bluuebunny/crossref_metadata_2025 huggingface dataset:
A bibliometric analysis of research foci and trends in cerebral ischemia-reperfusion injury involving autophagy during 2008 to 2022
Authors: Shi Zhuolu , Xu Tao , Hu Chao , Zan Rui , Zhang Yumei , Jia Gaozhi , Jin Liang
Published: December 2023

Background:

Cerebral ischemia-reperfusion injury (CIRI) is a complex pathophysiological process that typically occurs during the treatment of ischemia, with limited therapeutic options. Autophagy plays a vital role during the reperfusion phase and is a potential therapeutic target for preventing and treating cerebral ischemia-reperfusion injury.

Methods:

We conducted a comprehensive search of the Web of Science Core Collection for publications related to cerebral ischemia-reperfusion injury with autophagy, published between January 1, 2008, and January 1, 2023. We analyzed the selected publications using VOSviewer, CiteSpace, and other bibliometric tools.

Results:

Our search yielded 877 relevant publications. The field of autophagy in cerebral ischemia-reperfusion injury has grown rapidly since 2016. China has been the leading contributor to publications, followed by the USA and Iran. Chen Zhong and Qin Zhenghong have been influential in this field but have yet to reach all groups. In addition, there has been a shortage of collaboration among authors from different institutions. Our literature and keyword analysis identified Neurovascular protection (#11 Neuroprotective, #13 Neurovascular units, etc) and Inflammation (NLRP3 inflammasome) as popular research directions. Furthermore, the terms “Blood-Brain Barrier,” “Mitophagy,” and “Endoplasmic reticulum stress” have been frequently used and may be hot research topics in the future.

Conclusions:

The role of autophagy in cerebral ischemia-reperfusion injury remains unclear, and the specific mechanisms of drugs used to treat ischemia-reperfusion injury still need to be explored. This work outlines the changing trends in investigating cerebral ischemia-reperfusion injury involving autophagy and suggests future lines of inquiry.
Clinical efficacy evaluation and potential mechanism prediction on Guizhi-Shaoyao-Zhimu decoction in the treatment of gouty arthritis based on meta-analysis, network pharmacology analysis, and molecular docking
Authors: Qu Pengda , Wang Haiyang , Wang Wei , Hu Qian , Du Shiyu , Peng Zhaorong , Tang Xiaohu
Published: December 2023

Background:

Guizhi-Shaoyao-Zhimu decoction (GSZD) is a Chinese herb formula. Previous studies have reported that the clinical symptoms and laboratory indicators of gouty arthritis patients could be improved by GSZD. However, no previous study has evaluated and analyzed its efficacy, safety, underlying mechanisms, and the relationship between related ingredients of herbs and targets of gouty arthritis.

Methods:

Randomized controlled trials of GSZD for gouty arthritis were retrieved from various databases. Meta-analysis was performed by Stata 17 software. Galbraith plot was used to find studies with possible heterogeneity. Publication bias was assessed by Egger test and funnel plot. The related ingredients of herbs and the targets of herbs and gouty arthritis were obtained from several databases, such as TCMSP, HERB, and DrugBank. The protein-protein interaction network was conducted by the STRING platform. DAVID database was used to perform GO and KEGG analysis. Molecular docking and visualization of docking results were carried out by AutoDock and PyMOL software.

Results:

Twenty studies with 1633 patients were included. Meta-analysis indicated that GSZD could better improve the clinical efficiency and visual analogue scale score, and reduce the level of blood uric acid and inflammatory biomarkers (including C-reactive protein, erythrocyte sedimentation rate, interleukin 6, interleukin 8, and tumor necrosis factor-α) than conventional treatment. In addition, we retrieved 157 active compounds, 517 herb target genes, 3082 disease targets, and 295 intersection targets of herb and disease. The results of network pharmacology analysis showed that the core related ingredients included quercetin, kaempferol, sitosterol, luteolin, catechin, etc. The core intersection targets contained AKT1, TNF-α, TP53, IL6, etc. And the critical signaling pathways included IL-17, HIF-1, TNF, PI3K-Akt, etc. Among the 56 molecular docking results, only 8 results had binding energy values greater than −5.0 kcal/mol.

Conclusion:

GSZD could be a satisfactory complementary and alternative therapy for treating gouty arthritis. However, it should be verified by further studies. Future research on gouty arthritis could be conducted from the active components including beta-sitosterol and sitosterol, the targets including TNF-1, IL1B, and ESR1, and the signaling pathways including IL-17 and HIF-1.
Genomic profiling for non-small cell lung cancer: Clinical relevance in staging and prognosis
Authors: Bhattarai Abhinav , Shah Sangam , Abu Serhan Hashem , Sah Ranjit , Sah Sanjit
Published: December 2023

Lung cancer is one of the most common cancers prevalent and around 80% of all cases are non-small cell lung cancer (NSCLC). Due to high recurrence rates, the mortality of NSCLC is high. Conventional staging systems allowed risk classification of patients in order to simplify the patient selection for adjuvant chemotherapy. Gene expression analysis has been shown to possess advantage over conventional staging systems in NSCLC in terms of patients risk classification. This article reviews the evidences on the genomic profiling of NSCLC patients into high and low-risk groups based on the expression of genes involved in various proliferative pathways.
A case report: Acute fibrinous and organizing pneumonia
Authors: Liu Chao , Chen Wei , Deng Yongjun , Li Siqi , Liu Yulin , Liang Jianping
Published: December 2023

Rationale:

Acute fibrinous and organizing pneumonia (AFOP) is a rare acute or subacute interstitial lung disorder characterized by the deposition of fibrin within the alveoli and organizing pneumonia with a patchy distribution. The clinical features of AFOP are nonspecific, and it is often misdiagnosed as pneumonia, cancer, tuberculosis, or other lung disorders.

