bluuebunny/crossref_metadata_2025 huggingface dataset:
Elevated Cystatin C Predicts Higher Mortality in Chronic Heart Failure Independently of Renal Function
Authors: Carreira Marta , Araújo José Paulo , Bettencourt Paulo , Lourenço Patrícia
Published: August 2024

Introduction:

Cystatin C (CysC) is a known prognostic marker in cardiovascular diseases and its role in acute heart failure (HF) has been documented.

Methods:

We prospectively recruited HF patients followed in a HF clinic. Inclusion criteria: HF diagnosed ≥6 months, optimized evidence-based therapy, and ejection fraction <40% (Heart Failure with reduced ejection fraction). Exclusion criteria: renal replacement therapy and hospitalizations or therapeutic adjustments in the previous 2 months. A venous blood sample and 24-hour urine were collected. Follow-up: 5 years; endpoint: all-cause mortality. CysC was measured and creatinine clearance (CrCl) was calculated using 24-hour urine creatinine excretion. A Receiver operating characteristic curve was used to assess association of CysC with 5-year mortality. The prognostic role of CysC was determined using Cox-regression analysis. The multivariate model included CrCl (24-hour urine).

Results:

We evaluated 215 chronic stable Heart Failure with reduced ejection fraction patients. Mean age was 68 years, 72.1% were male. Median CysC = 1.15 mg/L, creatinine = 1.20 mg/dL, and CrCl = 63.6 mL/min. During follow-up, 103 (47.9%) patients died. The area under the curve for CysC in predicting mortality was 0.77 (0.70–0.83). Best cut-off value for death prediction = 1.00 mg/L with a sensitivity = 83.5%, specificity = 56.2%, positive predictive value = 63.7%, and negative predictive value = 78.7%. Multivariate-adjusted (age-, B-type natriuretic peptide-, evidence-based therapy, New York Heart Association class, and CrCl) 5-year mortality Hazard ratio = 2.40 (95% Confidence interval, 1.25–4.61), P value = 0.008 when CysC ≥1.00 mg/L.

Conclusions:

Patients with CysC <1.00 mg/L have almost 80% probability of being alive at 5 years; If CysC ≥1.00 mg/L, there is almost 2.5-fold higher death risk independently of B-type natriuretic peptide and CrCl.
Applying a Computer-based Warfarin Management System at a Large Tertiary Cardiovascular Center in Iran
Authors: Barati Somayyeh , Mohammadpour Mohammad Mehdi , Sadrameli Mohammad Ali , Hosseini Saeed , Maleki Majid , Golpira Reza , Bakhshandeh Hooman , Kyavar Majid , Moosavi Jamal , Mohebbi Bahram , Talasaz Azita H. , Barco Stefano , Klok Frederikus A. , Sadeghipour Parham
Published: August 2024

Background:

Regarding adjustments to warfarin dosage, numerous studies have shown that computerized methods are superior to those based on personal experience.

Objectives:

To report the efficacy of a computer-based warfarin management system (WMS) in the Iranian population.

Methods:

By utilizing the existing dosing algorithms and obtaining expert opinions, we developed a computer-based WMS at a large tertiary cardiovascular center. The time in therapeutic range and the number of international normalized ratio (INR) tests of clinic patients were compared before and after the implementation of WMS.

Results:

Overall, 803 patients with 5407 INR tests were included in the before phase and 679 patients with 4189 INR tests in the after phase. The mean time in therapeutic range was 57.3% before and 59% after WMS implementation [mean difference, 1.64; 95% confidence interval (CI), −1.12–4.40]. In the before phase, the mean number of INR tests was 6.7, which dropped to 6.1 tests in the after phase (mean difference, −0.61; 95% CI, −0.97 to −0.24). Only 54.5% of the warfarin dosing prescriptions were consistent with the dosing recommendations of the WMS, and adherence to the WMS was poorest in the highest INR target range.

Conclusions:

For the first time in Iran, we demonstrated that a computerized system was as effective as a traditional experience-based method to monitor INR in VKA-anticoagulated patients. Furthermore, it could reduce both the number of INR tests and that of visits.
Reported Physical Symptoms During Screening Echocardiography Are Not Associated With Presence of Suspected Hypertrophic Cardiomyopathy
Authors: Movahed Mohammad Reza , Bahrami Ashkan , Bates Sharon
Published: August 2024

Background:

The prevalence of hypertrophic cardiomyopathy (HCM) can be silent and can present with sudden death as the first manifestation of this disease. The goal of this study was to evaluate any association between reported physical symptoms with the presence of suspected HCM.

Method:

The Anthony Bates Foundation has been performing screening echocardiography across the United States for prevention of sudden death since 2001. A total of 4120 subjects between the ages of 4 and 79 underwent echocardiographic screening. We evaluated any association between various symptoms and suspected HCM defined as any left ventricular wall thickness³ ≥15 mm.

Results:

The total prevalence of suspected HCM in the entire study population was 1.1%. The presence of physical symptoms was not associated with HCM (chest pain in 4.3% of participants with HCM vs. 9.9% of the control, P = 0.19, palpitation in 4.3% of participants with HCM vs. 7.3% of the control, P = 0.41, shortness of breath in 6.4% of participant with HCM vs. 11.7% of the control, P = 0.26, lightheadedness in 4.3% of participant with HCM vs. 13.1% of the control, P = 0.07, ankle swelling in 2.1% of participant with HCM vs. 4.0% of the control, P = 0.52, dizziness in 8.5% of participant with HCM vs. 12.2% of the control, P = 0.44).

