bluuebunny/crossref_metadata_2025 huggingface dataset:
(Cost-)effectiveness and implementation of a combined lifestyle intervention for outpatients with severe mental illness (GOAL!): a hybrid quasi-experimental study protocol
Authors: Noortman-van Meteren C. R. , van Schothorst M. M. E. , den Bleijker N. M. , Braakhuis-Keuning B. , Houwert-Zuidema W. M. H. , van Amelsvoort T. A. M. J. , Deenik J.
Published: November 2024

Background

People with severe mental illness (SMI) face not only impaired mental health, but also a greater risk of physical comorbidities and a shorter life expectancy compared to the general population. A poor lifestyle plays a substantial role in this disparity. Combined Lifestyle Interventions targeting multiple lifestyle behaviors can improve mental and physical health, and quality of life. However, there is currently no appropriate structural support for people with SMI in outpatient care in the Netherlands. The Combined Lifestyle Intervention for Outpatients with SMI (GOAL!) is developed to address this gap. This study examines the (cost-)effectiveness and implementation of GOAL!.

Methods

In a type 1 hybrid quasi-experimental study with a mixed-method matched design, GOAL! participants (N = 50) are compared to people receiving care as usual (N = 50). The GOAL! program includes group and individual sessions, given by allied health professionals, over a period of two years. The first year starts with a 3-month intensive course on physical activity and nutrition, followed by 9 months of aftercare covering various lifestyle topics tailored to the group’s needs. There is close collaboration with local stakeholders to facilitate transfer to the community setting. The second year focuses on maintaining established activities in one’s daily living environment. Our primary outcome will be the change in physical activity, comparing GOAL! participants to those receiving care as usual. Secondary outcomes are changes in other lifestyle behaviors, physical health, mental well-being, and healthcare and societal costs. Additionally, achieving lifestyle-related goals, adverse effects, and barriers and facilitators to implementation are examined. Measurements are obtained at start (T0), and after 3 (T1), 12 (T2) and 24 months (T3).

Discussion

This study investigates the effects of GOAL! on lifestyle behaviors, health outcomes, implementation factors and cost-effectiveness after two years, aiming to offer valuable insights into the effectiveness and implementation outcomes of lifestyle interventions for outpatients with SMI.

Trial registration

: ClinicalTrials.gov (Identifier: NCT05600205). Prospectively registered on October 26, 2022.
Exploring the unconventional: health professionals’ experiences into medication-free treatment for patients with severe mental illness
Authors: Reitan Elisabeth C. Klæbo , Riley Henriette , Høifødt Tordis Sørensen , Iversen Valentina C. , Høye Anne
Published: November 2024

Background

In January 2017, the Norwegian government mandated the establishment of an inpatient unit for “medication-free treatment” for patients with severe mental illness at the University Hospital of North Norway in Tromsø. This study aims to explore the employees’ experiences with this unit.

Method

Focus group interviews were conducted October 2021 – February 2022. For analysis, the participants were divided into three groups; S (staff working at the medication-free unit), M (people involved in management at the unit) and T (therapists working elsewhere in the hospital). The analysis followed the Systematic Text Condensation and interviews were recorded, transcribed and analysed using NVivo software.

Results

Health professionals described their experiences with medication-free treatment through five main concepts: 1) Employees’ motivation; 2) Frames; 3) Network; 4) Relations; and 5) Patients’ motivation. Staff and management expressed strong motivation for an alternative to “treatment as usual,” focusing more on recovery and relationships than on the absence of medication. Therapists from other hospital areas highlighted resource allocation concerns and expressed a desire to learn from the unit. Challenges were acknowledged by all groups.

Conclusion

The term “medication-free treatment’’ might be misleadning. While patiens at the unit can use medications, there is a strong emphasis on patient autonomy and the option to taper off medication and live a life without them. The study adds valuable knowledge about the the experiences of employees working at a medication-free unit, and provides insights into the complexity of treating severe mental illness, both with and without medication. It highlights the importance of sufficient time, stability and resources to focus on each patient’s strengths and challenges. All employees agree that tailored measures in long-term treatment and a clear focus on recovery should be integral, even without an emphasis on “medication-free treatment”.
How do apathetic and depressive symptoms relate to functional capacity? A cross-sectional survey among community-dwelling middle-aged and older adults in Japan
Authors: Oba Hikaru , Kanda Akira , Ihara Kazushige , Tanabu Asano , Shimoda Hiroshi
Published: November 2024

Background

Apathetic and depressive symptoms are frequently observed among older adults, and are risk factors for functional decline and dementia progression. However, how these symptoms influence functional capacity remains unclear. This study investigated the relationship between apathetic and depressive symptoms and functional capacity, considering the interaction between apathetic and depressive symptoms.

Methods

A cross-sectional questionnaire survey targeting community dwelling middle-aged or older adults was conducted. We sent a questionnaire to 984 individuals and received 320 responses. Data with missing values and participants aged under 50 were excluded, resulting in 212 participants (88 men and 124 women, mean age = 73.4 ± 9.3 years). Apathetic symptoms were evaluated using the Dimensional Apathy Scale (J-DAS), which comprises executive, emotional, and cognitive and behavioral initiation aspects of apathy. Depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Functional capacity was assessed using the Japan Science and Technology Agency Index of Competence, which comprises technology usage, information practice, life management, and social engagement.

