bluuebunny/crossref_metadata_2025 huggingface dataset:
Rich dynamics of a hepatitis C virus infection model with logistic proliferation and time delays
Authors: Guo Ke , Ma Wanbiao
Published: October 2024

In this paper, we study a dynamic model of hepatitis C virus (HCV) infection with density‐dependent proliferation of uninfected and infected hepatocytes and two time delays, which is derived from a three‐dimensional model by the quasi‐steady‐state approximation. The model can exhibit forward bifurcation or backward bifurcation, and an explicit control threshold parameter is obtained for the case of backward bifurcation. It is shown that if the proliferation rate of infected hepatocytes is greater than the proliferation rate of uninfected hepatocytes by a certain amount, it becomes more difficult for the virus to be removed. The model has rich dynamical properties: (i) In some parameter regions, bistability can occur; (ii) both time delays (virus‐to‐cell delay) and (cell‐to‐cell delay) can lead to Hopf bifurcations; (iii) same length of time delays and can lead to at most one stability switch, but different time delays can lead to multiple stability switches. Several sufficient conditions for the global stability of the disease‐free equilibrium and the endemic equilibrium are obtained for both forward and backward bifurcation scenarios. In particular, several sharp results on global stability are obtained. Theoretical and numerical results portray the complexity of viral evolutionary dynamics in chronic HCV‐infected patients.
Orthogonal Laurent Polynomials of Two Real Variables
Authors: Cruz‐Barroso Ruymán , Fernández Lidia
Published: October 2024

In this paper, we consider an appropriate ordering of the Laurent monomials , that allows us to study sequences of orthogonal Laurent polynomials of the real variables and with respect to a positive Borel measure defined on such that . This ordering is suitable for considering the multiplication plus inverse multiplication operator on each variable and , and as a result we obtain five‐term recurrence relations, Christoffel–Darboux and confluent formulas for the reproducing kernel and a related Favard's theorem. A connection with the one‐variable case is also presented, along with some applications for future research.
Poetics in the work of three urban photographers: Love for the chaotic city from the site of urban rooftops
Authors: Nordström Paulina
Published: October 2024

By exploring the poetics of three photographers, this article attempts to capture the relationship between urban denizens and the ephemeral, tumultuous city. I understand poetics as arising from their spatial affection for, and sensemaking of, the city, which in turn engenders visual landscapes. I first outline poetics as the art of inhabiting, which generates affection for the city, drawing on the writings of Gaston Bachelard, Michel de Certeau, and Gilles Deleuze and Felix Guattari. Next, I examine how the poetics of photography is crafted in terms of creative sensemaking, where the affected body attunes to percepts and finds resonance with the city's vital forces, thereby enabling poetical landscapes to be captured by the lens.
Photoactivated chromophore for keratitis—Corneal cross‐linking in dogs and cats: A retrospective study in Italy
Authors: Crasta Manuela , Gimenez Eva , Ostan Pier Carlo , Arteaga Kevin
Published: October 2024

Objective

To evaluate the success and failure rate of photoactivated chromophore for keratitis—corneal cross‐linking (PACK‐CXL) therapy in a single population of dogs and cats. To identify the usefulness of the PACK‐CXL based on ulcer depth and establish a cutoff at which this procedure could be recommended. To analyze the influence of the different variables in corneal healing time and to report the presence of secondary endothelial damage and cataract formation.

Materials and Methods

Medical records of dogs and cats with presumptive infectious keratitis which underwent accelerated epithelium‐off PACK‐CXL between 2016 and 2023 were reviewed and analyzed.

Results

Records for 369 animals were included, and the overall success rate for healing was 97% (range 4–74 days and no rescue procedure). The second success (re‐epithelialization <30 days and no rescue procedure) rate was 86%, and a total of 40 eyes needed more than 1 month for the corneal repair. Corneal ulcers were classified in three categories based on the depth: 0%–33% (46%), 34%–66% (37.4%), and 67%–100% (16.5%). The cutoff at which PACK‐CXL had a higher probability of failure was with ulcer depth >66.5%. Animals who suffered from keratomalacia and hypopyon at presentation, or were treated with topical serum or gentamicin after PACK‐CXL showed an increase in epithelial healing time (EHT). Increasing age, brachycephalic conformation, keratomalacia alone, and deeper ulcers were identified as risk factors for the treatment outcome. Secondary endothelial injury or cataract formation was not noted in this study.

Conclusions

Accelerated PACK‐CXL is a non‐invasive, adjunctive treatment to medical therapy, which can be used in presumed infectious keratitis with a high probability of success. However, it is important to take in consideration the patient age, skull conformation, presence of keratomalacia, and the ulcer depth.
Immune system benefits of pulmonary rehabilitation in chronic obstructive pulmonary disease
Authors: Abbasi Asghar , Wang David , Stringer William W. , Casaburi Richard , Rossiter Harry B.
Published: October 2024