Conclusions:

Echocardiographic presence of suspected HCM is not associated with a higher prevalence of physical symptoms in the participants undergoing screening echocardiography.
TEN-YEAR FOLLOW-UP OF FELLOW EYES IN PATIENTS WITH UNILATERAL NAIVE EXUDATIVE AGE-RELATED MACULAR DEGENERATION
Authors: Pozzo Giuffrida Francesco , Nassisi Marco , de Sanctis Lorenzo , Milella Paolo , Malerba Alessia , Mapelli Chiara , Dell'Arti Laura , Casaluci Marco , Romano Francesco , Invernizzi Alessandro , Staurenghi Giovanni , Viola Francesco
Published: August 2024

Purpose:

To determine the 10-year morphologic outcomes and identify potential risk factors of exudative age-related macular degeneration (AMD) in the fellow eyes (FEs) in patients with naive exudative AMD.

Methods:

Data from 100 patients were retrospectively reviewed. Baseline macular neovascularization (MNV) type in the exudative AMD eye and presence of drusen, intraretinal hyperreflective foci, nonfoveal incomplete retinal pigment epithelium and outer retinal atrophy, central retinal thickness, and subfoveal choroidal thickness in the FEs were analyzed as biomarkers for progression in the second eye.

Results:

Fifty-four patients developed exudative AMD in the FE at the end of the follow-up. Subjects with Type 2 and Type 3 macular neovascularization in the exudative AMD eye had a higher risk of exudative AMD in the FE (hazard ratio [HR] = 3.365; P = 0.039 and HR = 3.801; P = 0.037). Fellow eyes with drusen (large HR = 6.938, P = 0.001; cuticular HR = 6.937, P < 0.0001; subretinal drusenoid deposits HR = 13.678, P < 0.0001) and intraretinal hyperreflective foci (HR = 1.853, P = 0.041) were also at higher risk. Seven patients were legally blind by the end of the follow-up.

Conclusion:

The rate of exudative AMD in the FE was 54% 10 years after the diagnosis in the exudative eye. The FE of patients with Type 2 and Type 3 macular neovascularization was at high risk of early progression. Drusen and intraretinal hyperreflective foci were also significant risk factors for macular neovascularization development.
HIGHER SUBFOVEAL CHOROIDAL THICKNESS IN CHOROIDAL MELANOMAS THAN IN CHOROIDAL NEVI
Authors: Benlarbi Abdelmajid , Malaise Denis , Estrada Walker Juliana , Apéré François , Lumbroso-Le Rouic Livia , Behar-Cohen Francine , Cassoux Nathalie , Matet Alexandre
Published: August 2024

Purpose:

To compare subfoveal choroidal thickness between eyes with choroidal melanoma and choroidal nevi.

Methods:

Retrospective study of 126 consecutive patients in a tertiary ocular oncology center. Eyes with tumors located less than two disk diameters from the fovea were excluded. In eyes with nevi, factors of potential transformation into melanoma were recorded (orange pigment, subretinal fluid, thickness >2 mm, diameter >5 mm, ultrasound hollowness). Subfoveal choroidal thickness was assessed by three independent observers on horizontal spectral-domain optical coherence tomography scans.

Results:

Sixty-seven eyes with choroidal melanoma and 59 eyes with choroidal nevi were included. The melanoma and nevi groups did not differ in gender (P = 0.14) nor age (P = 0.34). There was a very good agreement between the three independent observers for subfoveal choroidal thickness measurements (intraclass correlation coefficient = 0.89). Mean subfoveal choroidal thickness was higher in melanomas (294.3 ± 89.9 µm) than nevi (260.3 ± 76.7 µm) (P = 0.013), and the difference remained significant between melanomas and 28 nevi with ≥2 growth risk factors (256.3 ± 77.0 µm) (P = 0.027). In a multivariate model, the significant contributors to subfoveal choroidal thickness were presence of melanoma (P = 0.004), younger age (P < 0.0001), and shorter lesion distance to the fovea (P = 0.016).

Conclusion:

Subfoveal choroidal thickness may reflect the interplay between melanocytic tumors and their choroidal microenvironment. Its clinical utility should be explored in future studies.
Laparoscopic versus open pancreatoduodenectomy for periampullary tumors: a randomized clinical trial
Authors: Yoon Yoo-Seok , Lee Woohyung , Kang Chang Moo , Hong Taeho , Shin Sang Hyun , Lee Jung Woo , Hwang Dae Wook , Song Ki Byung , Kwon Jae Woo , Sung Min Kyu , Shim In Kyong , Lee Jung Bok , Kim Song Cheol ,   for Korean Study Group on Minimally Invasive Pancreatic Surgery (K-MIPS)
Published: August 2024

Background:

There is a lack of robust evidence on the efficacy of laparoscopic pancreatoduodenectomy compared to open surgery. This study was aimed to compare time to functional recovery (FR) between laparoscopic and open pancreatoduodenectomy.

Materials and methods:

This pragmatic, multicenter, randomized controlled phase 3 trial was conducted in seven tertiary centers. Patients with periampullary tumors were randomized using a block design in a 1:1 ratio and stratified by pancreatic fistula risk. Participants were randomized to undergo open or laparoscopic pancreatoduodenectomy by expert pancreatic surgeons. The primary outcome was the time to FR, defined as the number of days until FR was achieved in all five domains. The secondary endpoints included perioperative and short-term oncological outcomes.

