bluuebunny/crossref_metadata_2025 huggingface dataset:
Causal association between body mass index and autoimmune thyroiditis: evidence from Mendelian randomization
Authors: Huo Jinlong , Xu Yaxuan , Yu Jie , Guo Youming , Hu Xiaochi , Ou Dong , Qu Rui , Zhao Lijin
Published: November 2023

Background

Recent studies have reported associations between body mass index (BMI) and various autoimmune disorders. However, it is still uncertain whether there exists a direct cause-and-effect relationship between BMI and autoimmune thyroiditis (AIT). The aim of our study is to investigate the causal association between BMI and AIT.

Methods

We conducted a two-sample summary data Mendelian randomization (MR) analysis using genome-wide association studies (GWAS) summary statistics data related to BMI as exposure, and GWAS summary statistic data sets for AIT as the outcome. Robustly associated single-nucleotide polymorphisms (SNPs) for BMI were selected as instrumental variables (IVs). We used the inverse variance weighted (IVW) method as the primary method and performed other MR methods such as MR-Egger regression, weighted median, simple mode, and weighted mode analyses for further validation. The slope of MR-Egger regression was used to correct for pleiotropy and provide estimates of causality. The p-value for the intercept in MR-Egger was utilized to detect any directional pleiotropic effects. Heterogeneity and sensitivity analyses were performed to assess the robustness of our findings.

Results

Seventy-eight SNPs were selected from GWAS on BMI as the IVs. Our MR analysis using the IVW method showed a potential causal association between BMI and AIT (OR = 3.071, 95% CI 1.324–7.118). Findings from other MR methods are non-significant, although the direction of effect is consistent. There was no evidence that the result was affected by genetic pleiotropy (MR-Egger regression intercept = 0.01, SE = 0.00025, p = 0.719). Heterogeneity and sensitivity analyses revealed no significant heterogeneity among SNPs, and no single SNP drove the observed associations.

Conclusion

Our findings suggest a potential causal association between BMI and AIT, which may provide a basis for further investigation into the relationship between BMI and AIT. Further studies are required as only the IVW method shows significant results, and the case sample size is small.
The molecular landscape of neurological disorders: insights from single-cell RNA sequencing in neurology and neurosurgery
Authors: Awuah Wireko Andrew , Ahluwalia Arjun , Ghosh Shankaneel , Roy Sakshi , Tan Joecelyn Kirani , Adebusoye Favour Tope , Ferreira Tomas , Bharadwaj Hareesha Rishab , Shet Vallabh , Kundu Mrinmoy , Yee Amanda Leong Weng , Abdul-Rahman Toufik , Atallah Oday
Published: November 2023

Single-cell ribonucleic acid sequencing (scRNA-seq) has emerged as a transformative technology in neurological and neurosurgical research, revolutionising our comprehension of complex neurological disorders. In brain tumours, scRNA-seq has provided valuable insights into cancer heterogeneity, the tumour microenvironment, treatment resistance, and invasion patterns. It has also elucidated the brain tri-lineage cancer hierarchy and addressed limitations of current models. Neurodegenerative diseases such as Alzheimer’s disease, Parkinson’s disease, and amyotrophic lateral sclerosis have been molecularly subtyped, dysregulated pathways have been identified, and potential therapeutic targets have been revealed using scRNA-seq. In epilepsy, scRNA-seq has explored the cellular and molecular heterogeneity underlying the condition, uncovering unique glial subpopulations and dysregulation of the immune system. ScRNA-seq has characterised distinct cellular constituents and responses to spinal cord injury in spinal cord diseases, as well as provided molecular signatures of various cell types and identified interactions involved in vascular remodelling. Furthermore, scRNA-seq has shed light on the molecular complexities of cerebrovascular diseases, such as stroke, providing insights into specific genes, cell-specific expression patterns, and potential therapeutic interventions. This review highlights the potential of scRNA-seq in guiding precision medicine approaches, identifying clinical biomarkers, and facilitating therapeutic discovery. However, challenges related to data analysis, standardisation, sample acquisition, scalability, and cost-effectiveness need to be addressed. Despite these challenges, scRNA-seq has the potential to transform clinical practice in neurological and neurosurgical research by providing personalised insights and improving patient outcomes.
The clinical outcomes of xenografts in the treatment of burn patients: a systematic review and meta-analysis
Authors: Irilouzadian Rana , Khalaji Amirmohammad , Baghsheikhi Hediyeh , Sarmadian Roham , Hoveidamanesh Soodabeh , Ghadimi Tayyeb , Farokh Forghani Siamak
Published: November 2023

Background

Although autografts are not feasible in patients with extensive burn wounds, allografts and xenografts can be used for temporary coverage. In this systematic review and meta-analysis, we compared the outcomes of xenografts and the standard treatment of burn wounds.

Methods

International online databases were searched for English articles comparing xenografts with routine treatment in the burn patients. The random-effects model was used to estimate standardized mean differences (SMD) or odds ratios (OR) with a 95% confidence interval (CI).

Results

From a total of 7144 records, 14 studies were included in our review after screening by title and abstracts followed by full-texts. No significant difference in hospital stays was found between the mammalian xenografts and control groups (SMD [95% CI] = − 0.18 [− 0.54–0.18]). The mean number of dressing changes was significantly lower in both mammalian xenografts compared to the controls (SMD [95% CI] = − 1.01 [− 1.61–− 0.41]) and fish xenografts compared to controls (SMD [95% CI] = − 6.16 [− 7.65–− 4.66]). In the fish xenografts, re-epithelialization time was significantly lower compared to controls (SMD [95% CI] = − 1.18 [− 2.23–− 0.14]).