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by pulmonary and systemic inflammation. Inflammatory mediators show relationships with shortness of breath, exercise intolerance and health related quality of life. Pulmonary rehabilitation (PR), a comprehensive education and exercise training programme, is the most effective therapy for COPD and is associated with reduced exacerbation and hospitalization rates and increased survival. Exercise training, the primary physiological intervention within PR, is known to exert a beneficial anti‐inflammatory effect in health and chronic diseases. The question of this review article is whether exercise training can also make such a beneficial anti‐inflammatory effect in COPD. Experimental studies using smoke exposure mice models suggest that the response of the immune system to exercise training is favourably anti‐inflammatory. However, the evidence about the response of most known inflammatory mediators (C‐reactive protein, tumour necrosis factor α, interleukin 6, interleukin 10) to exercise training in COPD patients is inconsistent, making it difficult to conclude whether regular exercise training has an anti‐inflammatory effect in COPD. It is also unclear whether COPD patients with more persistent inflammation are a subgroup that would benefit more from hypothesized immunomodulatory effects of exercise training (i.e., personalized treatment). Nevertheless, it seems that PR combined with maintenance exercise training (i.e., lifestyle change) might be more beneficial in controlling inflammation and slowing disease progress in COPD patients, specifically in those with early stages of disease.
Transfusion-related acute lung injury/transfusion-associated circulatory overload in a child with non-transfusion dependent thalassemia and aplastic crisis due to acute parvovirus B19 infection
Authors: Mantadakis Elpis , Vittoraki Angeliki , Siorenta Alexandra , Kontekaki Eftychia
Published: October 2024

We present a never-transfused girl with thalassemia intermedia who was admitted for febrile aplastic crisis due to human parvovirus B19. After a first transfusion of packed red blood cells, she developed pulmonary oedema. She improved with supportive care including the use of intravenous diuretics. Due to severe anaemia, she received a second blood transfusion, antibiotics for febrile neutropenia and intravenous γ globulin for control of the parvovirus infection. She had an uneventful recovery. The first of her male blood donors had an antibody against a patient’s human leukocyte antigens type II antigen with a high mean fluorescent intensity. Our patient had clinical features and supportive laboratory evidence for mild transfusion-related acute lung injury (TRALI). However, she also met the criteria for transfusion-associated circulatory overload (TACO). We conclude that our patient likely suffered from TRALI/TACO, a consensus term proposed in 2019 for patients in whom TRALI cannot be distinguished from TACO or in whom both conditions occur simultaneously.
Minimising the rate of vascular complications in Deep Brain Stimulation surgery for the management of Parkinson’s disease: a single-centre 600-patient case series
Authors: Cook Raymond , Chennell Dutton Nyssa , Silburn Peter A , Meagher Linton J , Fracchia George , Anderson Nathan , Cooper Glen , Dinh Hoang-Mai , Cook Stuart J , Silberstein Paul
Published: October 2024

Objectives

Deep Brain Stimulation (DBS) is an effective, yet underused therapy for people living with Parkinson’s disease (PD) in whom tremor, motor fluctuations and/or dyskinesia are not satisfactorily controlled by oral medical therapy. Fear of vascular complications related to the operative procedure remains a strong reason for both the referrer and patient reluctance. We review the incidence of vascular complications in the first 600 patients with Parkinson’s disease treated at our centre by a single neurologist/neurosurgical team.

Methods

Surgical data routinely collected for patients who underwent DBS implantation for the management of PD between the years 2001–2023 was retrospectively reviewed. Incidences of vascular complication were analysed in detail, examining causal factors.

Results

Including reimplantations, 600 consecutive DBS patients underwent implantation with 1222 DBS electrodes. Three patients (0.50%) experienced vascular complications.

Conclusion

This vascular complication rate is at the low end of that reported in the literature. Risk mitigation strategies discussed include a consistent neurosurgical team, dual methodology target and trajectory planning, control of cerebrospinal fluid egress during the procedure, use of a specialised microelectrode recording (MER)/macrostimulation electrode without an introducing brain cannula and low number of MER passes. A reduced vascular complication rate may improve the acceptability of DBS therapy for both patients and referrers.
Associated impairments among children with cerebral palsy: findings from a cross-sectional hospital-based study in Vietnam
Authors: Khuc Thi Hong Hanh , Karim Tasneem , Nguyen Van Anh Thi , Giang Nguyen Thi Huong , Dũng Trịnh Quang , Dossetor Rachael , Cao Minh Chau , Van Bang Nguyen , Badawi Nadia , Khandaker Gulam , Elliott Elizabeth
Published: October 2024

Objective

This study aims to explore the associated impairments of cerebral palsy (CP) and their correlates among children with CP in Vietnam.

Design

Descriptive cross-sectional study using hospital-based surveillance.

Setting

National Children’s Hospital, Hanoi, Vietnam between June and November 2017.

Participants

765 children with CP were recruited.

Outcome measures

We assessed clinical characteristics of CP, associated impairments (epilepsy, intellectual, visual, hearing, speech impairments) and their correlates. We performed descriptive analyses (median, IQR and proportion). χ2test and Fisher’s exact test were used for categorical variables. Univariate logistic regression and multivariate logistic regression models were established and associated impairments were included as independent variables.

Results

The median age of children was 1.7 years (IQR=2.7). Quadriplegia was the predominant subtype (69.5%) and 46.5% were at Gross Motor Function Classification System level IV–V. Of children, 76.3% had ≥one associated impairment, most commonly speech or intellectual impairments (59.1% and 57.8%, respectively). Severity of motor impairment, type of CP, maternal and perinatal factors (eg, gestational age, perinatal asphyxia, timing of injury causing CP) were associated with greater risk of associated impairments.

