bluuebunny/crossref_metadata_2025 huggingface dataset:
P209 A TEAM-BASED APPROACH TO MANAGE BLOOD PRESSURE BETWEEN COMMUNITY PHARMACISTS AND PRIMARY HEALTH CARE PHYSICIANS BY MEANS OF VASCULAR AGE (RIESCO/TOGETHER)
Authors: Rodilla Enrique , Aichberger Monika , Ardelt Florian , Baixauli Vicente , Cinza Sergio , Fernández María Soledad , García Luis , Mayer Christopher , Pereira Telmo , Santschi Valérie , Weber Thomas
Published: September 2024

Background and Objective:

Estimating arterial stiffness in Community Farmacies (CPh) has been shown to improve hypertension (HTN) management in Portugal, Austria and Spain. TOGETHER aims to evaluate whether empowering hypertensive subjects by determining arterial stiffness in CPh increases HTN control, establishing paths of lasting cooperation between Primary Care (PC) doctors and CPh.

Methods:

TOGETHER is a cluster-randomized, prospective study in Portugal, Austria and Spain. All consecutive expected 1260 subjects entering CPh will be offered BP measurement and ambulatory BP monitoring (ABPM) for those with high values. CPh will be randomly grouped into a usual care arm (health education associated with HTN and communication of the results to PC). In the experimental care group, early vascular aging (EVA) will additionally be assessed estimating oscillometric pulse wave velocity. The therapeutic options of EVA will be explained to patients/PC. HTN will be treated by PC according to usual clinical practice. A second evaluation with ABPM will be performed after 6 months and HTN control will be compared between the arms. The degree of patient-doctor interaction will be determined through validated surveys.

Results

Five fundamental unmet needs will be addressed by TOGETHER: 1) lack of HTN screening programs; 2) Implementation of the simpler and more informative EVA concept (“Your arteries are 10 years older than you”); 3) understanding CV risk on an individual basis (individual EVA) should improve patient adherence and reduce physician inertia; 4) Implementation of health educational programs, combined with the concept of EVA; 5) Higher collaboration and development of a team-based approach to HTN care between CPh and PC.

Conclusions:

The complementary organizational settings and strengths of CPh and PC will allow TOGETHER to create new strategies for early identification and intervention in HTN, ranging from lifestyle to medical treatment, taking social, economic, and behavioral aspects into account.
P210 ASSOCIATION BETWEEN FOLLOW-UP BLOOD PRESSURE AND BLOOD PRESSURE CONTROL: A META-REGRESSION ANALYSIS
Authors: Salam Abdul , Dhurjati Rupasvi , Pant Rashmi , Rodgers Anthony , Satheesh Gautam , Rajaram Shwetha , Nandakumar Krishna
Published: September 2024

Background:

Blood pressure (BP) control is typically defined as BP values under certain thresholds, most commonly <140/90 mmHg – but there is widespread uncertainty about how mean BP is related to BP control, and what mean BP is required to achieve BP control in 80% of patients.

Objective:

To assess the association between follow-up mean systolic BP (SBP) and BP control from randomised clinical trials (RCTs).

Methods:

We systematically searched multiple databases for relevant RCTs. We included double-blind individual RCTs (iRCTs) of adults with hypertension, randomised to BP-lowering drugs from five major antihypertensive classes for ≥2 to ≤ 26 weeks, and which reported data for follow-up mean SBP and BP control (clinic BP <140/90 mmHg) at the last follow-up visit. We also included cluster RCTs (cRCTs), of adults with hypertension, randomised to any BP-lowering intervention, for any duration. The association between follow-up mean SBP and BP control at the last follow-up visit was assessed using a linear regression model. The coefficient was interpreted as the increase in percentage of patients with BP control for every 1 mmHg decrease in follow-up mean SBP.

Results:

Seventy iRCTs (45,836 participants) and 36 cRCTs (28,154 participants) were included. Each 1 mmHg decrease in follow-up mean SBP was associated with about 2% improvement in BP control in both iRCTs and cRCTs (R2= 78% and 76%, respectively). This finding was broadly consistent in the subgroups of BP-lowering drug classes, baseline SBP categories, and pre-trial BP-lowering treatment status in iRCTs, and country income and baseline SBP categories in cRCTs. Mean SBP levels of 125, 130, and 135 mmHg were associated with BP control rates of 78%, 67%, and 55%, respectively, in iRCTs and 80%, 68%, and 56% in cRCTs.