Patient concerns:

In this case report, a 58-year-old woman presented with chest tightness, shortness of breath, cough and sputum. A chest CT scan showed multiple patchy shadows in both lungs. She was initially diagnosed with community-acquired pneumonia. Her purified protein derivative skin test was positive, but sputum was negative for acid-fast bacilli.

Diagnoses:

AFOP was diagnosed by bronchoscopic lung biopsy and histopathology.

Interventions:

Following AFOP diagnosis, all anti-infective drugs were discontinued, and replaced by methylprednisolone and prednisone.

Outcomes:

After 1 week of treatment with methylprednisolone 40 mg daily, the patient chest CT and clinical symptoms improved. After 1 month, the patient symptoms had demonstrated dramatic improvement and CT scan revealed complete absorption of lesions in both lungs. After 5 months of follow-up, the patient symptoms completely disappeared.

Lessons:

Acute AFOP is an uncommon lung condition with poor prognosis; hence, early diagnosis and identification are particularly important. Definitive diagnosis requires histopathological findings. Currently, there is no unified treatment guideline for AFOP, and treatment must be tailored based on the etiology and severity of each individual patient disease. Subacute AFOP shows a good response to corticosteroid treatment.
Prostate tuberculosis mimicking prostate cancer: Case report and literature review
Authors: Li Yu , Dan Siyu , Yang Fang , He Xiuli , He Ling , Yue Wensheng
Published: December 2023

Rationale:

Prostate tuberculosis (PTB) has no specific symptoms, or insidious presentation in male reproductive system tuberculosis, and is difficult to detect in the early stage. When PTB develops to the late stage, it leads to disease progression and irreversible organ and tissue damage. At present, the imaging manifestations of prostate tuberculosis vary and are not well known to imaging physicians and urologists.

Diagnoses and Interventions:

This case was a PTB patient, whose main manifestation was elevated serum prostate-specific antigen and the diagnosis was confirmed by ultrasound-guided prostate biopsy. We analyzed the imaging performance of various imaging techniques, and summarized and explored the imaging characteristics reported in the previous literature, with the aim of improving the early detection rate and providing evidence-based practice for early regular antituberculosis treatment in PTB.

Outcomes:

The multiparametric transrectal ultrasound performance of PTB is characteristic, and can be used for the differential diagnosis of prostate cancer causing elevated prostate-specific antigen levels in aged men.
Prevalence, characteristics, and impact on health outcomes of frailty in elderly outpatients with diabetes: A cross-sectional study
Authors: Wang Qinqin , Wang Juan , Dai Guizhi
Published: December 2023

The aims of this study were to determine the prevalence of frailty and its relationship with health outcomes in elderly outpatients attending a Diabetes Specialist Clinic. This study was a cross-sectional study. A total of 168 elderly patients (aged 65 years and above) attending the Diabetes Specialist Clinic of a Three-A hospital of Sichuan province were recruited from January 2021 to February 2021, and follow-up was conducted 1 year after day of screening. Baseline characteristics of patients were collected and frail status were assessed at recruitment. The longitudinal outcomes included hospitalization, fall, mortality, emergency visit, and clinic visit. The presence of frailty was determined by the 5-item FRAIL scale, which ranges from 0 to 5 and are categorized as frail (3–5), prefrail (1–2), and robust (0). A phone questionnaire was carried out to obtain health outcomes. Logistic regression analyses was used to evaluate adverse health outcomes at 1 year follow-up. Of the 168 outpatients, 28.0% was robust, 49.4% was prefrail, and 22.6% was frail. Frailty (both prefrail and frail status) was more prevalent in those patients, which were 75 years old and above (57.0%; P < .001), insulin dependent (45.6%; P = .008), and those had diabetic complications (43.8%; P = .005), previous admission (68.6%; P = .016), and co-morbidities (36.4%; P = .001). In the following year after recruitment, 19.1% of robust patients were hospitalized, while the proportion was 45.8% for prefrail patients and 65.8% for frail patients. Prefrail (OR [odds ratio] = 2.35, 95% confidence interval (CI) 1.63–2.88; P = .028) and frail (OR = 4.63, 95% CI 2.52–5.81; P = .005) patients were more likely to be hospitalized. Frail (OR = 3.37, 95% CI 2.68–4.04; P < .001) patients were more inclined to fall while prefrail patients (OR = 1.03, 95% CI 0.82–1.56; P = .371) were not. Moreover, prefrail (OR = 3.37, 95% CI 2.31–5.72; P = .017) and frail (OR = 4.29, 95% CI 3.16–5.54; P = .006) patients were more likely to return to the clinic. There is a high incidence of frailty among elderly patients attending a Diabetes Specialist Clinic. Frailty is a predictor of hospitalization, fall, and clinic visits within 1 year.
Are congenital heart defects connected to more severe attention-deficit/hyperactivity disorder?: A systematic review and meta-analysis
Authors: Hasan Mohammed Tarek , Shaban Abdelgalil Mahmoud , Elbadawy Merihan A. , Mahmoud Elrosasy Amr , Elkhadragy Ali , El Garhy Mahmoud , Awad Ahmed K.
Published: December 2023

Background:

Congenital heart defects (CHDs) are the most common cause of birth defect-related infant morbidity and mortality, affecting 1% of 40,000 births per year in the United States. On the other side, the etiology of attention-deficit/hyperactivity disorder (ADHD) is multifactorial. Multiple studies have found that cardiac surgery patients have higher morbidity of having this disorder. Many studies have investigated the prevalence of ADHD in different subtypes of CHD, but few have focused on the severity of ADHD symptoms. Thus, we conducted this systematic review and meta-analysis to investigate the severity of ADHD symptoms in CHD patients.