Conclusion

Children with CP have a high burden of associated impairments. Findings from our study will inform the development and implementation of appropriate screening and interventions and reduce the long-term adverse effects of these impairments on individuals with CP and their socioeconomic impact.
Knowledge, attitudes and practices around urinary tract infections of general practitioners in the Netherlands: a cross-sectional internet survey
Authors: Cox Stefan Martinus Leonardus , Giorgi Wesley , Platteel Tamara N , Cals Jochen W L , de Bont Eefje G P M
Published: October 2024

Objectives

Urinary tract infections (UTIs) are the most common reason for women to consult a general practitioner (GP). Current diagnostic tests are inadequate, complicating diagnosis and treatment decisions for GPs. To understand how this influences GPs in managing UTI, we aimed to determine GPs’ knowledge, attitudes, and practices around UTI care.

Design

Cross-sectional internet-based survey.

Setting

General practice in the Netherlands between December 2021 and February 2022.

Participants

We distributed invitations to participate via email to 126 practices. Additionally, we distributed invitations via social media and newsletters.

Outcomes

The survey included 15 questions covering GPs’ sociodemographic information, knowledge, attitudes and practices. Data analysis was based on frequencies and descriptive statistics.

Results

Among the 190 eligible respondents, 172 (90.5%) chose dysuria and 140 (73.7%) chose urinary frequency as a symptom likely indicating UTI in healthy women. One in three GPs would diagnose a UTI based on non-specific complaints with positive leucocyte and erythrocyte tests, discordant with established guidelines. GPs indicated that better point-of-care diagnostics would help improve antibiotic prescribing (72.6%) and would conserve time (60.0%). GPs considered a positive test result the most important factor to prescribe antibiotics while patient expectation was considered least important. Half of GPs indicated that the most urgent need in UTI care is improved diagnostics.

Conclusion

GPs often act in discordance with established guidelines, rely on non-specific symptoms for the diagnosis of UTI and rank patient expectation as less important in comparison to symptom recognition and culture result when deciding on antibiotic treatment.
Rapid Access Diagnostics for Asthma (RADicA): protocol for a prospective cohort study to determine the optimum series of investigations to diagnose asthma using conventional and novel tests
Authors: Murray Clare S , Fowler Stephen , Drake Sarah , Wang Ran , Durrington Hannah J , Wardman Hannah , Healy Laura , Bennett Miriam , Simpson Andrew , Barrett Emma , Roberts Stephen A , Simpson Angela
Published: October 2024

Introduction

The diagnosis of asthma is often based on characteristic patterns of symptoms in the absence of an alternative explanation, resulting in over and under diagnosis. Therefore, diagnostic guidelines usually recommend including confirmation of variable airflow obstruction. Some recommend using a sequence of objective tests; however the tests used, the specific cut-off values and the specified order are yet to be validated. We aimed to determine the optimal cut-off values and series of investigations to diagnose asthma. We also explore the potential for novel tests of small airways function and biomarkers, which could be incorporated into future diagnostic pathways.

Methods and analysis

The Rapid Access Diagnostics for Asthma study is an observational study of 300 symptomatic patients with ‘clinician-suspected asthma’ and healthy controls (aged ≥3 to <70 years), recruited from primary and secondary care in Greater Manchester, UK. Symptomatic participants will undergo four core visits and one optional visit. Participants will complete two baseline visits and undergo a series of established (spirometry, bronchodilator reversibility, exhaled nitric oxide, home peak flow monitoring and bronchial challenge testing) and novel tests. Following visit 2, participants will receive monitored medium-dose inhaled corticosteroid therapy for 6–8 weeks, after which they will return for repeat testing. Patients will be diagnosed with asthma by ‘expert panel’ opinion (minimum two respiratory specialists) on review of all data (excluding novel tests) pre and post treatment. Healthy controls will attend two visits to establish reference intervals and calculate repeatability coefficients for novel tests where there is a lack of evidence on what threshold constitutes a ‘normal’ set of values. The primary end point is to determine the optimum diagnostic pathway for diagnosing asthma.

Ethics and dissemination

The study was approved by Greater Manchester East Research Ethics Committee (18/NW/0777). All participants or parents/guardians are required to provide written informed consent and children to provide written assent. The results will be published in peer-review journals and disseminated widely at conferences and with the help of Asthma and Lung UK (www.asthmaandlung.org.uk).

Trial registration number

ISRCTN11676160.
Urinary tract infections and associated factors among patients with an enlarged prostate at a tertiary hospital, Dar es Salaam, Tanzania: a hospital-based cross-sectional study
Authors: Niccodem Elieshiupendo M , Majigo Mtebe , Nyongole Obadia Venance , Manyahi Joel , Shangali Aminiel , Mwingwa Anthon George , Kunambi Peter P , Lyamuya Eligius , Joachim Agricola
Published: October 2024

Objectives

The objectives are to determine the prevalence of urinary tract infection (UTI) and associated factors among patients diagnosed with benign prostatic hyperplasia and prostate cancer.

Design

Hospital-based cross-sectional study.

Settings

Urology clinic and urology ward at Muhimbili National Hospital, which is the main tertiary hospital in Tanzania’s largest city.

Participants

Patients with benign prostate hyperplasia and prostate cancer presenting with genitourinary symptoms.

Main outcome measure

The primary outcome was the occurrence of UTI and factors associated with UTI in patients with benign prostatic hyperplasia and prostate cancer.