Results

Mean score of each J-DAS factor and GDS was 5.3 ± 3.4 (executive), 12.0 ± 3.0 (emotional), 11.8 ± 5.1 (initiation), and 4.5 ± 3.3, respectively. The emotional and initiation aspects of J-DAS were significantly associated with information practice (β = -0.15, p < .05 for emotional; β = -0.27, p < .001 for initiation) and life management (β = -0.20, p < .01 for emotional; β = -0.22, p < .01 for initiation) in functional capacity. GDS was associated only with social engagement (β = -0.31, p < .001). Although the interaction between the initiation factor of J-DAS and GDS was significantly associated with life management (β = -0.16, p < .05), the R2 change was insignificant. The emotional factor of J-DAS was associated with technology usage (β = -0.13, p < .05), although less strongly than age. The executive factor of J-DAS had insignificant associations with all aspects of functional capacity.

Conclusions

Apathetic and depressive symptoms are independently, rather than interactively, associated with different aspects of functional capacity. As older adults with apathetic or depressive symptoms might struggle to seek help from public health services, they should be targeted with active interventions from healthcare professionals.
Clinical efficacy of three plating systems in management of mandibular parasymphyseal fractures: a retrospective study
Authors: Mahmoud Nermine Ramadan , Habaka Yasser Fekry
Published: November 2024

Background

The main goal of management of the mandibular fracture is to obtain the pre-injury contour of the bone and pre-injury occlusion as well as regain function early. For Parasymphyseal fractures, the ideal fixation method is still debatable. It could range from rigid to semi-rigid fixation. The current study aimed to compare the clinical and radiographic effect of two miniplates, 2.3 high-profile Miniplates, and three-dimensional (3D) Miniplates for internal fixation treatment of mandibular para-symphyseal fractures.

Methods

The study reviewed 240 medical records, dividing 60 patients into three treatment groups: Group I (25 patients received 2.0 mini plates), Group II (22 patients received 2.3 high profile miniplate), and Group III (13 patients received 3D miniplate). Data included demographics, fracture diagnosis, radiographs, maxillomandibular fixation use, surgical time, intervention, postoperative stability, and complications.

Results

The present study included 60 patients with mandibular parasymphyseal fractures, divided into three treatment groups: Group I (n = 25, 41.67%), Group II (n = 22, 36.67%), and Group III (n = 13, 21.67%). The study found no significant differences in age and sex distribution among the three groups, but the mean surgery time varied significantly. Group II had the highest rate of complications at 22.73%, followed by Group I at 20% and Group III at 7.69%.

Conclusion

In conclusion, the (3D) Miniplates could provide better internal fixation treatment of mandibular para-symphyseal fractures in terms of easy use, short surgery time and less complication such as malocclusion and infection.
Age-related STING suppression in macrophages contributes to increased viral load during influenza a virus infection
Authors: Lauf Thurid , Häder Antje , Hornung Franziska , Reisser Yasmina , Nietzsche Sandor , Schanz Fabian , Trümper Verena , Jeznach Aldona , Brunke Sascha , Doenst Torsten , Skirecki Tomasz , Löffler Bettina , Deinhardt-Emmer Stefanie
Published: November 2024

Ageing is a major risk factor that contributes to increased mortality and morbidity rates during influenza A virus (IAV) infections. Macrophages are crucial players in the defense against viral infections and display impaired function during ageing. However, the impact of ageing on macrophage function in response to an IAV infection remains unclear and offers potential insight for underlying mechanisms. In this study, we investigated the immune response of young and aged human monocyte-derived macrophages to two different H1N1 IAV strains. Interestingly, macrophages of aged individuals showed a lower interferon response to IAV infection, resulting in increased viral load. Transcriptomic data revealed a reduced expression of stimulator of interferon genes (STING) in aged macrophages albeit the cGAS-STING pathway was upregulated. Our data clearly indicate the importance of STING signaling for interferon production by applying a THP-1 STING knockout model. Evaluation of mitochondrial function during IAV infection revealed the release of mitochondrial DNA to be the activator of cGAS-STING pathway. The subsequent induction of apoptosis was attenuated in aged macrophages due to decreased STING signaling. Our study provides new insights into molecular mechanisms underlying age-related immune impairment. To our best knowledge, we are the first to discover an age-dependent difference in gene expression of STING on a transcriptional level in human monocyte-derived macrophages possibly leading to a diminished interferon production.
Complex interplay between the microfluidic and optical properties of Hoplia sp. beetles
Authors: Pavlović Danica , Salatić Branislav , Ćurčić Srećko , Milovanović Petar , Pantelić Dejan V.
Published: November 2024

Background

All living organisms exist in a world affected by many external influences, especially water and light. Photonic nanostructures present in certain insects, have evolved over time in response to diverse environmental conditions, facilitating communication within and between species, camouflage, thermoregulation, hydration, and more. Up to now, only a few insect species have been discovered whose elytron changes its color due to permeation of water (or its vapor) through cuticle.

Results

Here we report on a scarabaeid beetle Hoplia argentea remarkable in its ability to shift from green to brownish-red when exposed to water, demonstrating reversible changes. Here we show that elytron and scales form a complex and efficient micro/nano-optofluidic system. Water is channeled into the elytral lacunae, then transported internally to the petals of the scales, where it is wicked inside each scale, pushing the entrapped air out. Wicking is a very fast process, occurring during a few seconds. The advantage of this principle is in extremely high pressure (approximately 15 bar) produced by capillary forces, which expediates permeation of air. We present optical models that explain the physical mechanisms behind the coloration, detailing how superhydrophilic properties influence optical behavior.