Results:

Between March 2019 and June 2022, 252 patients were randomly assigned to laparoscopic (n=125) or open groups (n=127). Primary outcomes were reported in 235 patients. The mean time to FR was shorter in laparoscopic group compared to the open group (7.7 vs. 9.0 days, P=0.03). Laparoscopic group exhibited a higher cumulative rate of FR compared to the open group (Hazard ratio,1.34; 95% CI, 1.03–1.74; P=0.02). Severe complications, R0 resection, the number of retrieved lymph nodes and short-term survival rates were comparable between the two groups.

Conclusions:

Laparoscopic pancreatoduodenectomy demonstrated modest advantages in FR time over open surgery for selected patients with experienced surgeons.
Epidemiology of advanced cystic fibrosis lung disease in the modulator era
Authors: Westhoff Julia , Naehrlich Lutz
Published: August 2024

Purpose of review

Advanced cystic fibrosis lung disease remains the main cause of death in people with cystic fibrosis (pwCF). Cystic fibrosis transmembrane regulator (CFTR) modulators have changed the disease burden for eligible pwCF with access to this therapy.

Recent findings

Real-world data show that there are no safety concerns for patients with advanced cystic fibrosis lung disease treated with highly effective triple CFTR modulator therapy. The improvements are comparable to those in other people with cystic fibrosis and in part even better. Mortality and rates of lung transplantation have decreased since the approval of CFTR modulator therapy and, especially, highly effective triple CFTR modulator therapy. Nevertheless, at least 10% of people with cystic fibrosis are not eligible for highly effective CFTR modulator therapy, and the development of alternative treatments remains important.

The approval of highly effective CFTR modulator therapies has been a breakthrough in treatment for most people with cystic fibrosis, especially those with advanced lung disease, improving survival and reducing the burden of the disease.
Prophylactic red cell transfusions for sickle cell disease pregnancy: increased use of therapy could transform outcomes
Authors: Alan Sheinei , Sharma Deva , Pecker Lydia H.
Published: August 2024

Purpose of review

Pregnancy for people with sickle cell disease (SCD) is high risk with persistently high rates of severe maternal and fetal mortality and morbidity. Transfusion therapy is the best-studied treatment for SCD in pregnancy; hydroxyurea is not usually used because of teratogenicity concerns. In high-resource settings, red cell transfusions are likely underutilized, while in low-resource settings, they may be altogether unavailable.

Recent findings

A randomized controlled trial and meta-analysis, two of the strongest forms of clinical research, show transfusion significantly reduces maternal and fetal death, painful crisis, thrombosis, and acute respiratory failure. Downstream benefits of treatment are less well measured and may include improving maternal anemia, reducing opioid exposure, and avoiding hospitalization, which presents risk for additional complications. Alloimmunization is a particular transfusion risk in SCD. However, many strategies can mitigate this risk. Accordingly, the American Society of Hematology classifies chronic transfusion in pregnancy as low risk.

Given the low risk classification, lack of alternative therapies, dismal, stagnant pregnancy outcomes and the potential for profound treatment benefit, wider use of chronic transfusion therapy for SCD pregnancy is likely indicated. This review discusses the benefits and potential risks of prophylactic transfusions for SCD pregnancy. Use of chronic transfusions during pregnancy is indicated to help urgently transform outcomes.
Video-Based Study of the Progression of Pediatric Emergency Medicine Fellows' Tracheal Intubation Performance During Training
Authors: Thomas Phillip , Kerrey Benjamin , Edmunds Katie , Dean Preston , Frey Mary , Boyd Stephanie , Geis Gary , Ahaus Karen , Zhang Yin , Sobolewski Brad
Published: August 2024

Background

The lower clinical exposure of Pediatric Emergency Medicine (PEM) fellows to critical procedures may impede skill acquisition. We sought to determine the tracheal intubation learning curve of PEM fellows during training and compared PEM fellow success against standards for tracheal intubation success.

Methods

This was a retrospective, video-based study of a cohort of PEM fellows at a single academic pediatric emergency department (PED). All forms of tracheal intubation were included (rapid sequence intubation and crash or no medication). The cohort consisted of 36 PEM fellows from all or part of 5 consecutive fellowship classes. Data were collected by structured review of both existing ceiling-mounted videos and the electronic medical record. The main outcome was PEM fellows' success on the first or second attempt. We used cumulative summation to generate tracheal intubation learning curves. We specifically assessed the proportion of PEM fellows who reached 1 of 4 thresholds for procedural performance: 90% and 80% predicted success on the first and the first or second attempt.

Results

From July 2014 to June 2020, there were 610 patient encounters with at least 1 attempt at tracheal intubation. The 36 PEM fellows performed at least 1 attempt at tracheal intubation for 414 ED patient encounters (65%). Median patient age was 2.1 years (interquartile range, 0.4–8.1). The PEM fellows were successful on the first attempt for 276 patients (67%) and on the first or second attempt for 337 (81%). None of the 36 PEM fellows reached the 90% threshold for either first or second attempt success. Four fellows (11%) met the 80% threshold for first attempt success and 11 (31%) met the 80% threshold for first or second attempt success.