Results

402 participants were enrolled, with a median age of 68 years and IQR of 61–75 years. The proportion of UTI was 46.5% (95% CI 41.56% to 51.53%). UTI was more prevalent among inpatients, patients with indwelling urinary catheters, patients with prostate size>80 cm3and those with residual urine volume of >100 mL. In multivariate analysis, age>60 years (adjusted OR (aOR)=2.0, 95% CI 1.13 to 3.55, p=0.018), post-void residual urine volume>100 mL (aOR 1.32, 95% CI 0.67 to 2.59 p=0.001), patient with incomplete bladder emptying (aOR=2.57, 95% CI 1.44 to 4.59, p=0.001) and prolonged catheter duration (aOR=1.24, 95% CI 1.11 to 1.38, p=0.005) were significantly associated with UTI.

Conclusion

Almost half of the patients with an enlarged prostate and genitourinary symptoms had a laboratory-confirmed UTI. The risk of UTI increases with age, incomplete bladder emptying and increased duration of catheterisation. A 1-day increase in the duration of catheterisation increased the risk of UTI by 24%.
Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) Online: a mixed methods evaluation exploring the feasibility of implementing a virtual culturally tailored diabetes self-management programme for African and Caribbean communities
Authors: Low Joseph T S , Lowry Sophie , Goff Louise M , Irwin Sally , Brady Oliver , Curran Natasha , Sevdalis Nick , Walker Andrew
Published: October 2024

Objectives

To assess the feasibility and acceptability of delivering Healthy Eating and Active Lifestyles for Diabetes (HEAL-D) Online.

Intervention

HEAL-D Online—a 7-week culturally tailored type 2 diabetes educational programme delivered using online platform.

Setting

Programme delivered by a London NHS trust, with patients referred from primary care healthcare professionals via a central booking system.

Participants

53 HEAL-D service users completed a postcourse questionnaire, and 14 service users and 7 service delivery staff participated in interviews.

Design

Mixed methods service evaluation.

Primary and secondary outcomes

Service user engagement, acceptability and perceived patient benefit assessed using service activity data. Feasibility and acceptability of HEAL-D Online, using semi-structured interviews to explore the views and experiences of service users and service delivery staff.

Results

Service activity data showed that initial uptake of HEAL-D Online was good (62% attendance) with a high adherence to the programme (77% completion). A high fidelity (94%) was observed, and qualitative findings showed that staff and service users were satisfied with all aspects of course delivery. Both service activity and qualitative data indicated that attendees felt more confident in controlling their diet and managing their diabetes post-HEAL-D Online.

Conclusion

This evaluation demonstrates the feasibility of delivering HEAL-D using an online platform, with its ability to achieve similar goals compared with its face-to-face counterpart. Challenges were identified around the identification, recruitment and referral of eligible patients into the programme, which need to be addressed for successful implementation on a wider scale.
Knowledge, attitude and the associated factors regarding spectacle use among adults living in Debre Birhan Town, North Shewa, Ethiopia, 2023: a community-based, cross-sectional study
Authors: Bekele Matiyas Mamo , Adimassu Nebiyat Feleke , Zeleke Tarekegn Cheklie , Shumye Abebech Fikade , Tegegn Melkamu Temeselew , Sinshaw Assem Abel
Published: October 2024

Objective

This study aimed to assess the knowledge, attitude and the associated factors regarding spectacle use among adults living in Debre Birhan Town, North Shewa, Ethiopia.

Design

A community-based, cross-sectional study was conducted using a multistage sampling method.

Setting

The study was conducted in Debre Birhan Town, North Shewa, Ethiopia.

Participants

The study included 1022 adults aged ≥18 years living in Debre Birhan Town for more than 6 months.

Main outcome measures

Data were collected using face-to-face interviews completed by an interviewer.

Results

The study included 1022 adults with a median age of 45 years. Of the participants, 86.01% (95% CI 83.88, 88.14) had adequate knowledge and 85.32% (95% CI 83.15, 87.50) had favourable attitude towards spectacle use. Older age (adjusted OR (AOR)=1.21, 95% CI 1.17, 1.26), higher educational status (AOR=2.65, 95% CI 1.06, 6.60), history of spectacle use (AOR=3.20, 95% CI 1.31, 7.83) and family history of spectacle use (AOR=4.75, 95% CI 2.31, 9.75) were positively associated with having adequate knowledge of spectacle use. Higher educational status (AOR=2.56, 95% CI 1.26, 5.21), history of spectacle use (AOR=3.22, 95% CI 1.58, 6.55), family history of spectacle use (AOR=1.89, 95% CI 1.13, 3.16) and adequate knowledge about spectacle use (AOR=4.63, 95% CI 2.69, 7.98) were positively associated with having favourable attitude towards spectacle use.

Conclusion

This study revealed a good proportion of adults with adequate knowledge and favourable attitude towards spectacle use. Higher educational status, history of spectacle use and family history of spectacle use were significantly associated with having adequate knowledge and favourable attitude towards spectacle use.
INhaled Sedation versus Propofol in REspiratory failure in the Intensive Care Unit (INSPiRE-ICU1): protocol for a randomised, controlled trial
Authors: Boncyk Christina , Devlin John W , Faisal Hina , Girard Timothy D , Hsu Steven H , Jabaley Craig S , Sverud Ida , Falkenhav Magnus , Kress John , Sheppard Karen , Sackey Peter V , Hughes Christopher G
Published: October 2024

Introduction

Sedation in mechanically ventilated adults in the intensive care unit (ICU) is commonly achieved with intravenous infusions of propofol, dexmedetomidine or benzodiazepines. Significant limitations associated with each can impact their usage. Inhaled isoflurane has potential benefit for ICU sedation due to its safety record, sedation profile, lack of metabolism and accumulation, and fast wake-up time. Administration in the ICU has historically been restricted by the lack of a safe and effective delivery system for the ICU. The Sedaconda Anaesthetic Conserving Device-S (Sedaconda ACD-S) has enabled the delivery of inhaled volatile anaesthetics for sedation with standard ICU ventilators, but it has not yet been rigorously evaluated in the USA. We aim to evaluate the efficacy and safety of inhaled isoflurane delivered via the Sedaconda ACD-S compared with intravenous propofol for sedation of mechanically ventilated ICU adults in USA hospitals.