Conclusion

Species within the genus Hoplia exhibit diverse coloration strategies, likely linked to their specific ecological niches. These organisms have evolved intricate optical and microfluidic systems that facilitate rapid alterations in body coloration, potentially serving purposes such as environmental camouflage and thermoregulation. Studying microfluidic and optical properties of the elytra will not only enhance our understanding of the biological purposes behind color change but also inspires design of artificial biomimetic devices. Dynamic fluid flow patterns, described in this paper, are fairly constant and unique and can be used in security applications as a, so called, physically unclonable functions (PUF). More broadly, this kind of microfluidic system can be used for controlled drug release, sensing, hydraulic and pneumatic pumping.
BerryPortraits: Phenotyping Of Ripening Traits in cranberry (Vaccinium macrocarpon Ait.) with YOLOv8
Authors: Loarca Jenyne , Wiesner-Hanks Tyr , Lopez-Moreno Hector , Maule Andrew F. , Liou Michael , Torres-Meraz Maria Alejandra , Diaz-Garcia Luis , Johnson-Cicalese Jennifer , Neyhart Jeffrey , Polashock James , Sideli Gina M. , Strock Christopher F. , Beil Craig T. , Sheehan Moira J. , Iorizzo Massimo , Atucha Amaya , Zalapa Juan
Published: November 2024

BerryPortraits (Phenotyping of Ripening Traits) is open source Python-based image-analysis software that rapidly detects and segments berries and extracts morphometric data on fruit quality traits such as berry color, size, shape, and uniformity. Utilizing the YOLOv8 framework and community-developed, actively-maintained Python libraries such as OpenCV, BerryPortraits software was trained on 512 postharvest images (taken under controlled lighting conditions) of phenotypically diverse cranberry populations (Vaccinium macrocarpon Ait.) from the two largest public cranberry breeding programs in the U.S. The implementation of CIELAB, an intuitive and perceptually uniform color space, enables differentiation between berry color and berry brightness, which are confounded in classic RGB color channel measurements. Furthermore, computer vision enables precise and quantifiable color phenotyping, thus facilitating inclusion of researchers and data analysts with color vision deficiency. BerryPortraits is a phenotyping tool for researchers in plant breeding, plant genetics, horticulture, food science, plant physiology, plant pathology, and related fields. BerryPortraits has strong potential applications for other specialty crops such as blueberry, lingonberry, caneberry, grape, and more. As an open source phenotyping tool based on widely-used python libraries, BerryPortraits allows anyone to use, fork, modify, optimize, and embed this software into other tools or pipelines.
Study of rotavirus genotypes G and P in one Egyptian center-cross-sectional study
Authors: Mahmoud AbelRahman Eid , Zaki Maysaa El Sayed , Mohamed Eman Hamdy , Fahmy Ehab M. , Hamam Sanaa Samir Mohamed , Alsayed Mona Abdellatif
Published: November 2024

Background

Rotavirus-associated gastroenteritis is a common health problem in children, different variations of rotavirus genotypes differ according to geographic locations and the practice of wide-scale vaccination. Therefore, the present study aimed to detect both the G and P genotypes of rotavirus in children ≤ 5 years old in one center in Egypt as a cross-sectional study, to correlate the genotypes with various demographic and clinical data in infected children and to evaluate the common mixed genotypes G and P in infected children.

Method

The cross-sectional study included children with acute gastroenteritis ≤ 5 years old from January 2023 till March 2024 recruited from Mansoura University Children’s Hospital, Egypt based upon laboratory diagnosis by exclusion of bacterial and protozoa pathogens. The stool samples were obtained from each child and subjected to detection of rotavirus antigen by enzyme-linked immunosorbent assay (ELISA) followed by genotypes identification of G and P genotypes by nested polymerase chain reaction (PCR).

Result

A nested PCR study for rotavirus genotypes revealed that G1 was the most common genotype (24.7%) followed by G2 (21.1%), G3 (20%), G9 (20%), and G4 (14.1%). The genotyping of the P genotype revealed that P9 was the commonest genotype (24.7%), followed by P4 (21.2%), P10 (20%), P8 (17.6%) and P6 (16.5%). The commonest combined genotypes of G and P were G1P4 (85.7%), G3P8(88.2%), followed by G2P6 (77.8%) and G9P9(76.5%) and G4P9 (66.7%) followed by G4P10 (33.3%), G9P10(23.5%), G2P10(22.2%), G1P10 (14.3%), G3P10(11.8%). The distribution was significant (P = 0.001). The positive rotavirus antigen was more frequently detected in females (55.3%) than males (44.7%, Odd ratio 0.2, 95% CI 0.22–0.71, P = 0.001). There was a significant association between the summer season and positive rotavirus antigen (P = 0.001) and rural residence of the patients (Odd ratio 6,9 95%CI 3,5-13.5, P = 0.001). The significant associated clinical sign with positive rotavirus antigen was fever (Odd ratio 3,3, 95%CI 1,8-6.05, P = 0.001). The genotypes G and P were significantly associated with positive rotavirus antigen as all cases positive by antigen had been detected by nested PCR with the commonest genotypes G4 (24.7%, P = 0.001) and genotype P9 (24.7%, P = 0.001).