Conclusions

Xenografts showed a significantly lower number of dressing changes and fish xenografts showed significant benefit in re-epithelialization compared to routine treatment. The beneficial results of xenografts suggest further research in the use of different types of xenografts in patients with extensive burn.
The hospital Israelita Albert Einstein standards for constitutional sequence variants classification: version 2023
Authors: Quaio Caio Robledo D’Angioli Costa , Ceroni José Ricardo Magliocco , Pereira Michele Araújo , Teixeira Anne Caroline Barbosa , Yamada Renata Yoshiko , Cintra Vivian Pedigone , Perrone Eduardo , De França Marina , Chen Kelin , Minillo Renata Moldenhauer , Biondo Cheysa Arielly , de Mello Mariana Rezende Bandeira , Moura Lais Rodrigues , do Nascimento Amanda Thamires Batista , de Oliveira Pelegrino Karla , de Lima Larissa Barbosa , do Amaral Virmond Luiza , Moreno Carolina Araujo , Prota Joana Rosa Marques , de Araujo Espolaor Jessica Grasiela , Silva Thiago Yoshinaga Tonholo , Moraes Gabriel Hideki Izuka , de Oliveira Gustavo Santos , Moura Livia Maria Silva , Caraciolo Marcel Pinheiro , Guedes Rafael Lucas Muniz , Gretschischkin Michel Chieregato , Chazanas Pedro Lui Nigro , Nakamura Carolina Naomi Izo , de Souza Reis Rodrigo , Toledo Carmen Melo , Lage Fernanda Stussi Duarte , de Almeida Giovanna Bloise , do Nascimento Júnior José Bandeira , Cardoso Milena Andreuzo , de Paula Azevedo Victor , de Almeida Tatiana Ferreira , Cervato Murilo Castro , de Oliveira Filho Joao Bosco
Published: November 2023

Background

Next-generation sequencing has had a significant impact on genetic disease diagnosis, but the interpretation of the vast amount of genomic data it generates can be challenging. To address this, the American College of Medical Genetics and Genomics and the Association for Molecular Pathology have established guidelines for standardized variant interpretation. In this manuscript, we present the updated Hospital Israelita Albert Einstein Standards for Constitutional Sequence Variants Classification, incorporating modifications from leading genetics societies and the ClinGen initiative.

Results

First, we standardized the scientific publications, documents, and other reliable sources for this document to ensure an evidence-based approach. Next, we defined the databases that would provide variant information for the classification process, established the terminology for molecular findings, set standards for disease-gene associations, and determined the nomenclature for classification criteria. Subsequently, we defined the general rules for variant classification and the Bayesian statistical reasoning principles to enhance this process. We also defined bioinformatics standards for automated classification. Our workgroup adhered to gene-specific rules and workflows curated by the ClinGen Variant Curation Expert Panels whenever available. Additionally, a distinct set of specifications for criteria modulation was created for cancer genes, recognizing their unique characteristics.

Conclusions

The development of an internal consensus and standards for constitutional sequence variant classification, specifically adapted to the Brazilian population, further contributes to the continuous refinement of variant classification practices. The aim of these efforts from the workgroup is to enhance the reliability and uniformity of variant classification.
Evaluating police drug diversion in England: protocol for a realist evaluation
Authors: Stevens Alex , Hendrie Nadine , Bacon Matthew , Parrott Steve , Monaghan Mark , Williams Emma , Lewer Dan , Moore Amber , Berlin Jenni , Cunliffe Jack , Quinton Paul
Published: November 2023

There is increasing international interest in the use of police drug diversion schemes that offer people suspected of minor drug-related offences an educative or therapeutic intervention as an alternative to criminalisation. While there have been randomised trials of some such schemes for their effects on reducing offending, with generally positive results, less is known about the health outcomes, and what works, for whom, in what circumstances and why. This protocol reports on a realist evaluation of police drug diversion in England that has been coproduced by a team of academic, policing, health, and service user partners. The overall study design combines a qualitative assessment of the implementation, contexts, mechanisms, moderators and outcomes of schemes in Durham, Thames Valley and the West Midlands with a quantitative, quasi-experimental analysis of administrative data on the effects of being exposed to the presence of police drug diversion on reoffending and health outcomes. These will be supplemented with analysis of the cost-consequences of the evaluated schemes, an analysis of the equity of their implementation and effects, and a realist synthesis of the various findings from these different methods.
The structural model of mother-infant bonding in the first pregnancy based on the mother’s attachment style and parenting style: the mediating role of mentalization and shame
Authors: Yazdanimehr Reza , Aflakseir Abdolaziz , Sarafraz Mehdireza , Taghavi Mohammadreza
Published: November 2023

Introduction

This study aimed to evaluate the relationship between the mother’s attachment style and parenting style and mother-infant bonding in the first pregnancy considering the mediating role of mentalization and shame.