Methods and analysis

INhaled Sedation versus Propofol in REspiratory failure in the ICU (INSPiRE-ICU1) is a phase 3, multicentre, randomised, controlled, open-label, assessor-blinded trial that aims to enrol 235 critically ill adults in 14 hospitals across the USA. Eligible patients are randomised in a 1.5:1 ratio for a treatment duration of up to 48 (±6) hours or extubation, whichever occurs first, with primary follow-up period of 30 days and additional follow-up to 6 months. Primary outcome is percentage of time at target sedation range. Key secondary outcomes include use of opioids during treatment, spontaneous breathing efforts during treatment, wake-up time at end of treatment and cognitive recovery after treatment.

Ethics and dissemination

Trial protocol has been approved by US Food and Drug Administration (FDA) and central (Advarra SSU00208265) or local institutional review boards ((IRB), Cleveland Clinic IRB FWA 00005367, Tufts HS IRB 20221969, Houston Methodist IRB PRO00035247, Mayo Clinic IRB Mod22-001084-08, University of Chicago IRB21-1917-AM011 and Intermountain IRB 033175). Results will be presented at scientific conferences, submitted for publication, and provided to the FDA.

Trial registration number

NCT05312385.
Contactless monitoring to prevent self-harm and suicide in custodial settings: Protocol for a global scoping review
Authors: Bosworth Rebecca , Everett Bronwyn , Breen Paul , Klein Jason , Psillakis Eleni , Abbott Penelope , Smith Kirsty , Li Wanqing , Anderson Neil , Thakur Chetan Singh , Borschmann Rohan
Published: October 2024

Introduction

Self-harm and suicide are major contributors to the global burden of disease and people in custodial settings are at a markedly increased risk of these adverse outcomes. Contactless monitoring technology is emerging as a possible solution to prevent self-harm and suicide by detecting and predicting vulnerabilities among people at increased risk in custodial settings in realtime, however no reviews to date have synthesized the evidence base, in the custodial context, regarding (a) the extent to which this technology has been implemented; and (b) the acceptability and feasibility of its application among custodial staff, specifically in relation to maintaining the wellbeing and safety of both incarcerated people and custodial professionals.

Methods and analysis

Our scoping review will be reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. We searched key electronic health and social science databases (MEDLINE, PubMed, Scopus, Web of Science, ProQuest and Google Scholar) on 5 February 2024 for peer-reviewed studies, which report on the use of contactless monitoring in custodial settings. Any type of study design was eligible, and the publication format was not limited. We included quantitative peer-reviewed journal articles, all types of reviews (narrative, systematic and meta-analysis) and did not apply study eligibility restrictions on country of origin. We will also search grey literature. Inclusion of publications will be restricted to the English language.

Ethics and dissemination

This review does not require institutional ethics review or approval as it is a review of studies that have already been granted relevant ethics approval. Our dissemination strategy includes a peer-reviewed publication and presentations at relevant national and international academic conferences. A plain language summary will be distributed through consumers and professional networks.
Photobiomodulation therapy to prevent oral mucositis and functional impairment in adult patients with haematological cancer undergoing haematopoietic stem cell transplantation: randomised trial protocol
Authors: López-Espinoza Tomas , Sacomori Cinara , Araya-Castro Paulina , Quintiliano-Scarpelli Daiana , Roldán Paola , Peña-Espinoza Mónica , de Rezende Laura Ferreira , López-Vidal Hernán
Published: October 2024

Introduction

Oral mucositis is a highly prevalent condition in individuals treated for haematological neoplasms, primarily during haematopoietic stem cell transplantation (HSCT). The condition is known to delay recovery processes, increasing the risk of infection, the number of interventions and the length of hospital stays. The proposed Photobiomodulation Therapy for Oral Mucositis and Functional Impairment Transplantation Trial aims to assess the effectiveness and acceptability of using photobiomodulation in the oral cavity to prevent oral mucositis and functional impairment in adult patients undergoing HSCT.

Methods and analysis

This is an assessor-blinded and statistician-blinded, parallel-group randomised controlled clinical trial (photobiomodulation vs control group). Participants and setting: 30 patients, aged 18–65 years, with haematological neoplasms undergoing HSCT at the Clínica Dávila Oncology and Bone Marrow Transplant Unit. Primary outcome measures: oral mucositis will be assessed daily using the WHO grading scale, beginning on the day of transplant through day 20 post-transplant. Researchers will assess functional capacity using a 2 min step test, handgrip strength with the Jamar digital dynamometer, lower limb strength using a 30’ sit-to-stand test and quality of life with the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation Questionnaire. Acceptability will be assessed by logging treatment adherence and using a Visual Analogue Scale. Assessments will occur at two time points (1): on admission to the transplant unit, before starting the conditioning regimen and (2) on the day of discharge. Intervention: three times per week photobiomodulation therapy using a diode laser device will begin the first day of conditioning and continue through day 3 post-transplant.