Conclusion

The present study highlights the common genotypes of rotavirus at one center in Egypt, G1, G2, and G3 were the commonest G genotypes. As regard genotype P the commonest genotypes were P9, P4, and P10. The commonest combined genotypes were G1P4, G3P8, G2P6. There was no effect of the practice of rotavirus vaccination at limited rates at private health sections as the rotavirus is still a major pathogen of acute gastroenteritis in children. There is a need for the inclusion of rotavirus vaccination in the national program of children vaccination in Egypt.
Analysis of variable metabolites in preterm infants with bronchopulmonary dysplasia: a systematic review and meta-analysis
Authors: Guo Yanping , Liu Ying , Zhang Ruolin , Xu Songzhou , Guo Xin , Yu Zhangbin , Chen Guobing
Published: November 2024

Numerous studies have attempted to identify potential biomarkers for early detection of bronchopulmonary dysplasia (BPD) in preterm infants using metabolomics techniques. However, the presence of consistent evidence remains elusive. Our study aimed to conduct a systematic review and meta-analysis to identify differences in small-molecule metabolites between BPD and non-BPD preterm infants. Through meticulous screening of numerous samples, we identified promising candidates, providing valuable insights for future research. We searched PubMed, the Cochrane Library, Embase, Web of Science, China National Knowledge Internet, Wan-fang database, Chinese Science and Technique Journal Database and Chinese Biomedical Literature Database from inception until January 16, 2024. Studies were comprehensively reviewed against inclusion criteria. We included case-control studies and adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Study quality was assessed with the Newcastle-Ottawa scale. We compared the changes in metabolite levels between the BPD and non-BPD preterm infants. A meta-analysis was conducted on targeted metabolomics research data based on the strategy of standardized mean differences (MD) and 95% confidence intervals (CI).Fifteen studies (1357 participants) were included. These clinical-based metabolomics studies clarified 110 differential metabolites between BPD and non-BPD preterm infants. The meta-analysis revealed higher glutamate concentration in the BPD group compared to the non-BPD group (MD = 1, 95% CI 0.59 to 1.41, p < 0.00001). Amino acids were identified as the key metabolites distinguishing preterm infants with and without BPD, with glutamate potentially serving as a BPD predictor in this population.
Breast cancer and ATM mutations: treatment implications
Authors: Seca Marta , Narod Steven A.
Published: November 2024

Genetic testing for breast cancer predisposing genes has expanded beyond BRCA1 and BRCA2 and now includes panels of 20 or more genes. It is now recommended that all women diagnosed with breast cancer at age 65 or below be offered testing for an extended gene panel. The rationale for testing includes personalizing the management of breast cancer according to the mutation found. For BRCA1 and BRCA2 carriers, the finding of a mutation has clear implications for cancer management, but for other genes, such as ATM, the management implications are less clear. Women with an ATM mutation have a lifetime risk of breast cancer of approximately 25%, the majority of which are ER-positive. The risk of ovarian cancer is approximately 5%. It is not yet clear how the identification of an ATM mutation in a patient newly diagnosed with breast cancer should impact on her treatment and follow-up. At present, these women are treated in the same way as women without a mutation. It is important that large prospective studies be conducted looking at various treatment modalities in women with breast cancer and an ATM mutation in order to optimize outcomes.
Cohesin distribution alone predicts chromatin organization in yeast via conserved-current loop extrusion
Authors: Yuan Tianyu , Yan Hao , Li Kevin C. , Surovtsev Ivan , King Megan C. , Mochrie Simon G. J.
Published: November 2024

Background

Inhomogeneous patterns of chromatin-chromatin contacts within 10–100-kb-sized regions of the genome are a generic feature of chromatin spatial organization. These features, termed topologically associating domains (TADs), have led to the loop extrusion factor (LEF) model. Currently, our ability to model TADs relies on the observation that in vertebrates TAD boundaries are correlated with DNA sequences that bind CTCF, which therefore is inferred to block loop extrusion. However, although TADs feature prominently in their Hi-C maps, non-vertebrate eukaryotes either do not express CTCF or show few TAD boundaries that correlate with CTCF sites. In all of these organisms, the counterparts of CTCF remain unknown, frustrating comparisons between Hi-C data and simulations.

Results

To extend the LEF model across the tree of life, here, we propose the conserved-current loop extrusion (CCLE) model that interprets loop-extruding cohesin as a nearly conserved probability current. From cohesin ChIP-seq data alone, we derive a position-dependent loop extrusion rate, allowing for a modified paradigm for loop extrusion, that goes beyond solely localized barriers to also include loop extrusion rates that vary continuously. We show that CCLE accurately predicts the TAD-scale Hi-C maps of interphase Schizosaccharomyces pombe, as well as those of meiotic and mitotic Saccharomyces cerevisiae, demonstrating its utility in organisms lacking CTCF.