Methods

This was a descriptive-correlational study. The sample population included the women who had gone through their first pregnancy and were referred to the health centers in Neyshabur, Iran in 2022. In total, 330 women were selected by convenience sampling. To collect data, we used a demographic questionnaire, the Attachment Style Questionnaire, the Parenting Style Questionnaire, the Mother-Infant Bonding Scale, the Reflective Functioning Questionnaire, and the Guilt and Shame Proneness Scale. Data analysis was conducted using descriptive indices, correlation coefficients, and pass analysis.

Results

Overall, the findings showed that the studied model adequately fits the data. Further, the obtained results confirmed the mediating role of mentalization and shame in the relationship between the mother’s attachment style and parenting style and mother-infant bonding. A significant correlation was also observed between attachment styles, parenting styles, and mother-infant bonding (p < 0.01).

Conclusion

Mother-infant bonding is correlated with the mother’s attachment style/parenting style, shame, and mentalization. Thus, we can help vulnerable mothers by improving the quality of psychological care before the first pregnancy or during pregnancy.
3D-printed wound dressing platform for protein administration based on alginate and zinc oxide tetrapods
Authors: Schadte Philipp , Rademacher Franziska , Andresen Gerrit , Hellfritzsch Marie , Qiu Haoyi , Maschkowitz Gregor , Gläser Regine , Heinemann Nina , Drücke Daniel , Fickenscher Helmut , Scherließ Regina , Harder Jürgen , Adelung Rainer , Siebert Leonard
Published: November 2023

Wound treatment requires a plethora of independent properties. Hydration, anti-bacterial properties, oxygenation and patient-specific drug delivery all contribute to the best possible wound healing. Three-dimensional (3D) printing has emerged as a set of techniques to realize individually adapted wound dressings with open porous structure from biomedically optimized materials. To include all the desired properties into the so-called bioinks is still challenging. In this work, a bioink system based on anti-bacterial zinc oxide tetrapods (t-ZnO) and biocompatible sodium alginate is presented. Additive manufacturing of these hydrogels with high t-ZnO content (up to 15 wt.%) could be realized. Additionally, protein adsorption on the t-ZnO particles was evaluated to test their suitability as carriers for active pharmaceutical ingredients (APIs). Open porous and closed cell printed wound dressings were tested for their cell and skin compatibility and anti-bacterial properties. In these categories, the open porous constructs exhibited protruding t-ZnO arms and proved to be anti-bacterial. Dermatological tests on ex vivo skin showed no negative influence of the alginate wound dressing on the skin, making this bioink an ideal carrier and evaluation platform for APIs in wound treatment and healing.
ChatGPT and its ethical implications for STEM research and higher education: a media discourse analysis
Authors: Nam Benjamin H. , Bai Qiong
Published: November 2023

Background

With the increasing demand brought on by the beginning of the fourth industrial revolution in the period of post-digital education and bio-digital technology, artificial intelligence (AI) has played a pivotal role in supporting human intelligence and contributing to intellectuals within science, technology, science, and mathematics (STEM) and in the broader field of higher education. Thus, this study examines how writers for mainstream STEM journals and higher education magazines perceive the impact of ChatGPT, a powerful AI chatbot, on STEM research and higher education. ChatGPT can generate realistic texts based on user prompts. However, this platform also poses ethical challenges for academic integrity, authorship, and publication.

Results

Using a comparative media discourse analysis approach, this study analyzes 72 articles from four media outlets: (a) Springer Nature; (b) The Chronicle of Higher Education; (c) Inside Higher Ed; and (d) Times Higher Education. The results show that the writers expressed various concerns and opinions about the potential conflicts and crises caused by ChatGPT in three areas: (a) academic research and publication; (b) teaching and learning; and (c) human resources management.

Conclusions

This study concludes with some policy implications and suggestions for future research on ChatGPT and AI ethics in academia by reilluminating the most overarching policy concerns related to ethical writing in STEM research and higher education and limitations to the blindness to authorship and academic integrity among diverse stakeholders.
Paleomagnetism and paleomagnetic dating to large volcanic bombs: an example from the historical eruption of Azuma–Jododaira volcano, NE Japan
Authors: Hasegawa Takeshi , Kikuchi Bunta , Shibata Shohei , Yamamoto Yuhji , Imura Takumi , Ban Masao , Tsunematsu Kae , Kusu Chie , Okada Makoto , Ohba Tsukasa
Published: November 2023

Vulcanian activity is one of the most common eruption styles of arc andesitic volcanism on Earth. It ejects and deposits volcanic bombs around the source crater. Although paleomagnetic studies of volcanic bombs are limited, such studies can potentially provide more opportunities for high-resolution paleomagnetic dating of volcanic activity. In this study, paleomagnetic dating was applied to large (> 1 m) volcanic bombs around active craters in the Azuma volcano group, NE Japan. Oriented samples were collected from the interior parts of five large volcanic bombs situated on gentle slopes, a few hundred meters from the source crater. More than six core samples were collected from each bomb and all samples were subjected to a range of rock magnetic experiments, including anisotropy of magnetic susceptibility (AMS) and thermal/alternating field demagnetization (THD/AFD) analyses. The Characteristic Remanent Magnetization (ChRM) directions for specimens from all bombs were well-defined, have small α95 (< 2.5º), and are in close agreement with each other. Comparing our measured overall mean direction (Dm = 355.5º, Im = 49.8º, α95 = 1.6º) with modeled geomagnetic field estimates and a reference secular variation curve for this area (using MATLAB-based archaeomagnetic dating tool), we suggest that the volcanic bombs were produced in the historical Meiji period (1893–1895 CE) eruption. In addition, a combination of the data of ChRM, AMS, thermomagnetic analyses, hysteresis measurement, and XRF analysis indicates that the volcanic bombs were derived from a plug of lava in the conduit under the solidification point (ca. 800 °C), but above the Curie point of the titanomagnetite remanence carrier (around 300 °C). We show that volcanic bombs can be powerful for paleomagnetic dating if certain sampling conditions, such as quantity, situation, size and portion are satisfied.