Ethics and dissemination

The Clínica Dávila and Universidad del Desarrollo Clinical Research Ethics Committees approved this study in accordance with the Helsinki Declaration. Patients’ informed consent will be required. The dissemination strategy includes publication in scientific journals as well as presentations in the media and at conferences.

Trial registration number

NCT06260111.
Using artificial intelligence for bladder cancer detection during cystoscopy and its impact on clinical outcomes: a protocol for a systematic review and meta-analysis
Authors: Baana Mohamed , Arkwazi Murtada , Zhao Yi , Ofagbor Ojone , Bhardwaj Gaurika , Lami Mariam , Bolton Eva , Heer Rakesh
Published: October 2024

Introduction

Cystoscopy has revolutionised the process of diagnosing bladder cancer leading to better categorisation of risk levels and more precise treatment plans. Nonetheless, concerns arise about the lack of uniformity among observers in predicting tumour stage and grade. To address these concerns, artificial intelligence (AI) is being incorporated into clinical settings to aid in the analysis of diagnostic and therapeutic images. The subsequent report outlines a systematic review and meta-analysis protocol aimed at evaluating the effectiveness of AI in predicting bladder cancer based on cystoscopic images.

Methods and analysis

Our systematic search will use databases including PubMed, MEDLINE, Embase and Cochrane. The articles published between May 2015 and April 2024 will be eligible for inclusion. For articles to be considered, they must employ AI for analysis of cystoscopic images to identify bladder cancer, present original data and be written in English. The protocol adheres to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol 2015 checklist. Quality and bias risk across chosen studies will be evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2 score.

Ethics and dissemination

Ethical clearance will not be necessary for conducting this systematic review since results will be disseminated through peer-reviewed publications and presentations at both national and international conferences.

PROSPERO registration number

CRD42024528345.
Perceptions and experiences with two no-test direct-to-patient telehealth medication abortion regimens in the USA: an exploratory study with mifepristone and misoprostol and misoprostol-only regimens
Authors: Johnson Dana , Thompson Terri-Ann , Fix Laura , Jastaniah Ibtehal , Grant Melissa
Published: October 2024

Introduction

Telehealth medication abortion (teleMAB) is an option for expanding abortion access in the USA. In this study, we compared the accessibility of two no-test, direct-to-patient teleMAB regimens: mifepristone and misoprostol, and misoprostol-only.

Research design and methods

Over a 5-month period, we conducted an exploratory study surveying clients who received teleMAB services from an abortion clinic offering teleMAB. We calculated descriptive statistics focusing on the healthcare access dimensions of acceptability and accommodation. We conducted a content analysis of open-response comments focusing on convenience.

Results

Of the 218 clients in the study: 195 (89%) selected the mifepristone and misoprostol regimen and 23 (11%) selected the misoprostol-only regimen. Across all respondents, 88% reported they would use the service again if they needed an abortion in the future. Half of the respondents (52%) connected to the service using a smartphone, 99% owned the device that they used, 98% could easily hear and 99% could easily talk to the prescribing provider, and only 7% had a problem connecting to the service. Respondents felt that teleMAB was convenient because they had quality and trustworthy communications. It also accommodated their childcare needs, travel, and scheduling, felt private and comfortable, and facilitated a sense of reproductive autonomy.

Conclusions

Respondents found both teleMAB regimens to be acceptable, technologically accommodating and convenient. These results have promising implications for states positioned to expand insurance coverage and reimbursement for teleMAB, including misoprostol-only regimens. Results also inform a need to focus on policies that expand access to teleMAB through nationwide internet connectivity.
Impact of race, ethnicity, and social determinants on outcomes following immune checkpoint therapy
Authors: Nayak Rahul K , Aiello Meili , Maldonado Laneisha Marielis , Clark Tarralyn Y , Buchwald Zachary S , Chang Andres
Published: October 2024

Immune checkpoint blockade (ICB) therapies are one of the greatest advances in the history of cancer care and are now commonly used in the management of many different malignancies. However, much remains unknown about the factors that affect the efficacy and side effect profile of these agents. This review delves into the published literature that evaluates the intricate interplay between race, age, gender, and social determinants in shaping outcomes following ICB across solid tumors and hematologic malignancies. We examine the pivotal phase 2 and 3 trials to evaluate the demographics of participants and outcomes based on these variables, if reported. Most, but not all, trials reported some basic demographic information like age, sex, race, ethnicity, and/or geographic area for enrollment. Clinically relevant biological markers that could affect ICB outcomes such as obesity or markers of social determinants of health were largely not reported. Trials were generally representative for men and women based on expected prevalence for a given malignancy, but often under-represented non-white participants and rarely enrolled patients from the global south. Subgroup analyses were conducted in many ICB trials for solid malignancies, but rarely conducted for hematologic malignancies. These analyses largely showed similar qualitative benefit across subgroups, but adverse events were rarely reported by subgroup. This review adds to our understanding of the populations that these clinical trials have studied and highlight the urgent need to redouble our efforts at increasing the diversity of the population in future ICB trials.
Cardiac rhabdomyoma: a rare feature of Birt-Hogg-Dubé syndrome
Authors: Petit Florence , Devisme Louise , Tchernitchko Dimitri , Domanski Olivia , Gonzalez-Corcia Cecilia , Wemeau-Stervinou Lidwine , Lejeune Sophie
Published: October 2024