Conclusions

The success of CCLE in yeasts suggests that loop extrusion by cohesin is indeed the primary mechanism underlying TADs in these systems. CCLE allows us to obtain loop extrusion parameters such as the LEF density and processivity, which compare well to independent estimates.
Identification and transfer to stepped care of depressed and psychosocially stressed parents during peri- and postpartum—UPlusE: study protocol for cluster randomized trial of a screening intervention
Authors: Stentzel Ulrike , van den Berg Neeltje , Lanczik Freya , Gehrmann Andrea , Nehring Ina , Mall Volker , Friedmann Anna , Seivert Carolin , Schade Stefanie , Fusch Christoph ,   UPlusE-group, Bauer Ines , Emgenbroich Anke , Radau Tilo , Jonas-Dieke Sebastian , Monks Sean , Kittel-Schneider Sarah , Simen Susanne
Published: November 2024

Background

Perinatal depression affects 10–15% of mothers and approximately 5% of fathers. However, only a small number of affected individuals seek treatment. If left unrecognized and untreated, it can have negative long-term consequences for the family’s health, leading to subsequent high costs. Early treatment is crucial, yet there is a notable underdiagnosis and undertreatment. Affected individuals are often seen during this time, e.g. in paediatric practices, but not by specialists in mental health. Consequently, this study aims to increase detection and treatment rates of affected individuals by implementing a screening for depression and psychosocial stress in perinatal and postpartum parents within routine obstetric and paediatric care with subsequent advice and—if necessary—further referral to a mental health specialist.

Methods

UPlusE is a prospective, cluster-randomized controlled trial conducted in an outpatient setting. Obstetric and paediatric practices will be randomized into an intervention and control group (1:1 ratio). Practices and enrolling patients will be required to use specific smartphone apps (practice apps) for interaction. The screening will occur with the apps at each paediatric checkup up to the child’s age of 12 months, using the Edinburgh Postnatal Depression Scale (EPDS), KID-PROTEKT questionnaire, and the scale 1 (impaired bonding) of the Postpartum Bonding Questionnaire (PBQ-1). The goal is to screen 10,000 patients across Germany. Gynaecologists and paediatricians will receive certified training on peripartum depression. Participants in the intervention group with scores above cut-offs (EPDS ≥ 10, KID-PROTEKT ≥ 1, PBQ-1 ≥ 12) will receive counselling through their treating gynaecologists/paediatricians and will be provided with regional addresses for psychiatrists, psychotherapists, and “Frühe Hilfen” (early prevention) as well as family counselling centres, depending on symptom severity. At each screening, participants will be asked whether they sought support, where, and with whom (utilization). Utilization is the primary outcome.

Discussion

The screening is designed to reduce underdiagnosis to enable suitable support at an early stage (especially for those often overlooked, such as individuals with “high-functioning depression”) and hence to avoid manifestation of mental health problems in the whole family, especially infants who are exceptionally dependent on their parents and their well-being will benefit from this program.

Trial registration

German Clinical Trials Register, DRKS00033385. Registered on 15 January 2024.
Targeted dsRNA-mediated suppression of Phytophthora infestans infection via Avr3a
Authors: Lee Hyeonmin , Park Minsu , Kweon Yujin , Lee Dowhan , Shin Chanseok
Published: November 2024

Phytophthora infestans (P. infestans) is a highly destructive oomycete that causes the late blight in Solanaceous crops, such as potatoes and tomatoes, reducing crop yield. Although many pesticides are used to control P. infestans, the pathogen has evolved resistance to these chemical pesticides over time. In this study, we employed RNAi technology as an alternative strategy to suppress P. infestans infection. We designed and synthesized two dsRNAs targeting 5' and 3' regions of the Avirulence Protein 3a (Avr3a) gene, a key effector essential for the virulence of P. infestans. Interestingly, the dsRNA targeting the 5' region which contains the conserved RxLR-EER motif of Avr3a exhibited more substantial suppression of P. infestans infection and Avr3a expression level compared to the 3' region targeting dsRNA. Additionally, we identified changes in the expression of genes related to pattern-triggered immunity (PTI) and effector-triggered immunity (ETI) in plants treated with these dsRNAs. In leaves treated with dsRNAs targeting Avr3a, the expression of PTI-related genes was restored, while ETI-related genes showed lower expression levels compared to the mock-treated leaves. These results suggest that dsRNAs targeting Avr3a effectively suppress P. infestans infection, enabling plants to achieve balanced immunity and enhanced defense.
Cardiac arrhythmias during and after thoracic irradiation for malignancies
Authors: Heckmann Markus B. , Münster Jan P. , Finke Daniel , Hund Hauke , Schunn Fabian , Debus Jürgen , Mages Christine , Frey Norbert , Rahm Ann-Kathrin , Lehmann Lorenz H.
Published: November 2024

Background

Cardiac arrhythmia has been reported as a significant complication of thoracic radiotherapy. Both bradyarrhythmias and tachyarrhythmias have been reported, highlighting the arrhythmia-modulating potential of radiation in certain oncologic therapies. This study aimed to analyse the arrhythmic burden in patients with cardiac implantable electrical devices (CIEDs) undergoing thoracic irradiation, examining both immediate effects of radiotherapy and long-term sequelae post-therapy.