Methods:

We searched PubMed, Embase, Scopus, and Web of Science were searched from inception to March 6, 2023 without any restrictions. We included observational studies published in English language that evaluated burden of symptom of ADHD in CHD patients. Moreover, the standardized mean difference (SMD) for continuous outcomes with 95% confidence interval (CI) was pooled. P-values <.05 are considered as significant, and we performed all statistical analyses using RevMan software Version 5.4.1.

Results:

Eight studies were included in our review with a total number of 120,158 patients. CHD was associated with a statistically significant increase in both ADHD index T score and ADHD Hyperactivity-Impulsivity Subscale (informant) with (SMD = 0.65, 95% CI [0.40, 0.90], P < .00001, I2 = 81%) and (SMD = 0.16, 95% CI [0.04, 0.28], P = .008, I2 = 0%). Regarding ADHD Inattention Subscale (informant), the pooled data showed that a significant increase of this score in the CHD group (SMD = 0.25, 95% CI [0.13, 0.37], P < .001, I
2 = 0%), and ADHD Combined Score (informant) showed a significant increase of this score in the CHD group (SMD = 0.23, 95% CI [0.11, 0.35], P = .0002, I2 = 0%).

Conclusion:

Our study revealed a strong association between CHD and not only ADHD, but also the severity of ADHD, making early diagnosis of ADHD in children with CHD a mandatory step in the clinical evaluation practice to improve these children on both clinical and psychological aspects.
Clinical analysis of prophylactic uterine artery embolization combined with double balloon catheter for second-trimester pregnancy termination in cases of complete placenta previa: A retrospective study
Authors: Li Hao , Cheng Wenxing , Wen Jiao , Peng Jing , Wu Shiyao , Zhao Yun , Xia Weina
Published: December 2023

Complete placenta previa often causes significant bleeding in a short period during second-trimester pregnancy termination. This can destabilize the mother’s circulation, threatening her life. Furthermore, the condition is complicated by an immature cervix, making it a challenging clinical problem. The aim of this study was to investigate the effect of prophylactic uterine artery embolization (UAE) combined with double balloon catheter (DBC) deal with those cases. A total of 7 patients who underwent pregnancy termination in the second-trimester in Maternal and Child Health Hospital of Hubei Province between March 1st, 2021 and August 31st, 2023 were retrospectively analyzed in this study. All patients were diagnosed with complete placenta previa status and placenta accreta spectrum, and were treated with prophylactic UAE combined with DBC, and/or dilation and evacuation. All the patients received mifepristone, and 5 of them underwent medical termination with ethacridine lactate. Following prophylactic UAE combined with DBC, 6 patients underwent dilation and evacuation, which was monitored by ultrasound. And one patient experienced natural delivery of their fetus and placenta. Only one patient (patient 3) developed an intrapartum fever after prolonged duration of 18 hours from ethacridine to UAE and 56 hours from UAE to DBC. The amount of intrapartum hemorrhage ranged from 20 mL to 300 mL. The combined therapy of prophylactic UAE and DBC is a preferred option for patients with complete placenta previa undergoing second-trimester pregnancy termination. The use of dilation and evacuation may depend on the cervical condition, bleeding, or infection.
Investigating the relationship between vitamin-D deficiency and glycemia status and lipid profile in nondiabetics and prediabetics in Saudi population
Authors: Atia Tarek , Abdelzaher Mohammad H. , Nassar Somaia A. , Gafar Hoda H. , Husseini Mohammed A. M. , Kaabi Abdulhadi M. Y. , Sakr Hader I.
Published: December 2023

Vitamin D deficiency increases the risk of developing diabetes, dyslipidemia, and other chronic diseases. We aimed to investigate the relationship between vitamin D deficiency, glycemic levels, and lipid profiles in individuals with prediabetes and nondiabetes. This observational cross-sectional study was conducted on 249 adults who were divided into 2 groups based on the American Diabetes Association classification: nondiabetics and prediabetics. The serum vitamin D levels, lipid profiles, fasting blood glucose levels, hemoglobin A1c levels, fasting insulin levels, and insulin resistance (IR) were evaluated. The prevalence of vitamin D deficiency in all participants was 30.9%, and mean vitamin D levels were significantly [P = .0004] lower in prediabetics, who were more common in females. Furthermore, prediabetics had significantly higher serum triglycerides [P = .0006], and significantly lower serum high-density lipoprotein levels [P = .0148] than those nondiabetics. Serum cholesterol and low-density lipoprotein levels did not differ significantly between the 2 groups. 31.4% of all participants were overweight and 40.2% were obese. Furthermore, there was a strong correlation between vitamin D levels and IR and body mass indices ≥ 25 in prediabetics [r = −0.92] [P < .001]. Finally, vitamin D levels had a significant inverse relationship with glycemic parameters and IR, particularly in obese participants, but there was no significant relationship with lipid profile. In conclusion, vitamin D deficiency is common in females, regardless of whether they are prediabetics, but is more prevalent in prediabetics. Vitamin D deficiency is associated with high triglycerides and low high-density lipoprotein levels, but there were no significant changes in total cholesterol or low-density lipoprotein levels. Furthermore, vitamin D levels were negatively correlated with both fasting blood glucose and hemoglobin A1c levels, and its deficiency was strongly associated with IR especially in obese patients despite there being no significant correlation with blood lipids.
Transcatheter aortic valve replacement in patients with chronic kidney disease: a multi-centre retrospective study
Authors: Al Jarallah Mohammed , Abdulsalam Salman , Rajan Rajesh , Dashti Raja , Zhanna Kobalava D. , Setiya Parul , Al-Saber Ahmad , Alajmi Mohammad , Brady Peter A. , Luisa Baca Georgiana , Al Balool Joud , Tse Gary
Published: December 2023

Background:

Chronic kidney disease (CKD) is a common comorbid condition in patients undergoing transcatheter aortic valve replacement (TAVR). Reported outcome studies on the association of baseline CKD and mortality is currently limited.