Conclusions

Despite performing the majority of attempts, PEM fellows often failed to reach the standard thresholds for performance of tracheal intubation. Clinical exposure alone is too low to ensure acquisition of airway skills.
Prognostic Significance of “High” Tumor Budding and “High” Poorly Differentiated Clusters in Endometrial Carcinomas: Independent Predictors of Lymphovascular Space Invasion and Lymph Node Metastasis
Authors: James Elina , Ravikumar Gayatri , Michael Raj A. John , Kulkarni Kiran
Published: August 2024

Tumor budding (TB) and poorly differentiated clusters (PDCs) are well-established prognostic factors in various cancers. This study aimed to assess the independent prognostic role of these markers in endometrial carcinomas. Retrospective analysis of endometrial carcinoma resection specimens by examining traditional histologic prognostic parameters. TB and PDC were observed at 20× magnification in ten fields at the invasive front and categorized as present or absent. In addition, a count of ≥5 was stratified as “high.” Clinical and follow-up details were extracted from Gynecologic Oncology records. Sixty-five endometrial carcinomas were studied and were predominantly endometrioid (n=47, 72.3%). TB was identified in 52.3% of cases, with high TB observed in 38.5%. PDC was evident in 44.6%, with high PDC seen in 29.2%. Associations were significant between the presence of TB/high TB and higher tumor grade (P < 0.001), deep myometrial invasion (P = 0.006/P = 0.002), diffuse pattern of invasion (P = 0.007/P = 0.03), microcystic elongated and fragmented pattern (P < 0.001), lymphovascular space invasion, lymph node metastasis (P=<0.001) and International Federation of Gynecology and Obstetrics stage (P = 0.000/P = 0.002). PDC/high PDC showed similar associations, and, in addition, with nonendometrioid histologic type (P = 0.02) and tumor location in a lower uterine segment (high PDC, P = 0.009). After adjusting for other significant parameters, both high TB (P = 0.03) and high PDC (P = 0.031) emerged as independent prognostic parameters for lymphovascular space invasion or Lymph node metastasis. No recorded deaths or significant events occurred, precluding commentary on overall survival status. High TB and PDC are independent predictors of Lymph node metastasis in endometrial carcinomas. Their association with the microcystic elongated and fragmented pattern makes them histologic predictors of epithelial-mesenchymal transition. Their simple application underscores their potential as valuable additional prognostic indicators for endometrial carcinomas.
Efficiency and Safety of Targeted Alpha Therapy in Metastatic Neuroendocrine Tumors
Authors: Lee Dong Yun , Kim Yong-il
Published: August 2024

Purpose

Despite the effectiveness of 177Lu-based peptide receptor radionuclide therapy in treating metastatic neuroendocrine tumors (NETs), disease progression posttreatment remains a significant challenge. Targeted alpha therapy (TAT) has emerged as a promising option for patients experiencing such progression. This study aims to assess the therapeutic efficiency and toxicity of TAT in patients with metastatic NET through a meta-analysis.

Patients and Methods

We conducted a comprehensive search of PubMed, Embase, Cochrane Library, and CINAHL using relevant keywords. The analysis focused on the pooled proportions of objective response rate (ORR) and disease control rate (DCR) to determine therapeutic efficiency. We also evaluated the incidence of serious hematologic and renal adverse events (grade 3 or 4) to assess toxicity. A subgroup analysis was performed to identify factors influencing therapeutic outcomes.

Results

Our meta-analysis included 7 studies comprising 162 patients. The results showed that TAT achieved ORR of 49.5% (95% confidence interval [CI]: 41.7%–57.4%) and DCR of 87.0% (95% CI: 72.1%–96.8%). The incidences of hematologic and renal toxicities were low, at 2.1% (95% CI: 0.5%–5.5%) and 3.4% (95% CI: 1.2%–7.3%), respectively. Subgroup analysis indicated consistent therapeutic efficiency across different variables, including prior 177Lu-based peptide receptor radionuclide therapy treatment, 225Ac-based TAT, absence of radiosensitizer, and methods of response evaluation, with ORR ranging from 46.6% to 57.1% and DCR from 82.0% to 91.5%.

Conclusions

TAT is an effective treatment for metastatic NET, demonstrating substantial disease control and response rates with minimal toxicity. These findings suggest that TAT is a viable therapeutic alternative for patients with metastatic NET.
Role of Combining Grayscale Findings With Superb Microvascular Imaging and Shear Wave Elastography in Standardization and Management of NON-MASS Breast Lesions
Authors: Kurt Seda Aladag , Taskin Fusun , Kayadibi Yasemin , Ozturk Tulin , Adaletli İbrahim , Icten Gul Esen
Published: August 2024

The non-mass breast lesions on ultrasound (US) are a group of challenging pathology. We aimed to standardize these grayscale findings and investigate the effectiveness of superb microvascular imaging (SMI) and shear wave elastography (SWE). A total of 195 lesions were evaluated by B-mode US, SWE, and SMI in the same session. A “NON-MASS model” was built on grayscale US to group the lesions only as areas and those with associated features: microcalcifications, architectural distortion, ductal changes, and microcysts. The mean stiffness parameters E
mean, E
ratio, and mean vascular index (VI) were recorded following consecutive measurements. Besides, the microvascularity was graded based on Adler's classification (grades 0 to 3). Lesions were divided into 3 groups: benign, category B3, and malignant. One hundred twelve (57.4%) lesions were benign, 23 (11.8%) were B3, and 60 were (30.8%) in the malignant category. Thirty-eight (19.5%) lesions were observed only as an area, whereas associated features were present in 157 lesions (80.5%). Distortion was the only associated feature predicting malignancy among the grayscale findings (P < 0.001). There was a significant difference between malignant and nonmalignant (benign and B3) groups in terms of Adler's grade, E
mean, E
ratio, and VI values (P < 0.001). Sensitivity, specificity, and accuracy increased when advanced imaging parameters were added to grayscale findings (P < 0.001). In the presence of microcalcifications, architectural distortion, high elasticity, and hypervascularity in the “NON-MASS” imaging model, the suspicion of malignancy increases. The non-mass findings and advanced imaging techniques have the potential to find greater coverage in the following versions of BI-RADS atlas.
Community Privilege and Unplanned Surgery for Access-Sensitive Surgical Conditions
Authors: Munir Muhammad Musaab , Woldesenbet Selamawit , Pawlik Timothy M.
Published: August 2024

Objective:

We sought to define the association of privilege on rates of unplanned surgery and perioperative outcomes for access-sensitive surgical conditions.