Graphical Abstract
Autologous micro‐fragmented adipose tissue injection provides significant and prolonged clinical improvement in patients with knee osteoarthritis: a case‐series study
Authors: Russo Arcangelo , Cortina Gabriele , Condello Vincenzo , Collarile Marco , Orlandi Roberto , Gianoli Riccardo , Giuliani Emanuele , Madonna Vincenzo
Published: November 2023

Purpose

Among the conservative strategies to manage patients with symptomatic knee osteoarthritis (OA), an innovative approach exploiting the regenerative capability of adipose tissue and its resident MSCs (Mesenchymal Stem Cells or Medicinal Signalling Cells) has been proposed with encouraging results. This study aims to demonstrate the benefits of autologous micro‐fragmented adipose tissue (MAT) injection in the conservative treatment of knee osteoarthritis and whether any variables may affect the outcome. This is a case series single‐centre study in which patients underwent intraarticular MAT injection without any associated procedures.

Methods

Based on inclusion and exclusion criteria, 49 patients (67 Knees) were included and retrospectively analysed with a mean follow‐up of 34.04 ± 13.62 months (minimum 11 – maximum 59). Patients were assessed through the WOMAC and KOOS questionnaires at baseline (pre‐treatment) and 1‐, 3‐, 6‐, 12‐, 24‐ and 36‐month follow‐up. A minimal clinically important difference (MCID) of at least 7.5 points for the WOMAC pain scale and 7.2 for the WOMAC function scale compared to the baseline value was used.

Results

WOMAC and KOOS scores improved after treatment compared to baseline at all follow‐ups with p < 0.001. Male gender and Kellgren‐Lawrence (KL) grade 2 were associated with smaller improvement in WOMAC and KOOS scores (with respect to females and to KL grade 1, respectively) up to 24 months. The percentage of patients who reach the MCID for WOMAC pain is generally lower than that of patients who reach the MCID for WOMAC function (around 80% at all time points), but it increases significantly over time. Moreover, the baseline score of the WOMAC pain and function influence the outcome. Patients with worse symptoms are more likely to reach the MCID.

Conclusions

Intra‐articular knee injection of MAT for the treatment of knee osteoarthritis (KOA), recalcitrant to traditional conservative treatments, proved to be effective in a high percentage of cases. The positive association between a worse pre‐operative score and a better clinical response to the treatment would support the idea that intra‐articular administration of MAT could be considered in patients with very symptomatic KOA in which joint‐replacement surgeries are not indicated (or accepted).

Level of Evidence

IV, case series.
Designing a synthetic microbial community through genome metabolic modeling to enhance plant–microbe interaction
Authors: Gonçalves Osiel S. , Creevey Christopher J. , Santana Mateus F.
Published: November 2023

Background

Manipulating the rhizosphere microbial community through beneficial microorganism inoculation has gained interest in improving crop productivity and stress resistance. Synthetic microbial communities, known as SynComs, mimic natural microbial compositions while reducing the number of components. However, achieving this goal requires a comprehensive understanding of natural microbial communities and carefully selecting compatible microorganisms with colonization traits, which still pose challenges. In this study, we employed multi-genome metabolic modeling of 270 previously described metagenome-assembled genomes from Campos rupestres to design a synthetic microbial community to improve the yield of important crop plants.

Results

We used a targeted approach to select a minimal community (MinCom) encompassing essential compounds for microbial metabolism and compounds relevant to plant interactions. This resulted in a reduction of the initial community size by approximately 4.5-fold. Notably, the MinCom retained crucial genes associated with essential plant growth-promoting traits, such as iron acquisition, exopolysaccharide production, potassium solubilization, nitrogen fixation, GABA production, and IAA-related tryptophan metabolism. Furthermore, our in-silico selection for the SymComs, based on a comprehensive understanding of microbe-microbe-plant interactions, yielded a set of six hub species that displayed notable taxonomic novelty, including members of the Eremiobacterota and Verrucomicrobiota phyla.