Objectives:

To determine the prevalence of chronic kidney disease in patients undergoing TAVR and analyse their overall procedural outcomes.

Methods:

This retrospective observational study was conducted at 43 publicly funded hospitals in Hong Kong. Severe aortic stenosis patients undergoing TAVR between the years 2010 and 2019 were enroled in the study. Two groups were identified according to the presence of baseline chronic kidney disease.

Results:

A total of 499 patients (228, 58.6% men) were enroled in the study. Baseline hypertension was more prevalent in patients with CKD (82.8%; P=0.003). As for primary end-points, mortality rates of CKD patients were significantly higher compared to non-CKD patients (10% vs. 4.1%; P=0.04%). Gout and hypertension were found to be significantly associated with CRF. Patients with gout were nearly six times more likely to have CRF than those without gout (odds ratio = 5.96, 95% CI = 3.12–11.29, P<0.001). Patients with hypertension had three times the likelihood of having CRF compared to those without hypertension (odds ratio=2.83, 95% CI=1.45–6.08, P=0.004).

Conclusion:

In patients with severe aortic stenosis undergoing TAVR, baseline CKD significantly contributes to mortality outcomes at long-term follow up.
Knowledge of Maternal Mortality Risk Among Women with Substance Use Disorders during Pregnancy and Postpartum
Authors: Renbarger Kalyn M. , Slater Greta , Phelps Barbara
Published: December 2023

Purpose:

The purpose of this study was to investigate knowledge of maternal mortality risk of women with substance use disorder in the perinatal period.

Study Design:

This study was conducted using a qualitative descriptive design.

Methods:

Participants were recruited from a residential substance use treatment center in a rural Midwestern city. We used semi-structured interviews during which participants described their understanding of maternal mortality risk and their related experiences. We analyzed the transcribed interviews using content analysis to yield themes and subthemes.

Results:

Sixteen women participated. Three main themes were identified: Women with substance use disorder lack understanding of maternal mortality; Women with substance use disorder experience barriers to perinatal care; and Women with substance use disorder have additional risk factors for maternal mortality.

Clinical Implications:

Nurses can use validated screening tools, offer brief interventions, and refer women to appropriate substance use disorder treatment and mental health resources. Nurses must educate women with substance use disorder about their risk for maternal mortality as well as the signs and symptoms of perinatal mood and anxiety disorders. Nurses should provide education about the access and use of naloxone. A non-judgmental and trauma-informed approach should be used during interactions with this population.
Short-Term Exposure to Air Pollution and the Incidence and Mortality of Stroke
Authors: Lin Wenjian , Pan Jie , Li Jiahe , Zhou Xiaoyu , Liu Xueyuan
Published: December 2023

Background:

The relationship between short-term exposure to various air pollutants [particulate matter <10 μm (PM10), particulate matter <2.5 μm (PM2.5), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide, and ozone (O3)] and the incidence and mortality of stroke remain unclear.

Review Summary:

We conducted a comprehensive search across databases, including PubMed, Web of Science, and others. A random-effects model was employed to estimate the odds ratios (OR) and their 95% CIs. Short-term exposure to PM10, PM2.5, NO2, SO2, and O3 was associated with increased stroke incidence [per 10 μg/m3 increase in PM2.5: OR = 1.005 (95% CI: 1.004-1.007), per 10 μg/m3 increase in PM10: OR = 1.006 (95% CI: 1.004-1.009), per 10 μg/m3 increase in SO2: OR = 1.034 (95% CI: 1.020-1.048), per 10 μg/m3 increase in NO2: OR = 1.029 (95% CI: 1.015-1.043), and O3 for per 10 μg/m3 increase: OR: 1.006 (95% CI: 1.004-1.007)]. In addition, short-term exposure to PM2.5, PM10, SO2, and NO2 was correlated with increased mortality from stroke [per 10 μg/m3 increase in PM2.5: OR = 1.010 (95% CI: 1.006-1.013), per 10 μg/m3 increase in PM10: OR = 1.004 (95% CI: 1.003-1.006), per 10 μg/m3 increase in SO2: OR = 1.013 (95% CI: 1.007-1.019) and per 10 μg/m3 increase in NO2: OR = 1.012 (95% CI: 1.008-1.015)].