Background:

Social determinants of health (SDOH) are critical in influencing timely access to healthcare. Privilege represents a right, benefit, advantage, or opportunity that positively influences all SDOH.

Methods:

The California Department of Health Care Access and Information (HCAI) database identified patients who underwent abdominal aortic aneurysm repair, ventral hernia repair, or colectomy for colon cancer between 2017 and 2020 and was merged using ZIP codes with the Index of Concentration of Extremes, a validated measure of racial and economic privilege obtained from the American Community Survey. Clustered multivariable regression was performed to assess the association between privilege and outcomes.

Results:

Among 185,316 patients who underwent a surgical procedure for one of three access-sensitive surgical conditions, roughly 1 in 5 individuals resided in areas with the highest (Q5; n=37,308; 20.1%) or lowest (Q1; n=36,352, 19.6%) privilege. Nearly one-half of the surgeries were unplanned (n=88,814, 46.9%), and colectomy for colon cancer was the most performed emergent procedure. Patients residing in the lowest privileged areas had higher rates of unplanned surgery compared with those residing in the highest privilege (Q1; 55.4% vs. 39.4%; referent: Q5; adjusted odds ratio [OR], 1.23, 95%CI 1.16-1.31; P<0.001). For each access-sensitive surgical condition, patients in the least privileged areas were more likely to experience higher rates of inpatient mortality (Q1; 3.1% vs. 2.1%; referent: Q5; adjusted OR, 1.41, 95%CI 1.24-1.60; P<0.001), perioperative complications (Q1; 30.4% vs. Q5; 23.8%; referent: Q5; adjusted OR, 1.24, 95%CI 1.18-1.31; P<0.001) and extended hospital stays (Q1; 26.3% vs. 20.1%; referent: Q5; adjusted OR, 1.16, 95%CI 1.09-1.22; P<0.001).

Conclusions and Relevance:

Privilege was associated with rates of unplanned surgery and adverse clinical outcomes. This indicates the role privilege as a key SDOH that influences patient access to and quality of surgical care.
Pelvic Floor Symptoms 4 Years After Elective Labor Induction: A Randomized Clinical Trial
Authors: Nicola-Ducey Lauren , Allshouse Amanda A. , Canfield Dana , Nygaard Ingrid E.
Published: August 2024

Importance

Pelvic floor disorders are common and burdensome. Data on the effect of induction of labor on pelvic floor disorders are sparse and results are mixed.

Objective

Our aim was to evaluate whether elective labor induction in nulliparous women increases the risks of symptomatic urinary incontinence (UI), anal incontinence (AI), or pelvic organ prolapse (POP) 4 years after delivery.

Study Design

In this single-site follow-up study of “A Randomized Trial of Induction Versus Expectant Management” (ARRIVE) that randomized low-risk nulliparous women with a singleton fetus to elective induction of labor versus expectant management, we compared pelvic floor symptoms between groups at a median of 4 years (interquartile range, 3.5–5.3) after first delivery using validated questionnaires.

Results

Seventy hundred sixty-six of 1,042 (74%) original participants responded, and 647 participants (62%) were included in the analysis after exclusions. The overall prevalence rates of symptomatic moderate to severe UI, AI, and POP were 21%, 14%, and 8%, respectively. There were no significant differences in any of the outcomes between women randomized to induction of labor and those to expectant management, either in unadjusted or adjusted analyses. There were also no differences in secondary outcomes, including subtypes of UI or flatal versus stool incontinence.

Conclusions

In this single-site study, we found no significant differences in any UI, AI, and POP symptoms between nulliparous women randomized to elective induction of labor and to expectant management; however, for the least frequent outcome (POP), meaningful differences cannot be ruled out.
At the Scrub Sink: Permanent Versus Absorbable Sutures for Sacrocolpopexy Vaginal Mesh Fixation
Authors: El-Nashar Sherif A.
Published: August 2024

Thirty years ago, open sacrocolpopexy was the main route for the procedure, and at that time, most surgeons used permanent sutures to attach the mesh to the vagina. With the changes to laparoscopic and robotic-assisted routes, some urogynecologists started using delayed absorbable sutures while others continued using permanent sutures. The current data suggest no increased failures with delayed absorbable sutures. Given that the risk of suture exposure is almost eliminated with delayed absorbable sutures, it is reasonable to use delayed absorbable sutures in attaching the mesh to the vagina over permanent sutures. Regardless of the suture selection, the 10% long-term mesh exposure rate after sacrocolpopexy should prompt us to continue discussing and working on solutions to lower the mesh exposure rate and improve prolapse surgery outcomes for our patients.
Exercise Preconditioning of the Donor Liver Decreases Cold Ischemia/Reperfusion Injury in a Mouse Model
Authors: Yazdani Hamza O. , Yang Ruiqi , Haykal Tony , Tohme Celine , Kaltenmeier Christof , Wang Ronghua , Nakano Ryosuke , Nigmet Yermek , Gambella Alessandro , Loughran Patricia , Hughes Christopher B. , Geller David A. , Tohme Samer
Published: August 2024

Background.

Liver transplantation stands as the primary treatment for end-stage liver disease, with demand surging in recent decades because of expanded indications. However, hepatic ischemia/reperfusion injury can lead to liver transplant failure in both deceased donor and living donor transplantation. This study explored whether preconditioning donor livers through exercise training (ExT) could mitigate cold ischemic injury posttransplantation.