Conclusion

Overall, the study contributes to the growing body of research on synthetic microbial communities and their potential to enhance agricultural practices. The insights gained from our in-silico approach and the selection of hub species pave the way for further investigations into the development of tailored microbial communities that can optimize crop productivity and improve stress resilience in agricultural systems.
Randomized trial of shunt infection rates comparing intraoperative Vancomycin versus Gentamicin in ventriculoperitoneal shunt system preparation
Authors: Olomo Surajudeen A. , Obande Joseph O. , Bot Gyang M. , Binitie Peter O.
Published: November 2023

Background

Ventriculoperitoneal (VP) shunt is the mainstay of surgical management of patients with hydrocephalus. The insertion of ventriculoperitoneal shunt may be accompanied by many potentially life-threatening complications including shunt infection. Concerted efforts have been made to reduce shunt infection rates, including use of saline- antibiotic solutions containing antibiotics such as Gentamicin, mixture of Gentamicin and Vancomycin in shunt system preparation. We therefore set out to determine the infection rates following the use of intraoperative Gentamicin and Vancomycin in ventriculoperitoneal shunt system preparation and compare the infection rates. Therefore, a randomized single blind comparative study was carried out for a period of seventeen months, among 56 patients that presented to 2 tertiary health centers in Nigeria diagnosed of hydrocephalus. Patients were randomized into Vancomycin- and Gentamicin-shunt preparation groups. The outcome measure was postoperative shunt infection rates. Statistical analysis was performed using SPSS software (version) 21. Group comparisons were made using the Student's t-test for numerical variables, and chi-square test or fisher’s exact test for categorical variables. Statistical significance was inferred at p-value < 0.05.

Result

Fifty-six patients were included in the study. One patient was lost to follow-up in Vancomycin group. Another patient died in Gentamicin group of sudden death without the patient exhibiting symptoms of shunt infection leaving a total of 54 for analysis. All the patients included in the study were followed up for six months. Their mean ages were between 1688.5 ± 665.3 (days) for Vancomycin group and 10,222 ± 6635.8 (days) for Gentamicin group. There was male preponderance of 55.6% as against female of 44.4%. Majority of the hydrocephalus were of congenital cause accounting for 64.8%. There was one shunt infection in the Gentamicin group giving rise to an infection rate of 1.9% which was not statistically significant (P –value—0.313). The organism isolated was Pseudomonas species.

Conclusion

Ventriculoperitoneal shunt infection rates can be reduced to the barest minimum if standard concentration of antibiotics is used to prepare the shunt hardware employing a standard surgical technique.
The sucrose non-fermenting-1 kinase Snf1 is involved in fludioxonil resistance via interacting with the high osmolarity glycerol MAPK kinase Hog1 in Fusarium
Authors: Wang Jing , Wen Ziyue , Chen Yun , Ma Zhonghua
Published: November 2023

Fusarium head blight (FHB) caused by Fusarium graminearum complex is a worldwide devastating disease of wheat, barley, maize, and other cereals. In the field, application of fungicides is one of the main strategies for management of FHB. With the long-time usage of fungicides, resistant pathogen populations have become a new challenge for disease management. Application of new pesticide is necessary for sustainable control of this disease. The phenylpyrrole fungicide fludioxonil has been registered recently for management of FHB. However, the resistance mechanisms of F. graminearum to this compound are largely unknown. Here we isolated a biocontrol bacterium Burkholderia pyrrocina W1, which produced the antifungal compound pyrrolnitrin and showed greatly antagonistic activity towards FHB. Spontaneous mutants of pyrrolnitrin-resistant F. graminearum were induced and re-sequenced. Single base mutations were identified in the genes encoding the osmoregulation MAP kinase Hog1 and the AMP dependent kinase Snf1 in pyrrolnitrin-resistant mutants. Snf1 was further confirmed to interact with Hog1 and involved in the response of this fungus to pyrrolnitrin and its derivate, the fungicide fludioxonil. This study reveals that the Snf1 interacts with Hog1 to regulate fludioxonil resistance in a pathogenic fungus.
Adapting Connect for Health pediatric weight management program for telehealth in response to the COVID-19 pandemic
Authors: Simione Meg , Aschbrenner Kelly , Farrar-Muir Haley , Luo Man , Granadeno Jazmin , Caballero-Gonzalez Ariadne , Price Sarah N. , Torres Carlos , Boudreau Alexy Arauz , Fiechtner Lauren , Hambidge Simon J. , Sease Kerry , Taveras Elsie M.
Published: November 2023

Background

To address the evolving needs and context changes due to the COVID-19 pandemic, we adapted Connect for Health, an evidence-based, primary care, pediatric weight management intervention. The objective of this study is to describe the planned adaptation process to ensure continued and equitable program uptake during the pandemic.

Methods

Guided by adaptation frameworks, we identified the core functions and forms of Connect for Health and then adapted the intervention in response to a changing healthcare context. We engaged stakeholders and surveyed parents of children with a BMI ≥ 85th percentile and pediatric clinicians and examined their experiences using telehealth for pediatric weight management and needs and preferences. Using multivariable logistic regression, we examined the preferences of parents with limited English proficiency regarding key aspects of pediatric weight management.

Results

We surveyed 200 parents and 43% had a primary language of Spanish. Parents wanted care to be a combination of in-person and virtual visits (80%). We found that parents with limited English proficiency had a higher odds ratio of affirming in-person visits are better than virtual visits for ensuring their child’s health concern can be taken care of (OR: 2.91; 95% CI: 1.36, 6.21), feeling comfortable when discussing personal information (OR: 3.91; 95% CI: 1.82, 8.43), talking about healthy behaviors and setting goals (OR: 3.09; 95% CI: 1.39, 6.90), and talking about mental health and overall well-being (OR: 4.02; 95% CI: 1.83, 8.87) than parents without limited English proficiency. We surveyed 75 clinicians and 60% felt telehealth was a useful tool to provide care for pediatric weight management. Clinicians felt virtual visits did not pose barriers to all aspects of care. Informed by the surveys and stakeholder input, we made clinician- and family-level adaptations while retaining the program’s function.