Methods and results

A retrospective cohort study was conducted involving patients with CIEDs who received thoracic radiotherapy between January 2012 and December 2022. Two distinct analyses were performed involving (1) daily CIED follow-ups during radiotherapy and (2) long-term arrhythmic outcomes post-therapy. For long-term outcomes, Patients were matched in a 1:2 ratio with non-irradiated controls based on age, sex, cardiovascular risk factors, cardiac disease, and beta-blocker use. Statistical analyses included negative binomial regression and propensity score matching. A total of 186 patients underwent daily CIED monitoring during radiotherapy, with 79 receiving thoracic irradiation. Thoracic irradiation was negatively associated with atrial arrhythmia (OR 0.11 [0.02;0.70, 95% CI], adjusted p = 0.0498) and there was a tendency towards less ventricular events (OR 0.14 [0.02;1.41, 95% CI], adjusted p = 0.3572) during radiotherapy in a univariate regression analysis. This association was not significant in the multivariate (OR 0.44 [0.10;1.80, 95%-CI], p = 0.16) model including a history of atrial fibrillation, diabetes and beta-blocker use. Coronary artery disease was associated with an increase in atrial and ventricular arrhythmia. For the long-term analysis, 122 patients were followed up after thoracic (N = 33) and non-thoracic radiation (N = 89) and compared to 244 matched controls drawn from approximately 10.000 CIED-patients. There was no significant increase in arrhythmic events compared to controls over a median follow-up of 6.6 months. A previous history of ventricular or atrial arrhythmic events was the strongest predictor for events during the follow-up.

Conclusion

Thoracic radiotherapy can be safely administered in patients with CIEDs. However, patients with a history of arrhythmia are more prone to arrhythmic events during and after radiation. These findings highlight the need for personalized arrhythmia management strategies and further research to understand the mechanisms underlying the antiarrhythmic effects of thoracic radiation.

Graphical Abstract
Fine construction of gene coexpression network analysis using GTOM and RECODE detected a critical module of neuroblastoma stages 4 and 4S
Authors: Nakamura Fumihiko , Nakano Yushi , Yamada Shiro
Published: November 2024

Background

Stage 4 neuroblastoma (NBL), a solid tumor of childhood, has a poor prognosis. Despite intensive molecular genetic studies, no targetable gene abnormalities have been identified. Stage 4S NBL has a characteristic of spontaneous regression, and elucidation of the mechanistic differences between stages 4 and 4S may improve treatment. Conventional NBL studies have mainly focused on the detection of abnormalities in individual genes and have rarely examined abnormalities in gene networks. While the gene coexpression network is expected to contribute to the detection of network abnormalities, the fragility of the network due to data noise and the extraction of arbitrary topological structures for the high-dimensional network are issues.

Results

The present paper concerns the classification method of stages 4 and 4S NBL patients using highly accurate gene coexpression network analysis based on RNA-sequencing data of transcription factors (TFs). In particular, after applying a noise reduction method RECODE, generalized topological overlapping measure (GTOM), which weighs the connections of nodes in the network structure, succeeded in extracting a cluster of TFs that showed high classification performance for stages 4 and 4S. In addition, we investigated how these clusters correspond to clinical information and to TFs which control the normal adrenal tissue and NBL characters.

Conclusions

A clustering method is presented for finding intermediate-scale clusters of TFs that give considerable separation performance for distinguishing between stages 4 and 4S. It is suggested that this method is useful as a way to extract factors that contribute to the separation of groups from multiple pieces of information such as gene expression levels.
Relationship between exercise habits and social isolation in older patients with predialysis CKD: a cross-sectional study
Authors: Tabata Aki , Yabe Hiroki , Katogi Takehide , Mitake Yuya , Oono Shunta , Yamaguchi Tomoya , Fujii Takayuki
Published: November 2024

Background

Maintaining exercise habits in older patients with predialysis chronic kidney disease (CKD) is important to prevent conversion to renal replacement therapy and improve prognosis. This study identified factors influencing exercise habits in older patients with predialysis CKD.

Methods

This cross-sectional study included 113 patients aged ≥ 65 years with stages 3–5 predialysis CKD who were admitted for CKD education purposes. Exercise habits were assessed using the transtheoretical model. Social isolation was assessed using the Lubben Social Network Scale (LSNS-6). Furthermore, the short physical performance battery (SPPB) and grip strength, exercise self-efficacy (SE), hemoglobin, and estimated glomerular filtration rate of the participants were assessed.

Results

Among the 55 patients who maintained exercise habits, 20 (57.1%) were at CKD stage 3, 19 (43.2%) were at CKD stage 4, and 16 (47.1%) were at CKD stage 5. The LSNS-6, SPPB, grip strength, and exercise SE scores significantly differed between the with exercise habits group and without exercise habits group (p < 0.05). The multivariate logistic regression analysis results indicated that the LSNS-6 (OR:1.10; 95%CI:1.022–1.210) and exercise SE (OR:1.10; 95%CI:1.009–1.199) were significantly associated with exercise habits (p < 0.05). Conversely, no significant associations were found between exercise habits and SPPB, grip strength, renal function, or anemia.

Conclusions

Social isolation and SE may be an important factor influencing exercise habits in older patients with predialysis CKD.
Clinical outcome of severe and critical covid patient receiving NIV or invasive ventilation
Authors: Saad Tarif Ahmed , Badr Salem Mohamed , Abdalrazik Fatmaalzahraa S.
Published: November 2024

Background

Oxygen support therapy plays a pivotal role in managing severe COVID-19 pneumonias causing respiratory failure. Non-invasive ventilation (NIV) strategies are commonly suggested methods to improve oxygenation in such patients.

Objective

We aimed to determine clinical outcomes in hypoxemic COVID-19 patients receiving non-invasive vs. invasive ventilation.