Methods.

Donor C57BL/6 mice underwent ExT via treadmill running or remained sedentary. After 4 wk, the donor liver underwent cold storage and subsequent orthotopic liver transplantation or ex vivo warm reperfusion.

Results.

Donor liver from mice subjected to ExT showed significantly decreased hepatic injury on reperfusion. Tissue histology revealed decreased sinusoidal congestion, vacuolization, and hepatocellular necrosis in livers from ExT mice, and immunofluorescence staining further revealed a decreased number of apoptotic cells in ExT grafts. Livers from ExT donors expressed decreased intragraft inflammatory cytokines cascade, decreased neutrophil infiltration and neutrophil extracellular traps, and increased M2 phenotype of recipient macrophages compared with grafts from sedentary mice. After cold storage, liver grafts from ExT donors showed decreased accumulation of reactive oxygen species and decreased levels of cytochrome c and high mobility group box 1 released in the liver effluent. In addition, ExT grafts showed upregulated peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) and higher levels of mitochondrial content. Similar effects of decreased hepatic injury were observed in wild-type mice when pretreated with a PGC-1α stimulator ZLN005 instead of ExT.

Conclusions.

These findings suggest that augmenting hepatocytic mitochondrial content through donor exercise or PGC-1α stimulation may offer therapeutic avenues to mitigate postreperfusion inflammation and improve transplant outcomes.
The Influence of Personality Traits on Driving Behaviors in Preclinical Alzheimer Disease
Authors: Aschenbrenner Andrew J. , Carr David B. , Benzinger Tammie L.S. , Morris John C. , Babulal Ganesh M.
Published: August 2024

Introduction:

Alzheimer disease (AD) has a long preclinical phase in which AD pathology is accumulating without detectable clinical symptoms. It is critical to identify participants in this preclinical phase as early as possible since treatment plans may be more effective in this stage. Monitoring for changes in driving behavior, as measured with GPS sensors, has been explored as a low-burden, easy-to-administer method for detecting AD risk. However, driving is a complex, multifaceted process that is likely influenced by other factors, including personality traits, that may change in preclinical AD.

Methods:

We examine the moderating influence of neuroticism and conscientiousness on longitudinal changes in driving behavior in a sample of 203 clinically normal older adults who are at varying risk of developing AD.

Results:

Neuroticism moderated rates of change in the frequency of speeding as well as the number of trips taken at night. Conscientiousness moderated rates of change in typical driving space.

Conclusions:

Personality traits change in early AD and also influence driving behaviors. Studies that seek to utilize naturalistic driving behavior to establish AD risk need to accommodate interpersonal differences, of which personality traits are one of many possible factors. Future studies should explicitly establish how much benefit is provided by including personality traits in predictive models of AD progression.
Effect of Genetic Polymorphisms of ABCB1, ABCG2, and SLC22A1 on the Steady-State Plasma Concentrations of Lamotrigine in Treatment-Resistant Depressed Patients Treated With Lamotrigine Augmentation Therapy
Authors: Tomori Yoko , Suzuki Takeshi , Mihara Kazuo , Nagai Goyo , Kagawa Shoko , Nakamura Akifumi , Nemoto Kenji , Kondo Tsuyoshi
Published: August 2024

Objectives

The authors have demonstrated that a plasma lamotrigine concentration of 12.7 μmol/L may be a threshold for a good therapeutic response to lamotrigine augmentation therapy in treatment-resistant depressed patients. Lamotrigine is a substrate of P-glycoprotein, breast cancer resistant protein and organic cation transporter 1, which are encoded by ABCB1, ABCG2, and SLC22A1, respectively. There have been several polymorphisms that affect its function. The present study investigated the relationship between these polymorphisms and the steady-state plasma concentrations (Css) of lamotrigine in treatment-resistant depressed patients receiving lamotrigine as augmentation therapy.

Methods

One hundred twenty-nine treatment-resistant depressed patients were included in this study. Treatment resistance is defined as lack of therapeutic response to at least 3 psychotropics despite adequate doses and duration. Their diagnoses were as follows: major depressive disorder (n = 58), bipolar II disorder (n = 52), and bipolar I disorder (n = 19). Lamotrigine augmentation therapy for 8 weeks was conducted. The final lamotrigine doses were 75 mg/d for 39 patients with valproate and 100 mg/d for 90 without it. Blood was sampled at 8:00 am after the 8th week of treatment. Plasma lamotrigine levels were quantified by using LC/MS/MS. The polymorphisms of ABCB1 1236C>T, 2677G>T/A, 3435C>T, ABCG2 421C>A, and SLC22A1 1222G>A were detected by polymerase chain reaction analyses.

Results

No significant relationships were observed between these polymorphisms and the Css of lamotrigine in the patients with or without valproate.