Birt-Hogg-Dubé syndrome (BHDS) is a rare autosomal disorder, primarily characterised in adults by cutaneous features, pulmonary cysts that predispose to spontaneous pneumothorax and renal tumours. The syndrome is caused by pathogenic variants in theFLCNtumour suppressor gene, which plays a role in the mammalian target of rapamycin (mTOR) signalling pathway. We present the case of a newborn infant diagnosed with BHDS, who died of sudden cardiac death due to complications from cardiac rhabdomyoma. This is only the second reported case of such an association. Both cases were initially misdiagnosed with tuberous sclerosis complex, highlighting the diagnostic challenges. We discuss this differential diagnosis and suggest that cardiac rhabdomyomas, although rare, may be associated with BHDS and potentially life threatening. Therefore, we recommend cardiac screening in newborns at risk.
Prevalence of extended-spectrum β-lactamase-producing Enterobacterales and carbapenemase-resistant Enterobacterales in British military cohorts
Authors: Toriro Romeo , Pallett S J C , Nevin W , Ross TM , Hale I , Routledge M , Bennett C , Knott J , Burns DS , Edwards T , O'Shea MK , Fletcher TE , Beeching NJ , Woolley SD
Published: October 2024

Introduction

Travel to resource-limited settings is a known risk for acquisition of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) and carbapenem-resistant Enterobacterales (CRE), which are both associated with increased morbidity and mortality. We investigated the ESBL-PE and CRE baseline prevalence in British service personnel (SP).

Methods

SP provided faecal samples for research projects in several different settings, between September 2021 and April 2022. Bacterial colonies from faecal isolates were recovered from incubated ChromID ESBL plates (bioMérieux, Marcy-l'Étoile, France) and DNA extracted using Qiagen DNeasy extraction kits (Qiagen, UK). PCR to identify β-lactamase and CRE encoding genes was performed using the Rotor-Gene Q (RGQ) (Qiagen, UK), with positivity detected by RGQ software. Phenotypic assessment of antimicrobial susceptibility was not performed.

Results

Out of 250 personnel approached, 239 (85.5% men, median (IQR) age 31 (26–37) years) provided faecal samples suitable for analysis. The ESBL prevalence was 40/239 (16.7%), with ESBL-producingEscherichia colidetected in 39 (16.3%) samples and ESBL-producingKlebsiella pneumoniaein 1 (0.4%) sample. Combinations including Temoniera, sulfhydryl reagent variable (SHV), cefotaxime hydrolysing β-lactamase (Munich) (CTX-M) 1 and CTX-M 9 genes were detected in 18 (7.5%), 33 (13.8%) 16 (6.7%) and 8 (3.3%) samples, respectively.E. colisamples had mixtures of all four genotypes with SHV predominating. One (0.4%) sample carried all four gene types and the onlyK. pneumoniaesample carried a single SHV gene. No CRE were detected.

Conclusions

The prevalence of ESBL-PE in cohorts of SP closely matches that of civilian populations in England; however, we noted differences in ESBL genotype distribution. Potential exposure risks for SP from international travel and occupational trauma emphasise the need for repeated surveillance to characterise and detect changes in acquisition epidemiology and carriage of ESBL. Such prospective data have important antimicrobial stewardship implications in optimising clinical outcomes, controlling resistance and guiding empirical antibiotic formulary policy recommendations.
MRI genicular nerve mapping: a novel approach to sagittal genicular nerve localization
Authors: Hillery Terence , Hill Hannah , Imka Emily , Di Lorenzo David , van Acker Gustaf , Kim Chong
Published: October 2024

Background and objectives

Chronic knee pain, including postarthroplasty knee pain, is a major cause of morbidity. Radiofrequency ablation of genicular nerve branches is a treatment option. The literature to date has demonstrated and recommended consistent rhizotomy targets in the coronal and axial position of the three primary genicular nerve branches (superomedial genicular nerve, superolateral genicular nerve, inferomedial genicular nerve). The debate on genicular nerve positions focuses on the anterior-posterior courses of the nerve branches.

Methods

The sagittal positions of the three primary genicular neurovascular bundles were measured in 28 consecutive knee MRI and described relative to the total anterior-posterior depth of the bony cortex. Standard radiofrequency capture radius at the classic rhizotomy targets sites was compared with identified nerve position to report proportion of observed nerves within the capture radius.

Results

The genicular neurovascular bundles were found further posterior than classic landmark targets. Proportion of visualized nerve branches captured by classic rhizotomy target radius varied by genicular nerve branch.

Conclusions

This study supports updated guidance on genicular rhizotomy targets. Nerve localization studies using MRI data may be a promising avenue in future nerve localization research pertinent to rhizotomy.
Baseline and 2-year differences in spinal symptoms and spinal and hip mobility in early axial spondyloarthritis and non-axial spondyloarthritis chronic back pain patients
Authors: Bento da Silva Ana , Ramiro Sofia , van Lunteren Miranda , Marques Mary Lucy , van de Sande Marleen , Fongen Camilla , Exarchou Sofia , Ramonda Roberta , van der Heijde Désirée , van Gaalen Floris A
Published: October 2024

Objective

To compare spinal symptoms and spinal/hip mobility at baseline and 2 years in early axial spondyloarthritis (axSpA) and non-axSpA chronic back pain (BP) patients.