Conclusion:

Reducing outdoor air pollutant levels may yield a favorable outcome in reducing the incidence and mortality associated with strokes.
#PathX: #PathTwitter’s Transformation and a Discussion on Different Social Media Platforms Used by Pathologists in 2024
Authors: Schukow Casey P. , Punjabi Lavisha S. , Abdul-Karim Fadi W.
Published: December 2023

#PathTwitter is a well-known virtual community that has historically been positive for pathologists, trainees, and medical students worldwide to communicate, collaborate, and connect for free. However, in 2023, the popular social media platform Twitter (parent company: X Corp.) transitioned to “X” and, with this, #PathTwitter evolved into #PathX. Although the overall user experience of X and Twitter has not changed significantly, this transition brought much anecdotal hesitancy from the online virtual pathology community early on. Thus, the purpose of this review is to discuss the background of Twitter’s importance in pathology, the implications of this transition to the online pathology community, current views from this community regarding Twitter versus X, and to provide an overview of pertinent changes in the platform, as well as of different popular social media platforms that may be used by pathologists in 2024.
Are Pediatric Trauma Transfers Justified?
Authors: Jones Vinci S. , Wirtenson Catherine , Penta Keri
Published: December 2023

Introduction

Definitions of pediatric overtriage and unnecessary transfers for injured children have been instituted from a viewpoint of referral centers and have doubtful value for effecting interventions at referring centers. This study provides a unique insight into the factors prompting transfers at a peripheral institution.

Methods

The trauma registry of a level 2 pediatric trauma center was accessed, and pediatric transfers out to 2 level 1 pediatric trauma centers were identified over a period of 4 years. The outcomes of these patients at the accepting institutions were charted for descriptive analysis.

Results

The study identified 46 patients transferred out with a transfer rate of 6.6% when compared with total admissions. The mean Injury Severity Score (ISS) was 6.5, and the mean length of stay (LOS) at the receiving institution was 2.8 days. The reason for transfer from a specialty standpoint revealed 21 neurosurgical, 12 burn, 6 orthopedic, 4 faciomaxillary, and 2 ophthalmology patients. Overall transfer rate was 6.6%. Pediatric overtriage when defined as LOS < 24 hours at the receiving institution was 46.7%. Fifty percent of pediatric overtriage was prompted by need for a pediatric neurosurgery consult with medicolegal concern being cited as reason for transfer. Secondary overtriage when defined as LOS < 24 hours, no pediatric intensive care admission, no surgical intervention, and ISS < 9 was found in 13 patients (30.9%). The proportion of patients with Medicaid insurance was not different for the admissions (43.5%) when compared with the transfers (42.7%).

Conclusions

Existing definitions of overtriage have limited value in effecting interventions to reduce unnecessary transfers. Identifying specific factors at referring institutions including providing local availability of pediatric surgical specialists will potentially help mitigate injury-related pediatric overtriage.
Diagnostic Accuracy of the World Health Organization Pediatric Emergency Triage, Assessment and Treatment Tool Plus Among Patients Seeking Care in Nairobi, Kenya
Authors: Chen Josephine , Aluisio Adam R. , Tang Oliver Y. , Nwakibu Uzoma A. , Hunold Katherine M. , Wangara Ali Akida , Kiruja Jason , Maingi Alice , Mutiso Vincent , Thompson Peyton , Wachira Benjamin , Dunlop Stephen J. , Martin Ian B.K. , Myers Justin G.
Published: December 2023

Introduction

The World Health Organization developed Emergency Triage Assessment and Treatment Plus (ETAT+) guidelines to facilitate pediatric care in resource-limited settings. ETAT+ triages patients as nonurgent, priority, or emergency cases, but there is limited research on the performance of ETAT+ regarding patient-oriented outcomes. This study assessed the diagnostic accuracy of ETAT+ in predicting the need for hospital admission in a pediatric emergency unit at Kenyatta National Hospital in Nairobi, Kenya.

Methods

This was a secondary analysis of a cross-sectional study of pediatric emergency unit patients enrolled over a 4-week period using fixed random sampling. Diagnostic accuracy of ETAT+ was evaluated using receiver operating curves (ROCs) and respective 95% confidence intervals (CIs) with associated sensitivity and specificity (reference category: nonurgent). The ROC analysis was performed for the overall population and stratified by age group.

Results

A total of 323 patients were studied. The most common reasons for presentation were upper respiratory tract disease (32.8%), gastrointestinal disease (15.5%), and lower respiratory tract disease (12.4%). Two hundred twelve participants were triaged as nonurgent (65.6%), 60 as priority (18.6%), and 51 as emergency (15.8%). In the overall study population, the area under the ROC curve was 0.97 (95% CI, 0.95–0.99). The ETAT+ sensitivity was 93.8% (95% CI, 87.0%–99.0%), and the specificity was 82.0% (95% CI, 77.0%–87.0%) for admission of priority group patients. The sensitivity and specificity for the emergency patients were 66.0% (95% CI, 55.0%–77.0%) and 98.0% (95% CI, 97.0%–100.0%), respectively.

Conclusions

ETAT+ demonstrated diagnostic accuracy for predicting patient need for hospital admission. This finding supports the utility of ETAT+ to inform emergency care practice. Further research on ETAT+ performance in larger populations and additional patient-oriented outcomes would enhance its generalizability and application in resource-limited settings.
68Ga-DOTATATE PET to Characterize Lesions in the Neuroaxis
Authors: Hartmann Katherine , Gillman Jennifer A. , Lazor Jillian W. , Ware Jeffrey B. , Weeks Joanna K. , Nasrallah Ilya M. , Farwell Michael D. , Pantel Austin R.
Published: December 2023

Aim

The differentiation of paragangliomas, schwannomas, meningiomas, and other neuroaxis tumors in the head and neck remains difficult when conventional MRI is inconclusive. This study assesses the utility of 68Ga-DOTATATE PET/CT as an adjunct to hone the diagnosis.

Patients and Methods

This retrospective study considered 70 neuroaxis lesions in 52 patients with 68Ga-DOTATATE PET/CT examinations; 22 lesions (31%) had pathologic confirmation. Lesions were grouped based on pathological diagnosis and best radiologic diagnosis when pathology was not available. Wilcoxon rank sum tests were used to test for differences in SUVmax among paragangliomas, schwannomas, and meningiomas. Receiver operator characteristic curves were constructed.

