratory variations of pulse contour-based stroke volume or the respiratory variations of the inferior or superior vena cava diameters. All these tests share the same limitations, the most frequent being low tidal volume ventilation, persistent spontaneous breathing activity and cardiac arrhythmia. Nevertheless, when their main limitations are properly addressed, all these tests can help intensivists in the decision-making process regarding fluid administration and fluid removal in critically ill patients.
Scientific analysis of folk contract documents from Tianshui region: insights of fiber use and preservation state
Authors: Ge Mengfan , Gu Zhou , Tian Feifei , Shi Jiatong , Yang Yiming , Shi Jilong , Han Bin
Published: August 2024

Folk contract documents (FCD) are valuable materials for studying social history, and the paper they use reflects the social realities of different eras and social classes. Research and scientific analysis of numerous FCD samples after the fourteenth century are rare. We conducted a study on 96 Tianshui folk contract documents (TFCD, 107 paper samples) from the Tianshui area of Gansu Province, Northwest China, taking into account both the textual content and the materiality of paper carriers, and interpreted the results from multiple lines of evidence and discussion. Physical performance analysis revealed that the paper used by the northern folk exhibits a lower apparent density, which is not conducive to the long-term preservation of paper. The preservation status investigation, curtain pattern analysis, and fiber analysis show that the paper used in the TFCD differs from traditional cultural paper regarding disease types, production precision, and fiber materials, providing a basis for its protection and restoration. The analysis of chemical components indicated that the aging and yellowing of paper can be correlated with the content of sulfur and carbonyl groups. The feasibility of using pyrolysis gas chromatography-mass spectrometry (Py-GC/MS) analysis to quickly identify papermaking fibers in a large number of paper samples was proposed. By utilizing various techniques to inspect the paper of documents, this study helps to enhance the academic understanding of FCD materials. In addition, it expands the knowledge base of Northwest handmade paper.
Correlation and concordance of carotid Doppler ultrasound and echocardiography with invasive cardiac output measurement in critically ill patients
Authors: Arango-Granados María Camila , Quintero-Ramírez Jaime Andrés , Mejía-Herrera Felipe , Henao-Cardona Lina Mayerly , Muñoz-Patiño Valentina , Bustamante-Cristancho Luis Alfonso
Published: August 2024

Background

Critical care management heavily relies on accurate cardiac output (CO) measurement. Echocardiography has been a mainstay in non-invasive cardiac monitoring; however, its comparability to invasive methods warrants further exploration. Recent studies have suggested the potential of carotid Doppler measurements as a promising approach to estimate CO. Despite this potential, the literature presents mixed outcomes regarding its reliability and accuracy. This study aims to evaluate the correlation and concordance between carotid Doppler ultrasonography and invasive hemodynamic monitoring in estimating CO in critically ill patients. Furthermore, it assesses the concordance and correlation between echocardiography CO and the standard invasive CO measurements.

Methods

This concordance study involved critically ill adults requiring invasive CO measurement. Patients with arrhythmias, severe valvulopathy, pregnancy, and poor acoustic window were excluded. Statistical analyses comprised univariate analysis, Wilcoxon signed-rank test, Spearman correlation, and intraclass correlation coefficient. Ethical approval was granted by the institution’s ethics committee.

Results

A total of 49 critically ill patients were included, predominantly male (63.27%), with a median age of 57 years. Diagnoses included subarachnoid hemorrhage (53.06%) and heart failure (8.16%). Mean cardiac index was 3.36 ± 0.81 L/min/m2 and mean cardiac output was 5.98 ± 1.47 L/min. Spearman correlation coefficient between echocardiography and invasive CO measurements was 0.58 (p-value = p < 0.001), with an ICC of 0.59 for CO and 0.52 for cardiac index. Carotid measurements displayed no significant correlation with invasive CO.

Conclusion

There is a moderate correlation and concordance between echocardiography and invasive CO measurements. There is no significant correlation between carotid variables and invasive CO, underscoring the necessity for cautious interpretation and application, particularly in patients with distinctive cerebral blood flow dynamics.