Conclusions

By engaging stakeholders and adapting the program for telehealth, we optimized the reach and fit of Connect for Health to ensure its continued uptake. We have provided a real-world example of how clinical innovations can evolve and how to systematically plan adaptations in response to changing healthcare contexts.

Trial registration

Clinicaltrials.gov (NCT04042493), Registered on August 2, 2019.
The association between non-alcoholic fatty liver disease and chronic kidney disease in Egyptian patients
Authors: Kasem Heba El Sayed , Abdelatty Ehab Ahmed , Yahia Ahmed Mohamed Mokhtar , Abdalla Ezzat Mohamed
Published: November 2023

Background

NAFLD is a spectrum of disorders ranging from hepatic steatosis to nonalcoholic steatohepatitis (NASH), NASH related cirrhosis and hepatocellular carcinoma (HCC). There is sparse data on the prevalence CKD in Egyptian patients with NAFLD. The aim of this study is to estimate the prevalence of CKD in the subjects with NAFLD and to assess the risk factors of CKD among them.

Methods

A cross-sectional study was conducted on 430 patients from the Internal Medicine Department, Menoufia University Hospitals, including 215 patients with NAFLD, and 215 patients without NAFLD. NAFLD was diagnosed by abdominal ultrasonography. The liver fibrosis was assessed by NAFLD fibrosis score (NFS) and fibrosis-4 index (FIB-4). CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2 and/or abnormal albuminuria (urinary albumin-to-creatinine ratio ⩾ 30 mg/gm). The logistic regression analysis was performed to examine the association between NAFLD and risk of CKD.

Results

The prevalence of CKD was higher in individuals with NAFLD than in those without NAFLD (38.1% vs 7.4%, p < 0.001). Logistic regression analysis demonstrated that both NAFLD and CKD were risk factors of each other. The presence of hypertension, high levels of BMI and waist circumference were the other independent risk factors of NAFLD. While the presence of DM, and the high level of BMI were the other significant risk factors of CKD in the NAFLD group.

Conclusion

The presence and severity of NAFLD are associated with an increased risk of CKD.
COVID-19 Post- vaccination infection among hospital attendants in Qena city
Authors: Mohamed Reham Abdallah , Hany Ahmed Mohammed Mahmoud , Nafady Asmaa Abdelhakim
Published: November 2023

Background

The duration of immunological persistence in COVID-19-vaccinated individuals is considered a matter of concern. Some studies have shown that anti-SARS-CoV-2 antibodies degrade rapidly. Due to diminishing immunity after vaccination, some people may catch an infection again after receiving the COVID-19 vaccine.

Objectives

The purpose of the present study was to measure the COVID-19 post-vaccination infection reported by the vaccinated participants and to identify possible associated risk factors among hospital attendants in Qena city.

Material and method

A cross-sectional study was carried out on 285 participants who received COVID-19 vaccines and were aged 18 years or more. A structured questionnaire was used as a tool for data collection.

Results

13.7% of the vaccinated participants reported catching the COVID-19 infection after vaccination. Healthcare workers were more susceptible to the COVID-19 infection after vaccination than non-healthcare workers. Post-vaccination infection among participants who received Viral vector vaccines, Inactivated vaccines, and mRNA vaccines were 16.7%, 15.7%, and 3.6%, respectively.

Conclusion

Healthcare professionals need to take strict preventive measures since, even after receiving the COVID-19 vaccine, they are more vulnerable to infection than non-healthcare personnel. mRNA vaccines can be given in place of viral vector vaccinations because they show a reduced incidence of post-vaccination infection.
Which ultrasound-guided parasternal intercostal nerve block for post-sternotomy pain? Results from a prospective observational study
Authors: Toscano Antonio , Capuano Paolo , Perrucci Chiara , Giunta Matteo , Orsello Alberto , Pierani Tommaso , Costamagna Andrea , Tedesco Mario , Arcadipane Antonio , Sepolvere Giuseppe , Buono Gabriella , Brazzi Luca
Published: November 2023

Background

Parasternal intercostal blocks (PSB) have been proposed for postoperative analgesia in patients undergoing median sternotomy. PSB can be achieved using two different approaches, the superficial parasternal intercostal plane block (SPIP) and deep parasternal intercostal plane block (DPIP) respectively.

Methods

We designed the present prospective, observational cohort study to compare the analgesic efficacy of the two approaches. Cardiac surgical patients who underwent full sternotomy from January to September 2022 were enrolled and divided into three groups, according to pain control strategy: morphine, SPIP, and DPIP group. Primary outcomes were was postoperative pain evaluated as absolute value of NRS at 12 h. Secondary outcomes were the NRS at 24 and 48 h, the need for salvage analgesia (both opioids and NSAIDs), incidence of postoperative nausea and vomiting, time to extubation, mechanical ventilation duration, and bowel disfunction.

Results

Ninety-six were enrolled. There was no significant difference in terms of median Numeric Pain Rating Scale at 24 h and at 48 h between the study groups. Total postoperative morphine consumption was 1.00 (0.00–3.00), 2.00 (0.00–5.50), and 15.60 mg (9.60–30.00) in the SPIP, DPIP, and morphine group, respectively (SPIP and DPIP vs morphine: p < 0.001). Metoclopramide consumption was lower in SPIP and DPIP group compared with morphine group (p = 0.01). There was no difference in terms of duration of mechanical ventilation and of bowel activity between the study groups. Two pneumothorax occurred in the DPIP group.