Results

Paragangliomas had a significantly greater 68Ga-DOTATATE uptake (median SUVmax, 62; interquartile range [IQR], 89) than nonparagangliomas. Schwannomas had near-zero 68Ga-DOTATATE uptake (median SUVmax, 2; IQR, 1). Intermediate 68Ga-DOTATATE uptake was seen for meningiomas (median SUVmax, 19; IQR, 6) and other neuroaxis lesions (median SUVmax, 7; IQR, 9). Receiver operator characteristic analysis demonstrated an area under the curve of 0.87 for paragangliomas versus all other lesions and 0.97 for schwannomas versus all other lesions.

Conclusions

Marked 68Ga-DOTATATE uptake (>50 SUVmax) favors a diagnosis of paraganglioma, although paragangliomas exhibit a wide variability of uptake. Low to moderate level 68Ga-DOTATATE uptake is nonspecific and may represent diverse pathophysiology including paraganglioma, meningioma, and other neuroaxis tumors but essentially excludes schwannomas, which exhibited virtually no uptake.
Intraoperative Radioguided Localization of an Occult Neuroendocrine Tumor of the Ileum
Authors: Manca Gianpiero , Nonne Giovanna , Volterrani Duccio
Published: December 2023

We report the intraoperative radioguided localization of an occult well-differentiated neuroendocrine tumor of the ileum in a patient with a known neuroendocrine lymphonodal metastasis in the mesentery. Preoperative imaging included CT, PET/CT with 68Ga-DOTATOC, and SPECT/CT with 99mTc-HYNICTOC. These scans revealed morphological and functional properties of the primary tumor localized in the ileum. The day after IV 99mTc-HYNICTOC injection, the patient underwent surgery, and the target lesion was intraoperatively detected by a collimated handheld γ-probe. Postoperative pathology examination confirmed the target lesion to be a neuroendocrine tumor of the ileum.
FDG PET/CT in Solitary Isolated Renal Metastasis From Squamous Cell Lung Cancer
Authors: Zhang Jun , Dong Aisheng , Wang Yang
Published: December 2023

We describe FDG PET/CT findings in a patient with a solitary isolated renal metastasis from squamous cell lung cancer. The renal metastasis appeared as a small focus of activity at the renal cortex on FDG PET/CT at initial staging of the lung tumor, misinterpreted as cortical tracer retention, and was significantly enlarged on the second FDG PET/CT performed 4 months after the first PET/CT. This case demonstrates the usefulness of FDG PET/CT in identifying unexpected extrathoracic metastasis from lung cancer. Focal FDG uptake in the renal cortical region in a cancer patient should be evaluated carefully to avoid misdiagnosis.
Electroconvulsive Therapy Versus Repetitive Transcranial Magnetic Stimulation in Patients With a Depressive Episode
Authors: Strandberg Pontus , Nordenskjöld Axel , Bodén Robert , Ekman Carl Johan , Lundberg Johan , Popiolek Katarzyna
Published: December 2023

Objectives

Electroconvulsive therapy (ECT) and repetitive transcranial magnetic stimulation (rTMS) are both effective in treating depression. Although rTMS induces fewer adverse effects, its effectiveness relative to ECT is not well established. The aim of this study was to investigate the treatment outcomes of ECT and rTMS in patients who have received both interventions.

Methods

This was a register-based observational crossover study in patients with depression who had undergone ECT and rTMS in Sweden between 2012 and 2021. Primary outcome was reduction in the Montgomery-Åsberg Depression Rating Scale—Self-report (MADRS-S) score. Secondary outcome was response defined as a 50% or greater decrease in the MADRS-S score. Subgroup analyses were performed to identify factors that predicted differential responses between rTMS and ECT. Continuous and categorical variables were analyzed using paired-samples t tests and McNemar tests, respectively.

Results

In total, 138 patients across 19 hospitals were included. The MADRS-S score after ECT and rTMS was reduced by 15.0 and 5.6 (P = 0.0001) points, respectively. Response rates to ECT and rTMS were 38% and 15% (P = 0.0001), respectively. Electroconvulsive therapy was superior across all subgroups classified according to age and severity of depression.

Conclusions

Our results suggest that ECT is more effective than rTMS in treating depression among patients who have received both interventions. Age and baseline depression severity did not predict who would similarly benefit from rTMS and ECT.
Rare isotope-containing diamond colour centres for fundamental symmetry tests
Authors: Morris Ian M. , Klink Kai , Singh Jaideep T. , Mendoza-Cortes Jose L. , Nicley Shannon S. , Becker Jonas N.
Published: December 2023

Detecting a non-zero electric dipole moment in a particle would unambiguously signify physics beyond the Standard Model. A potential pathway towards this is the detection of a nuclear Schiff moment, the magnitude of which is enhanced by the presence of nuclear octupole deformation. However, due to the low production rate of isotopes featuring such ‘pear-shaped’ nuclei, capturing, detecting and manipulating them efficiently is a crucial prerequisite. Incorporating them into synthetic diamond optical crystals can produce defects with defined, molecule-like structures and isolated electronic states within the diamond band gap, increasing capture efficiency, enabling repeated probing of even a single atom and producing narrow optical linewidths. In this study, we used density functional theory to investigate the formation, structure and electronic properties of crystal defects in diamond containing

 

229

Pa

, a rare isotope that is predicted to have an exceptionally strong nuclear octupole deformation. In addition, we identified and studied stable lanthanide-containing defects with similar electronic structures as non-radioactive proxies to aid in experimental methods. Our findings hold promise for the existence of such defects and can contribute to the development of a quantum information processing-inspired toolbox of techniques for studying rare isotopes.