Conclusions

The present study suggests that these genetic polymorphisms do not play a role in controlling the Css of lamotrigine in treatment-resistant depressed patients treated with lamotrigine augmentation therapy.
Weight-Related Hypertension in Youth: Evaluation of Family Nutrition and Physical Activity Tool
Authors: Bailey-Davis Lisa , McCabe Carolyn F , Zeng Chengpeng , Peyer Karissa L , Gidding Samuel S. , Cook Adam , Wood G. Craig , Franceschelli-Hosterman Jennifer , Ge Shuping , Welk Gregory J
Published: August 2024

Objectives and Background: This study explores the potential moderating influence of Family Nutrition and Physical Activity (FNPA) behavior scores on reducing hypertension incidence associated with overweight changes during childhood. Methods: A longitudinal design was used to explore associations between childrens FNPA scores and overweight status change (when ages 3-9 years) on hypertension during latter childhood and adolescence (ages 9-18 years). Data were obtained from well-child visits. Participants were classified into 3 by 3 subgroups by FNPA score (low, moderate, high) and overweight status (loss, stable, gain). Cox proportional hazards models were used to estimate hazard ratios of hypertension development with the moderate FNPA score X overweight stable reference group. Results: Among 3808 participants, 58% were publicly insured. Among participants who gained overweight during childhood, 41.7% developed hypertension compared to 29.9% who were overweight stable and 27.3% who lost overweight (P <0.001). After accounting for confounders, participants who gained vs. maintained overweight had 2.01 (95% CI 1.65-2.44) times higher hypertension risk. Although FNPA scores were not associated with hypertension incidence, the interaction term between a high FNPA and overweight gain was significant (P = 0.01). Among children who gained, hazard ratios for hypertension among low, moderate, and high FNPA groups were estimated at 1.99 (95% CI 0.98-4.05), 2.01 (95% CI 1.64-2.44), 1.54 (95% CI 0.71-3.34), respectively. Conclusions: FNPA screening can inform preventive counseling about healthy home environments. Behaviors associated with high FNPA scores potentially reduce hypertension risk among children who experience overweight gain by approximately 25%.
Spatiotemporally-resolved mapping of extracellular proteomes via in vivo-compatible TyroID
Authors: Zhang Zijuan , Wang Yankun , Lu Wenjie , Wang Xiaofei , Guo Hongyang , Pan Xuanzhen , Liu Zeyu , Wu Zhaofa , Qin Wei
Published: August 2024

Extracellular proteins play pivotal roles in both intracellular signaling and intercellular communications in health and disease. While recent advancements in proximity labeling (PL) methods, such as peroxidase- and photocatalyst-based approaches, have facilitated the resolution of extracellular proteomes, their in vivo compatibility remains limited. Here, we report TyroID, an in vivo-compatible PL method for unbiased mapping of extracellular proteins with high spatiotemporal resolution. TyroID employs plant- and bacteria-derived tyrosinases to produce reactive o-quinone intermediates, enabling the labeling of multiple residues on endogenous proteins with bioorthogonal handles, thereby allowing for their identification via chemical proteomics. We validate TyroID's specificity by mapping extracellular proteomes and HER2-neighboring proteins using nanobody-directed recombinant tyrosinases. Demonstrating its superiority over other PL methods, TyroID enables in vivo mapping of extracellular proteomes, including mapping HER2-proximal proteins in tumor xenografts, quantifying the turnover of plasma proteins and labeling hippocampal-specific proteomes in live mouse brains. TyroID emerges as a potent tool for investigating protein localization and molecular interactions within living organisms.
Prevalence and diversity of Helicobacter species in captive wild carnivores, and their implications for conservation management of endangered species
Authors: Uddin Wasim , Khan Gulafsha , Narayan Sneha , Sharma Neha , Holeyachi Basavaraj S , Hakeem Md. Abdul , Siva Archana Bharadwaj , Reddy Anuradha P
Published: August 2024

Helicobacter species colonize the gastrointestinal tract of various hosts, and have always been of interest due to their potential zoonotic transmission and impact on health of humans and animals. Comprehensive studies involving wild animals from different locations are lacking, hindering our understanding of their natural host range, prevalence, and genetic diversity. Here we investigated the prevalence and genetic diversity of Helicobacter species in thirteen wild carnivore species across twenty-two zoos and rescue centers in India by targeting partial 16S rRNA gene. We used sequences obtained from positive samples for phylogenetic analysis, and further evaluated factors influencing Helicobacter prevalence with generalised linear mixed models. We analysed 985 faecal samples of which 286 (29%) tested positive for Helicobacter, spanning all the host species included in this study. Helicobacter prevalence is strongly related to host species and location, and varied from 7.3% in common leopard to 80% in Indian fox. Phylogenetic analysis identified 59 unique genotypes clustered into 11 groups of three major Helicobacter types: enterohepatic, gastric, and unsheathed. Diverse Helicobacter species associated with diseases in humans and domestic animals were observed, such as H. canis, H. bilis, along with several novel strains/ species which require formal classification. Overall, this study highlights the wide occurrence and high genetic diversity of Helicobacter species in captive wild carnivores in India. Our findings underscore the need for regular health assessments in captive facilities to monitor Helicobacter infections, which could impact the health and management of endangered species. Future research should explore Helicobacter presence in biotic and abiotic factors in zoo and free-ranging populations following One Health approaches.
Prevalence and zoonotic risk of multidrug-resistant Escherichia coli in bovine subclinical mastitis milk: Insights into the virulence and antimicrobial resistance
Authors: Chowdhury Tonmoy , Roy Mithu Chandra , Hossain Ferdaus Mohd Altaf
Published: August 2024