Conclusions

Both SPIP and DPIP seem able to guarantee an effective pain management in the postoperative phase of cardiac surgeries via full median sternotomy while ensuring a reduced consumption of opioids and antiemetic drugs.
Resection of a rapidly growing chest wall cyst: a case report
Authors: Kato Shumpei , Sakai Takashi , Kusano Megumi , Koezuka Satoshi , Otsuka Hajime , Azuma Yoko , Kurose Yasuko , Tochigi Naobumi , Iyoda Akira
Published: November 2023

Background

When cystic lesions are detected in the chest wall, postoperative seroma and abscesses can be considered in the differential diagnoses. Herein, we present a case of a large chest wall cyst with rapid growth 5 years after thoracic surgery.

Case presentation

A male patient in his 60s was admitted to our hospital complaining of a rapidly enlarging chest wall swelling. He underwent a pleural biopsy for pleural thickening and was diagnosed with pleurisy 5 years ago. Computed tomography revealed a cystic lesion with a capsule measuring 14 cm × 10 cm, and contrast-enhanced magnetic resonance imaging revealed a heterogeneous enhancement effect inside the lesion. Surgical resection was performed for definitive diagnosis and therapeutic purposes. Intraoperatively, a cystic lesion with a thick capsule located outside the thorax was seen. The lesion was resected completely with no remaining adherence to the surrounding tissues and muscles. Histopathological examination revealed that the cyst wall was a non-epithelial fibrous connective tissue with inflammatory cell infiltration, and the contents were viscous liquid and fibrin, suggestive of a chest wall cyst. The cyst wall had abundant CD34-positive vascular endothelium, suggestive of rapid enlargement due to the influx of exudate associated with angiogenesis. No recurrence was observed 1 year postoperatively.

Conclusions

In addition to bacteriology, pathological examination, including immunohistological examination, is useful for the differential diagnosis of chest wall cystic lesions.
Telemonitoring: ethical lessons from the COVID-19 pandemic
Authors: Bolt Ineke , Specker Jona , Schermer Maartje
Published: November 2023

Background

The COVID-19 pandemic accelerated the development and application of telemonitoring, enabling health care providers to continue to provide medical care. Telemonitoring oftentimes replaced face-to-face health care services instead of as being offered as a supplement to regular medical care. Given that pressure on hospitals is expected to remain, telemonitoring is seen as an important means of alleviating those pressures. In this paper, we consider the intensified deployment of telemonitoring during the pandemic as an excellent opportunity to learn how telemonitoring can be implemented in a morally responsible way.

Results

In order to gain concrete, contextual and in-depth knowledge of the ethical issues raised by telemonitoring during the corona pandemic, we explore telemonitoring for two conditions: COVID-19 and Idiopathic pulmonary fibrosis. We conducted interviews with patients and professionals on five important ethical themes: 1. a shift in responsibilities, 2. empowerment and self-management, 3. the value of face-to-face consultations, 4. inclusivity and equal access, and 5. privacy and big data. Based on the findings of this empirical study and medical ethical principles, we formulate lessons for responsible implementation and upscaling: 1. ensure explicit and realistic allocation of responsibilities and avoid expectations that monitoring is more direct and continuous than it actually is; 2. create opportunities for an optimal form of self-management—in particular for patients with chronic conditions—and for meaningful conversations; 3. integrate telemonitoring within an established HCP – patient trust relation and stimulate research on the conditions for face-to-face consultations; 4. take vulnerability into account in inclusion & exclusion criteria and involve patients in design and implementation processes; 5. concerns of collection of data are beyond privacy and identify the risks of dependency on commercial companies.

Conclusions

Our findings show that offering patients choices for telemonitoring will not necessarily result in increased and equal accessibility, good quality of care and patient autonomy. Whether or not these aims and promises will be fulfilled, and the ethical challenges adequately met, is highly dependent on choices regarding the design of specific monitoring systems, the development process and the embeddedness in a trusting physician–patient relationship.
Charting Professional Waters: Diary of a Young Psycho-Oncologist
Authors: Mathew Bincy
Published: November 2023

A young psycho-oncologist faces a moral dilemma, testing professional ethics against personal morals.
Amplification of Wild-Type RET Represents a Novel Molecular Subtype of Several Cancer Types With Clinical Response to Selpercatinib
Authors: Gandhi Malini M. , Ricciuti Biagio , Harada Guilherme , Repetto Matteo , Gildenberg Melissa S. , Singh Ankit , Li Yvonne Y. , Gagné Andréanne , Wang Xinan , Aizer Ayal , Fitzgerald Kelly , Nishino Mizuki , Alessi Joao , Pecci Federica , Di Federico Alessandro , Fisch Adam , Drilon Alexander , Nardi Valentina , Sholl Lynette , Awad Mark M. , Rotow Julia
Published: November 2023

PURPOSE

RET rearrangements and RET activating point mutations represent targetable genomic alterations in advanced solid tumors. However, the frequency and clinicopathologic characteristics of wild-type RET amplification in cancer and its potential role as a targetable oncogenic driver are not well-characterized.