Methods

Baseline and 2 years data of the SPondyloarthritis Caught Early cohort were analysed. Outcomes assessed: overall BP, BP at night, morning stiffness (MS) intensity, MS duration, occiput-to-wall distance (OWD), cervical rotation, chest expansion, lateral spinal flexion (LSF), modified Schober test (mSchober), intermalleolar distance (IMD) and Bath Ankylosing Spondylitis Metrology Index (BASMI). Linear or zero-inflated negative binomial regression was used to compare 2 years outcomes between groups (adjusting for baseline value, sex, age and use of non-steroidal anti-inflammatory drugs).

Results

There were 294 axSpA and 123 non-axSpA patients (mean symptom duration: 13 months). At baseline, non-axSpA patients had worse symptoms and mobility, except OWD (eg, mean(SD): BP at night 3.6 (2.9) axSpA vs 4.6 (2.7) non-axSpA; OWD 0.5 (1.2) vs 0.1 (0.7)). After 2 years, all symptoms and cervical rotation significantly improved in both groups, but LSF and mSchober only in axSpA. In multivariable analyses, axSpA was associated with larger improvements in BP at night (β (95% CI): −0.85 (−1.47; −0.23)), mSchober (0.26 (0.03; 0.50)), IMD (4.86 (1.93; 7.80)) and BASMI (−0.24 (−0.41; −0.08)), and with lower likelihood of a normal OWD (OR (95% CI): 0.09 (0.01; 0.83)).

Conclusion

Over 2 years, all spinal symptoms and some mobility measures improved in both groups, but impairments remained prevalent (particularly in non-axSpA). Nevertheless, axSpA was associated with larger improvements in BP at night, mSchober, IMD and BASMI, but with more OWD impairment.
Disease response in rheumatoid arthritis across four biologic therapies associates with improvement in paraoxonase-1 activity and oxylipins
Authors: Razmjou Amir A , Kremer Joel M , Pappas Dimitrios A , Curtis Jeffrey R , Wang Jennifer , Shahbazian Ani , Elashoff David A , Guo Rong , Meriwether David , Sulaiman Dawoud , O'Connor Ellen , Reddy Srinivasa T , Charles-Schoeman Christina
Published: October 2024

Objective

Paraoxonase-1 (PON1) is a high-density lipoprotein (HDL)-associated enzyme, that has been implicated as a biomarker of cardiovascular risk in patients with rheumatoid arthritis (RA). We aimed to investigate how different biologic therapies affect levels of PON1 and oxylipins.

Methods

1213 adult patients with RA in the Comparative Effectiveness Registry to study Therapies for Arthritis and Inflammatory CoNditions cohort study with moderate-to-high disease activity (Clinical Disease Activity Index (CDAI) >10) who initiated a new biologic (tocilizumab (TCZ), n=296; abatacept, n=374; tumour necrosis factor inhibitors, n=427; rituximab, n=116) were followed prospectively with serum specimens analysed for PON1 activity by arylesterase (ARYL), lactonase (LAC) and PON assays at baseline and after 6 months of biologic therapy. A targeted panel of oxylipins was evaluated by liquid chromatography-mass spectrometry/mass spectrometry in a subset of patients with the lowest and highest 6-month Disease Activity Score 28 (DAS28)-C reactive protein (CRP) responses in each treatment group.

Results

PON1 activity generally increased in the entire cohort after 6 months of new biologic therapy, showing the greatest, most consistent increases in the TCZ group. Increases in all three PON1 domains associated with significant decreases in disease activity in DAS28-CRP/CDAI (p<0.05), and increases in LAC/ARYL were significantly associated with the American College of Rheumatology 20/50/70 responses (OR (95% CI) of 1.12 (1.04, 1.22) and 1.13 (1.04, 1.23), p<0.01, respectively), after controlling for other RA disease characteristics. Some oxylipins, including 12-hydroxyeicosatetraenoic acid correlated with RA disease activity measures.

Conclusion

Improvement in disease activity across four classes of biologics is associated with enhanced PON1 activity, which has significant implications for cardiovascular safety.
Heart rate variability and insomnia in depressed patients with breast cancer
Authors: Zhang Qianqian , Yu Sheng , Tang Lingxue , Li Wen , Yao Senbang , Chai Jiaying , Li Anlong , Jia Yingxue , Huang Runze , Cheng Huaidong
Published: October 2024

Objectives

Depression is associated with unhealthy autonomic regulation. However, whether patients with breast cancer (BC) with different degrees of depression can be identified from linear and non-linear dynamics in the autonomic nervous system is unclear. We aimed to evaluate the differences in linear and non-linear heart rate variability (HRV) parameters in patients with BC with different degrees of depression and the relationship between HRV parameters and depression and sleep disorders.

Methods

A total of 115 patients with BC were enrolled. According to their Self-Rating Depression Scale (SDS) scores, the patients were divided into a non-depressed group, a mildly depressed group and a moderately to severely depressed group. The Pittsburgh Sleep Quality Index (PSQI), HRV, linear index (including time and frequency domains) and non-linear index (including Poincare plot, approximate entropy (ApEn) and short-term fluctuation slope (DFAα1)) were evaluated.

Results

Compared with patients without depssion, patients with mild depression and moderate-to-severe depression had significant differences in the time domain, frequency domain index, the SD perpendicular to the line-of-identity (SD1) and DFAα1 of non-linear HRV and sleep quality. SDS and PSQI scores were correlated with HRV parameters.

Conclusions

The severity of depression in patients with BC is associated with reduced variability, complexity of cardiac dynamics and sleep disturbance.