Material and methods

This cross-sectional study was conducted on 40 patients who tested positive by RT-PCR for SARS-CoV-2 RNA and required either invasive or NIV and admitted to the ICU of the 15th of May hospital for 3 months from June 2022 to August 2022. Patients were classified as: Severe: SpO2 < 90%, Pao2\FiO2 < 300, RR > 30, or lung infiltrate > 50%. Critical: the above criteria plus respiratory failure, septic shock, and\or multiorgan dysfunction.

Results

There was a significant difference between the two groups regarding shifting to another mode and ferritin levels. In the NIV group, seven patients were successfully discharged and only two patients were discharged in the invasive group. There was a significant difference between critical and severe regarding length of stay (ICU and Hospital). The Kaplan-Meier survival curve for dead cases showed that the mortality occurrence was significant in invasive ventilation than NIV group with mean duration free from death in NIV group 18.8 compared to 14.8 in the invasive ventilation group.

Conclusions

The NIV use in subjects with critical-to-severe COVID-19 was successful in most of the subjects and can be a safe treatment option. Invasive mechanical ventilation is associated with adverse outcomes possibly due to ventilator-associated lung injury.
Germline Genetic Susceptibility Testing Among Emirati Nationals at Risk for Hereditary Breast and Ovarian Cancer Syndrome
Authors: Rawashdeh Rifaat R. , Pederson Holly , Iskanderian Rafal , Khan Fawad , Altrabulsi Basel , Ricci Stephanie , Eng Charis , Jallad Bassel , Al Mannaei Asma Ibrahim , Alameri Mohamed Salem , Attia Azza , Grobmyer Stephen R.
Published: November 2024

PURPOSE

Breast cancer among Emirati patients is characterized by early-onset disease and later stages at presentation. Little is known about the germline genetic variants that may contribute to these observations. The goal of this study is to characterize the rate and implications of germline genetic variants among a cohort of Emirati patients at risk for hereditary breast and ovarian cancer syndrome.

MATERIALS AND METHODS

A retrospective study was performed to analyze the results of clinical germline genetic testing (March 2020-January 2023) among a cohort of consecutive Emirati patients at risk for hereditary breast and ovarian cancer syndrome: group A: patients with personal history of breast or ovarian cancer (n = 135); group B: unaffected patients with family history of breast or ovarian cancer (n = 37); and group C: patients presenting for cascade testing (n = 20). Management of patients identified to have pathogenic/likely pathogenic (P/LP) variants was analyzed.

RESULTS

The rate of P/LP germline variants for each group was: group A: 17.3%, group B: 16.6%, group C: 57.9%.
BRCA1
gene was the most commonly identified gene harboring P/LP variants, followed by
BRCA2
, among this cohort. Four unrelated patients had a recurrent
BRCA1
pathogenic variant: c.4065_4068del (p.Asn1355Lysfs*10). Only two patients in this series elected risk-reducing mastectomy and four patients elected risk-reducing bilateral salpingo-oophorectomy.

CONCLUSION

A higher rate of P/LP variants is seen among Emirati patients at risk for hereditary breast and ovarian cancer syndrome compared with reports of similar patients from Western populations. Efforts to increase utilization and awareness of germline genetic testing are warranted among Emirati patients.
The History and Current State of Neurosurgery in Albania
Authors: Nico Elsa , Grada Mirel , Xhumari Artur , Seferi Arsen , Rosseau Gail , Petrela Mentor
Published: November 2024

Up to one-third of the global burden of disease involves surgical conditions; however, 5 in 7 people across the world do not have access to timely, affordable surgical care. Low- and middle-income countries account for the majority of the inequities in access to timely surgical care, where the availability of specialty surgical services such as neurosurgery is limited or unavailable. Albania, situated in the Western Balkan region, was once one of the poorest countries in Europe. It is now an upper-middle-income country, and an example of the impact of democratic regime changes in Europe after 1990. This article provides the first-ever examination of the history and current state of neurosurgery in this country. We set the stage with a brief historical background on Albania, including its neurosurgical history. Then, we describe the current state of neurosurgical activity and infrastructure in Albania. Finally, we conclude with suggestions on future neurosurgical efforts for the development of neurosurgery in small countries with variable economic resources.
Cranial Nerve IX and X Neurectomy for Glossopharyngeal Neuralgia: Case Report and Operative Video
Authors: Patel Bhuvic , Pugazenthi Sangami , Dowling Joshua
Published: November 2024

BACKGROUND AND IMPORTANCE:

Glossopharyngeal neuralgia (GPN) is a rare condition that is often misdiagnosed as trigeminal neuralgia. The condition is characterized by intermittent, severe pain in the distribution of the glossopharyngeal nerve. We present an illustrative case of GPN with an operative video detailing neurectomy of the glossopharyngeal nerve and the upper rootlets of the vagus nerve for treatment of idiopathic GPN in a patient with a history of squamous cell carcinoma.

CLINICAL PRESENTATION:

A 62-year-old man with a history of left mandibular alveolar squamous cell carcinoma status postresection presented with left-sided severe, paroxysmal pain in the posterior one-third of his tongue refractory to medical treatment and without evidence of recurrent malignancy or vascular compression on imaging studies. After he failed medical management, glossopharyngeal neurectomy was performed through a left suboccipital craniotomy during which cranial nerves IV, V, VI, VII/VII, IX, X, and XI were visually inspected for malignant recurrence, and the glossopharyngeal nerve and the upper 2 to 3 nerve rootlets of the vagus nerve were severed. The patient had immediate, complete, and durable resolution of his symptoms without any new neurological deficits.