METHODS

In two institutional cohorts of patients with solid cancers from the Dana-Farber Cancer Institute (DFCI) and Memorial Sloan Kettering Cancer Center (MSKCC) whose tumors underwent next-generation sequencing (NGS), the frequency and clinicopathologic features of wild-type RET amplification in the absence of RET rearrangements or activating mutations was assessed. The findings were validated using merged data from The Cancer Genome Atlas (TCGA), Genomics Evidence Neoplasia Information Exchange (GENIE), and China Pan-Cancer data sets.

RESULTS

The frequency of wild-type RET amplification across all solid cancers was 0.08% (26 of 32,505) in the DFCI cohort, 0.05% (26 of 53,152) in the MSKCC cohort, and 0.25% (71 of 28,623) in the cohort from TCGA, GENIE, and China Pan-Cancer. Cancer types with RET amplification included non–small-cell lung cancer (NSCLC), hepatobiliary cancer, prostate cancer, breast cancer, and others. The median RET copy number in RET-amplified cases was 7.5 (range, 6-36) in the DFCI cohort and 5.7 (range, 4-27.7) in the MSKCC cohort. Among 11 RET-amplified NSCLCs, eight had no other concurrent driver mutations. Finally, we report on a 69-year-old man with recurrent NSCLC harboring high-level wild-type RET amplification (22-28 copies) as the only identified putative genomic driver who experienced both a systemic and intracranial confirmed response to the RET inhibitor selpercatinib.

CONCLUSION

Amplification of wild-type RET represents a novel, targetable molecular subset of cancer.
Pituitary Crooke Cell Adenoma: Two Cases of an Aggressive Pituitary Adenoma
Authors: Taiwo Adeyinka , Kamalumpundi Vijayvardhan , Becker Nicole , Correia Marcelo
Published: November 2023

Crooke cell adenoma (CCA) is a rare and aggressive subtype of a corticotroph adenoma, which requires lifetime surveillance. There have been 106 cases of CCAs reported in the English literature. We describe 2 cases of CCA, a 48-year-old man and an 84-year-old woman who both presented with binocular diplopia and temple pain. Neither case had clinical Cushing syndrome. Laboratory values for the 48-year-old man revealed, adrenocorticotropin (ACTH) 103 pg/mL (22 pmol/L) (RR: 7-63 pg/mL) and evening cortisol 14 µg/dL (386 nmol/L) (RR: 2.7-10.5 µg/dL). Computed tomography imaging demonstrated a mass adjacent to the right cavernous sinus extending into the sphenoid sinus. He underwent tumor resection with adjuvant radiation and has had a stable residual tumor for 4 years. Preoperative laboratory values for the 84-year-old woman revealed, ACTH 69 pg/mL (15 pmol/L) (RR: 7-63 pg/mL) and evening cortisol 16.2 µg/dL (447 nmol/L) (RR: 2.7-10.5 µg/dL). Brain magnetic resonance imaging revealed, a mass compressing the optic chiasm. She underwent resection and has had a stable residual tumor for 2 years. Surgical pathology in both cases revealed cytoplasmic hyaline deposits of more than 50% of the tumor cells, consistent with CCA. The CCA although rare, should be considered when evaluating cases with subclinical Cushing disease and visual symptoms.
Cushing Syndrome due to Adrenocortical Carcinoma During Pregnancy
Authors: Morris Jack Andrew , Campbell Peter , Xu Lily , O’Sullivan Anthony John
Published: November 2023

Cushing syndrome resulting from adrenocortical carcinoma in pregnancy is exceedingly rare. There are no validated guidelines to establish a diagnosis or guide management in pregnancy. We provide a case of a 31-year-old woman presenting for management of diabetes in pregnancy who appeared cushingoid. She was subsequently diagnosed with ACTH-independent Cushing syndrome and experienced preterm labor at 33 weeks’ gestation, delivering a healthy infant. Four weeks postpartum, the patient underwent a left adrenalectomy and was subsequently diagnosed with adrenocortical carcinoma.
A Rare Case of Placental Abruption and Postpartum Compression Fractures in Pregnancy With Cushing Syndrome
Authors: Iioka Masahito , Hayakawa Tomoaki , Otsuki Michio , Shimomura Iichiro
Published: November 2023

Cushing syndrome (CS) is a disorder rarely found during pregnancy. Patients with CS usually receive treatment before pregnancy. In addition, hypercortisolism suppresses gonadotropins, leading to amenorrhea or irregular menstruation. Therefore, few reports have described cases of pregnancy with untreated CS. Here, we observed the changes in the cortisol level of a 38-year-old woman with adrenal CS before and throughout pregnancy and delivery. She also had primary aldosteronism, and we were able to follow her plasma aldosterone levels. Her symptoms of CS before pregnancy were submandibular acne and irregular menstruation, but after conception, “moon face” and fatigue appeared. Laboratory tests also revealed impaired glucose tolerance, hypokalemia, lymphocytopenia, and increased urinary free cortisol levels. After administration of metyrapone to ameliorate her general condition, laparoscopic adrenalectomy was performed in the nineteenth week of pregnancy. After the operation, the patient's symptoms improved, and the cortisol level was maintained with hydrocortisone supplementation. The patient's plasma aldosterone level and blood pressure did not deteriorate throughout the course. However, the delivery was complicated by placental abruption. One month after delivery, the mother presented with compression fractures. We review the literature and discuss the treatment and complications of pregnancy with CS.