This article is part of the Theo Murphy meeting issue ‘Diamond for quantum applications’.
SiV
0
centres in diamond: effect of isotopic substitution in carbon and silicon
Authors: Boldyrev Kirill N. , Sektarov Eduard S. , Bolshakov Andrey P. , Ralchenko Victor G. , Sedov Vadim S.
Published: December 2023

The neutrally charged silicon-vacancy defect (SiV
0
) is a colour centre in diamond with spin S = 1, a zero-phonon line (ZPL) at 946 nm and long spin coherence, which makes it a promising candidate for quantum network applications. For the proper performance of such colour centres, all of them must have identical optical characteristics. However, in practice, there are factors that influence each individual centre. One of these factors is non-uniform isotope composition for both carbon atoms in diamond lattice and silicon atoms of dopant. In this work, we studied the isotopic shifts of SiV
0
centres for CVD-grown epitaxial layers of isotopically enriched
12
C and
13
C diamonds, as well as for diamond with natural isotope composition but doped only with one isotope of Si (
28
Si,
29
Si and
30
Si). The detected shift was 1.60 meV for
12
C/
13
C couple and 0.33 meV for
28
Si/
29
Si and
29
Si/
30
Si couples, which are close to the previously obtained values of the isotopic shift for the negatively charged silicon vacancy (SiV
−
), which indicates a similar model of interaction with the environment for these two charge states of the SiV colour centres.

This article is part of the Theo Murphy meeting issue 'Diamond for quantum applications'.
Genomic investigation of the emergence of vanD vancomycin-resistant Enterococcus faecium
Authors: Baines Sarah L. , Guérillot Romain , Ballard Susan , Johnson Paul D. R. , Stinear Timothy P. , Roberts Sally , Howden Benjamin P.
Published: December 2023

Vancomycin-resistant

Enterococcus

(VRE) is an increasingly identified cause of human disease, with most infections resulting from the vanA and vanB genotypes; less is known about other clinically relevant genotypes. Here we report a genomic exploration of a vanD VRE faecium (VREfm), which arose de novo during a single infectious episode. The genomes of the vancomycin-susceptible

E. faecium

(VSEfm) recipient and resulting VREfm were subjected to long-read sequencing and closed, with whole-genome alignments, cross-mapping and orthologue clustering used to identify genomic variation. Three key differences were identified. (i) The VREfm chromosome gained a 142.6 kb integrative conjugative element (ICE) harbouring the vanD locus. (ii) The native ligase (ddl) was disrupted by an ISEfm1 insertion. (iii) A large 1.74 Mb chromosomal inversion of unknown consequence occurred. Alignment and phylogenetic-based comparisons of the VREfm with a global collection of vanD-harbouring genomes identified strong similarities in the 120–160 kb genomic region surrounding vanD, suggestive of a common mobile element and integration site, irrespective of the diverse taxonomic, geographical and host origins of the isolates. This isolate diversity revealed that this putative ICE (and its source) is globally disseminated and is capable of being acquired by different genera. Although the incidence of vanD VREfm is low, understanding its emergence and potential for spread is crucial for the ongoing efforts to reduce antimicrobial resistance.
Position Statement: Postmenopausal Osteoporosis Treatment Strategies in Korea
Authors: Park So Young , Kim Se Hwa , Lee Young-Kyun , Shin Jung-Ho , Ha Yong-Chan , Chung Ho Yeon
Published: December 2023

Classifying patients with osteoporosis according to fracture risk and establishing adequate treatment strategies is crucial to effectively treat osteoporosis. The Korean Society for Bone and Mineral Research has issued a position statement regarding appropriate treatment strategies for postmenopausal osteoporosis. According to previous fragility fracture history, bone mineral density (BMD) test results, fracture risk assessment tool, and several clinical risk factors, fracture risk groups are classified into low, moderate, high, and very-high-risk groups. In high-risk groups, bisphosphonates (BPs) and denosumab are recommended as first-line therapies. Sequential BP treatment after denosumab discontinuation is required to prevent the rebound phenomenon. In the very high-risk group, anabolic drugs (teriparatide or romosozumab) are recommended as a first-line therapy; sequential therapy with antiresorptive agents is required to maintain BMD gain and reduce fracture risk. Fracture risk was reassessed annually, and the treatment plan was determined based on the results, according to the osteoporosis treatment algorithm for fracture risk.
Development and validation of a digital twin for the analog scoliometer
Authors: Suresh Sinduja , Stubbs Annabelle , Amiri Amir , Izatt Maree T , Labrom Robert D , Askin Geoffrey N , Little J Paige
Published: December 2023

Scoliosis is a complex 3D spine deformity characterised by an abnormal lateral curvature of the spine and associated rotation of the spine and ribcage. The rotational aspect of scoliosis is most commonly quantified in the Adam’s forward flexed position using an analog scoliometer. The scoliometer has a known user error of 5-8°, which is largely dependent on examiner experience, location of curve, patient positioning and BMI. The device is also limited by the 30° scale and parallax errors. Additionally, the scoliometer loses accuracy when the patient’s torso cannot be positioned parallel to the ground . This study describes the development of the first digital twin for the analog scoliometer to enable fast, gravity-independent reliable and accurate digital measurements of the Angle of Torso Rotation (ATR) from patient-specific 3D virtual models.