CONCLUSION:

Glossopharyngeal neurectomy has been shown to be an efficacious surgical treatment for GPN, as first described by Walter Dandy in 1920. In this report, we describe the workup and treatment of GPN with important diagnostic considerations and present a detailed video demonstrating technical and anatomic considerations when performing glossopharyngeal neurectomy.
The Risk Analysis Index Has Superior Discrimination Compared With the Modified Frailty Index-5 in Predicting Worse Postoperative Outcomes for the Octogenarian Neurosurgical Patient
Authors: Yocky Alyssa G. , Owodunni Oluwafemi P. , Courville Evan N. , Kazim Syed Faraz , Schmidt Meic H. , Gearhart Susan L. , Greene-Chandos Diana L. , George Naomi , Bowers Christian A.
Published: November 2024

BACKGROUND AND IMPORTANCE:

Healthcare systems continuously strive to improve quality and value of care. Advances in surgical technologies, enhanced perioperative surgical planning, and multidisciplinary care strategies are increasing the number of elective procedures in the geriatric population. However, frail older adults are still more likely to have poor postoperative outcomes. We examined the impact of frailty on postoperative outcomes, we compared the discriminative thresholds for the Risk Analysis Index (RAI), modified Frailty Index-5 (mFI-5), and increasing patient age.

CLINICAL PRESENTATION:

Octogenarian patients undergoing spine, cranial, and other procedures captured in the American College of Surgeons National Surgical Quality Improvement Program between 2012 and 2020 were included. We used receiver operating characteristic curve to examine discriminative thresholds of RAI, mFI-5, and increasing patient age. Multivariable analyses were performed. Our primary outcomes were 30-day mortality, extended length of stay (eLOS [≥75th percentile]), and continued inpatient care >30 days (pLOS). Secondary outcomes were skilled care facility (skilled nursing facility [SNF]) discharges and readmissions.

DISCUSSION:

In total, 20 710 octogenarians were included, with a mean age of 83 years (SD, 2.5) and a men (52.7%) and White (79.8%) majority. The RAI had higher predictive discriminative thresholds for 30-day mortality (C-statistic of 0.743), eLOS (C-statistic: 0.692), and pLOS (C-statistic: 0.697) compared with the mFI-5 (C-statistic: 0.574, 0.556, and 0.550, respectively), and increasing patient age (C-statistic: 0.577, 0.546, and 0.504, respectively), P < .001. On multivariable analyses, RAI showed a larger effect size with adverse postoperative outcomes by increasing frailty strata than mFI-5 and increasing patient age. Nonetheless RAI showed decreased risk for SNF discharges.

CONCLUSION:

We found that RAI was a more accurate predictor than mFI-5 and increasing patient age for 30-day mortality, eLOS, and pLOS in octogenarian neurosurgery patients. More research is needed on RAI's performance in different specialized neurosurgical populations. Moreover, it is increasingly clear that comprehensive risk assessment strategies tailored to optimize perioperative care should be prioritized to potentially improve outcomes for this at-risk population.
Cisterno-Ventricular Lavage After Aneurysm Clipping for the Prevention of Delayed Infarction in Patients With Subarachnoid Hemorrhage
Authors: Scheiwe Christian , Grauvogel Jürgen , Csók István , Fistouris Panagiotis , Fung Christian , Beck Jürgen , Reinacher Peter C. , Roelz Roland
Published: November 2024

BACKGROUND AND OBJECTIVES:

Cerebral infarction due to delayed cerebral ischemia (DCI) is an important source of morbidity after aneurysmal subarachnoid hemorrhage (aSAH). Breakdown products of cisternal and ventricular blood are putative triggers of cerebral vasospasm, which may progress to cerebral infarction. Therefore, intracranial blood clearance is a promising treatment approach. Surgical clipping of aneurysms of the anterior circulation grants access to the basal cisterns of the brain, allowing placement of cisterno-ventricular catheters (CVCs) for postoperative irrigation therapy. Here, we report on the implementation of this simple technique to enable clearance of subarachnoid and ventricular blood.

METHODS:

Twenty patients with aSAH were selected for intraoperative placement of a CVC through the fenestrated lamina terminalis after aneurysm clipping. Continuous irrigation was performed using the fibrinolytic urokinase and, on detection of vasospasm, nimodipine. All consecutive patients with aSAH with aneurysm clipping admitted between 2008 and 2015 served as controls. The primary end point was occurrence of cerebral infarction due to DCI.

RESULTS:

Placement of the CVC and application of lavage therapy were feasible and safe in all patients because no adverse events were observed. Cerebral infarction due to DCI occurred in 0/20 patients (0%) selected for lavage therapy vs 46/223 patients (20.6%) in the control cohort (P = .017). Shunt-dependent hydrocephalus occurred in 2/17 survivors (12%) from the CVC group vs 44/187 (23.5%) in the control group (P = .37).

CONCLUSION:

Clipping of ruptured aneurysms of the anterior circulation allows placement of a CVC through the fenestrated lamina terminalis and postoperative lavage therapy. The risks of infarction due to DCI can be mitigated using this simple intraoperative approach.