The emergence of antibiotic-resistant microorganisms has made AMR a major issue on a global scale, and milk has the potential to be a possible source for the propagation of resistant bacteria causing zoonotic diseases. SCM cases, often overlooked and mixed with normal milk in dairy farms, frequently involve E. coli, which can spread through contaminated milk. We conducted this study to determine the prevalence of virulence genes, ARGs, antimicrobial susceptibility, and the genetic relatedness of MDR-STEC isolated from SCM milk. SCM-positive bovine milk was subjected to E. coli detection using cultural, biochemical, and molecular methods. Further, we detected STEC virulence genes including stx1, stx2, and eaeA. STEC isolates were tested for ARGs including blaSHV, CITM, tetA, and aac(3)-IV, and underwent AST. Moreover, we performed a phylogenetic analysis of the stx1 gene of MDR-STEC. SCM was detected in 47.2% of milk samples of which 50.54% were E. coli positive. About 17.20% of E. coli isolates contained STEC virulence genes, and stx2 was the most prevalent. Moreover, all STEC isolates harbored at least one of the ARGs, while about 43.75% of the isolates carried multiple ARGs. Additionally, all the STEC isolates showed multidrug resistance, and were found to be fully resistant against amoxicillin, followed by ampicillin (87.50%) and gentamycin (75%); and were mostly sensitive to aztreonam (81.25%) and meropenem (68.75%). We found that MDR-STEC isolated from SCM were closely related to disease-causing non-O157 and O157 strains of different sources including cattle, humans, and food. These findings indicate a significant zoonotic risk.
Viscous influences on impulsively generated focused jets
Authors: Cheng Xianggang , Chen Xiao-Peng , Ding Hang , Zhang Chun-Yu , Hu Haibao , Jia Laibing
Published: August 2024

Impulsively generated focused jets play a significant role in various applications, including inkjet printing, needle-free drug delivery, and microfluidic devices. As the demand for generating jets and droplets from medium to highly viscous liquids increases, understanding the role of viscosity in jetting dynamics becomes crucial. While previous studies have examined the viscous effects on walls, the impact on free surfaces has not been thoroughly understood. This study aims to bridge this gap by integrating experiments with numerical simulations to investigate the viscous effects on focused jet formation. We demonstrate that mass and momentum transfer along the tangential direction of the free surface contribute to focused jet formation, and viscosity plays a key role in this transfer process. The viscosity-induced diffusion of the shear flow and vorticity near the free surface reduces the jet speed. Based on experimental observations and simulation results, we propose an equation to predict the viscous jet velocity. These findings offer new perspectives on viscous interface dynamics in advanced manufacturing and biomedical applications.

Published by the American Physical Society
2024
Dynamics of productive confirmation framing in an introductory lab
Authors: Descamps Ian , Jeon Sophia , Holmes N. G. , Scherr Rachel E. , Hammer David
Published: August 2024

In introductory physics laboratory instruction, students often expect to confirm or demonstrate textbook physics concepts. This expectation is largely undesirable: labs that emphasize confirmation of textbook physics concepts are generally unsuccessful at teaching those concepts and even in contexts that do not emphasize confirmation, such expectations can lead to students disregarding or manipulating their data in order to obtain the expected result. In other words, when students expect their lab activities to confirm a known result, they may relinquish epistemic agency and violate disciplinary practices. We present a contrasting case where, we claim, confirmatory expectations can actually support productive disciplinary engagement. In this case study, we analyze the complex dynamics of students’ epistemological framing in a lab where students’ confirmatory expectations support and even generate epistemic agency and disciplinary practices, including developing original ideas, measures, and apparatuses to apply to the material world.

Published by the American Physical Society
2024
Loss resilience of driven-dissipative remote entanglement in chiral waveguide quantum electrodynamics
Authors: Irfan Abdullah , Yao Mingxing , Lingenfelter Andrew , Cao Xi , Clerk Aashish A. , Pfaff Wolfgang
Published: August 2024

Establishing limits of entanglement in open quantum systems is a problem of fundamental interest, with strong implications for applications in quantum information science. Here, we study the limits of entanglement stabilization between remote qubits. We theoretically investigate the loss resilience of driven-dissipative entanglement between remote qubits coupled to a chiral waveguide. We find that by coupling a pair of storage qubits to the two driven qubits, the steady state can be tailored such that the storage qubits show a degree of entanglement that is higher than what can be achieved with only two driven qubits coupled to the waveguide. By reducing the degree of entanglement of the driven qubits, we show that the entanglement between the storage qubits becomes more resilient to waveguide loss. Our analytical and numerical results offer insights into how waveguide loss limits the degree of entanglement in this driven-dissipative system, and they offer important guidance for remote entanglement stabilization in the laboratory, for example using superconducting circuits.

Published by the American Physical Society
2024
Does aural accounting improve the stakeholder relationship capability?
Authors: Nouri Ali , Safari Gerayli Mehdi , Givaki Ebrahim , Laalbar Ali
Published: August 2024

Purpose

The aim of this study is to examine the effect of aural accounting (AA) on companies’ stakeholder relationship capability in the Iranian capital market.

Design/methodology/approach

In terms of methodology, this study adopts a mixed approach based on both inductive and deductive foundations. The goal is to develop a comprehensive theoretical framework regarding the feasibility and practical implementation of AA and to assess its impact on the ability to interact with stakeholders. In this research, the components of AA were identified through a meta-synthesis process. Subsequently, data on these variables were collected using a researcher-made questionnaire. Additionally, a standard questionnaire was used to measure the stakeholders' interaction capability. The study used partial least squares structural equation modeling for hypothesis testing. A total of 412 participants, consisting of financial managers and heads of accounting departments of capital market companies, were involved in hypothesis testing.

Findings

The results of this study indicate that AA has a significant and positive impact on companies’ stakeholder relationship capabilities. In other words, AA establishes a bidirectional flow of information, enabling companies to demonstrate a more appropriate response to the changing needs of their stakeholders.

Originality/value

To the best of the authors’ knowledge, this study represents the first research to present a framework for AA and examine its impact on companies' interaction capabilities with stakeholders. Consequently, the findings not only contribute to the expansion of theoretical literature in accounting and financial reporting but also provide multiple practical implications for capital market policymakers and standard setters regarding the potential consequences of AA.