A robust semi-automated algorithm of generative design which measures ATR from surface topography was developed. With an operating time of just a few seconds, it provides quick and reliable ATR measurements from simple parametric user inputs. 150 calibrated 3D virtual models of AIS patients treated at the Queensland Children’s Hospital Spine Clinic (QCHSC) obtained from our existing database of 3D surface scans (3DSS) and healthy non-scoliotic controls recruited for this study were used to validate the digital scoliometer tool.

The tool showed excellent reliability in both intra-user (0.99) and inter-user (0.98) conditions. The digital values had a high positive correlation (0.897) and agreement (92.7%) with the analog ATR measurements made clinically. The tool also showed high sensitivity (95.83%) and specificity (76.76%). The development and validation of this virtual digital tool is significant for telehealth implementation in paediatric spine deformity management and is expected to enhance the remote health management of scoliosis.
Negative feedback control of hunger circuits by the taste of food
Authors: Aitken Tara J. , Ly Truong , Shehata Sarah , Sivakumar Nilla , La Santa Medina Naymalis , Gray Lindsay A. , Dundar Naz , Barnes Chris , Knight Zachary A.
Published: December 2023

The rewarding taste of food is critical for motivating animals to eat, but whether taste has a parallel function in promoting meal termination is not well understood. Here we show that hunger-promoting AgRP neurons are rapidly inhibited during each bout of ingestion by a signal linked to the taste of food. Blocking these transient dips in activity via closed-loop optogenetic stimulation increases food intake by selectively delaying the onset of satiety. We show that upstream leptin receptor-expressing neurons in the dorsomedial hypothalamus (DMHLepR) are tuned to respond to sweet or fatty tastes and exhibit time-locked activation during feeding that is the mirror image of downstream AgRP cells. These findings reveal an unexpected role for taste in the negative feedback control of ingestion. They also reveal a mechanism by which AgRP neurons, which are the primary cells that drive hunger, are able to influence the moment-by-moment dynamics of food consumption.
Endothelial samplingin situenables genetic characterization of vein of Galen Malformation
Authors: Hale Andrew T. , Liu Shanrun , Huang Fengyuan , Song Yuwei , Crowley Michael R. , Crossman David K. , Caudill Caroline , Smith Anastasia A. , Chapman Lindsey , Feldman Michael J. , Saccomano Benjamin W. , Rocque Brandon G. , Rozzelle Curtis J. , Blount Jeffrey P. , Johnston James M. , Chong Zechen , Jones Jesse G.
Published: December 2023

Background and Objectives

Vein of Galen malformation (VOGM), the result of arteriovenous shunting between choroidal and/or subependymal arteries and the embryologic prosencephalic vein, is among the most severe cerebrovascular disorders of childhood. While endovascular treatment options have improved outcomes, morbidity and mortality remain high. We hypothesized thatin situanalysis of the VOGM lesion using endoluminal tissue sampling (ETS) is feasible and may identify somatic mutations and transcriptional aberrations. A mechanistic understanding of VOGM genetics, pathogenesis, and maintenance will guide future therapeutic efforts.

Methods

We utilized a Mendelian, trio-based study design, collecting germline DNA (cheek swab) from patients and their families for whole exome sequencing (WES).In situVOGM ‘endothelial’ cells (EC), defined as CD31+ and CD45-, were obtained from coils via ETS during routine endovascular treatment. Autologous peripheral femoral ECs were also collected from the access sheath. Single-cell RNA sequencing (scRNA-seq) of both VOGM and femoral ECs was performed to demonstrate feasibility to define the transcriptional architecture. Comparison was also made to a published normative cerebrovascular transcriptome atlas. A subset of VOGM ECs was reserved for future DNA sequencing to assess for somatic and second-hit mutations.

Results

Our cohort contains 6 patients who underwent 10 ETS procedures from arterial and/or venous access during routine VOGM treatment (aged 12 days to ∼6 years). No periprocedural complications attributable to ETS occurred. Six unique coil types were used. ETS captured 98 ± 88 (mean ± SD; range 17-256) experimental ‘endothelial’ cells (CD31+ and CD45-). There was no discernable correlation between cell yield and coil type or route of access. Single cell RNA sequencing demonstrated hierarchical clustering and unique cell populations within the VOGM EC compartment compared to autologous femoral controls when annotated using a publicly available cerebrovascular cell atlas.

Conclusion

We report the first successful utilization of ETS for VOGM. ETS appears safe and may supplement investigations aimed at development of a molecular-genetic taxonomic classification scheme for VOGM. Moreover, results may eventually inform the selection of personalized pharmacologic or genetic therapies for VOGM and cerebrovascular disorders more broadly.
Balanced Permeability Index: a multi-parameter index for improved in-vitro permeability
Authors: Weiss Dahlia R. , Baylon Javier L. , Evans Ethan D. , Paiva Anthony , Everlof Gerry , Cutrone Jingfang , Broccatelli Fabio
Published: December 2023

The optimization of passive permeability is a key objective for orally available small molecule drug candidates. For drugs targeting the central nervous system (CNS), minimizing P-gp mediated efflux is an additional important target for optimization. The physicochemical properties most strongly associated with high passive permeability and lower P-gp efflux are size, polarity and lipophilicity. In this study, a new metric called the Balanced Permeability Index (BPI) was developed that combines these three properties. The BPI was found to be more effective than any single property in classifying molecules based on their permeability and efflux across a diverse range of chemicals and assays. The BPI can also be used to guide optimization in non-traditional small molecule modalities, such as protein degraders, which often lie outside of traditional small molecule space. BPI is easy to understand, allowing researchers to make decisions about which properties to prioritize during the drug development process.