Conclusion:

Mean SBP levels of 125 mmHg are required for achieving BP control of <140/90 mmHg in about 80% of the patients. These findings should inform clinical care, guideline recommendations and hypertension control programs.
P221 ANKLE BRACHIAL INDEX AND ASSOCIATION WITH CHRONIC KIDNEY DISEASE IN THE H3 AFRICA KIDNEY DISEASE RESEARCH NETWORK
Authors: Olanrewaju Timothy Olusegun , Osafo Charlotte , Raji Yemi R , Mamven Manmak , Ajayi Samuel O , Arogundade Fatiu A , Ulasi Ifeoma I , Gbadegesin Rasheed , Parekh Rulan S , Tayo Bamidele , Adeyemo Adebowale A , Salako Babatund L , Ojo Akololu O , Adu Dwomoa
Published: September 2024

Background and Objective:

Abnormal ankle brachial index (ABI) is common in patients with chronic kidney disease (CKD). We evaluated the association of ABI, a non-invasive tool to evaluate peripheral arterial disease and arterial stiffness, with CKD among West Africans enrolled in the H3Africa Kidney Disease Research Network (H3AKDRN).

Methods:

We recruited 9206 participants (5356 with CKD), from Ghana and Nigeria in the H3AKDRN, a multinational case-control study. CKD was defined as estimated glomerular filtration rate of <60 ml/min/1.73m2 and/or albuminuria as albumin/creatinine ratio >3.0 mg/mmol (>30 mg/g) for ≥3months. ABI was divided into low (≤0.9), normal (0.91 – 1.3), and high (>1.3). We assessed low ABI, a marker of peripheral artery disease, and high ABI, the marker of arterial stiffness. We determined association of ABI with CKD by multivariate logistic regression.

Results:

The mean age of participants was 45.8±15.36 years and 56.3% were males. The prevalence of low ABI was higher in CKD group (32%% versus 16% (control), p=0.013). The prevalence of high ABI was also higher in CKD (15% versus 10.9% (control), p = 0.01). Patients with CKD and low ABI have reduced BMI, low haemoglobin, higher systolic BP and increased albuminuria. Male gender, history of hypertension and diabetes were independently associated with CKD. Higher BMI was associated with reduced odds of CKD (p = < 0.03). After adjustment for covariates, low ABI was associated with CKD, with 26% increased odd (aOR 1.26 (CI, 1.01 – 1.56; p = 0.037)), but high ABI was not associated with CKD (aOR 1.45 (0.88 – 2.38, p = 0.147)).

Conclusion:

The prevalence of abnormal ankle brachial index is high among adult populations of Ghana and Nigeria, with and without CKD. The Marker of peripheral arterial disease, but not marker of arterial stiffness was associated with CKD. A longitudinal study is required to determine the true relationship between ABI and CKD in West Africa.
P224 EFFECT OF SODIUM NITRITE ON RENAL DAMAGE FROM 2-KIDNEY, 1-CLIP (2K-1C) HYPERTENSION IN RATS
Authors: Ribeiro Jéssyca , Silva Alessandra , Almeida Carolina , Marques Fernanda , Victorino Thaís , Paula Fernanda , Tanus José Eduardo , Rizzi Elen , Torres Larissa , Ceron Carla
Published: September 2024

Renovascular hypertension is characterized by oxidative stress and decreased availability of nitric oxide (NO). Nitrite is a physiologically recycled metabolite that generates NO. Treatment with sodium nitrite has antihypertensive effects due to its antioxidant capacity. However, the renal effects of this treatment are not known in 2K1C hypertension. This study aims to evaluate the effect of treatment with sodium nitrite on kidney damage caused by 2K1C hypertension. Hypertension was induced by cleavage of the left renal artery in Wistar rats. Two weeks after surgery, the animals were treated with two doses (1 mg/kg/day or 15 mg/kg/day) of sodium nitrite or vehicle for 4 weeks, by gavage. Blood pressure (BP) was checked weekly by tail plethysmography. To assess renal function, plasma urea and creatinine were determined. Kidney oxidative stress was evaluated through the activity of catalase (CAT), superoxide dismutase (SOD), levels of reduced glutathione (GSH), lipid peroxidation, and superoxide (O2-) levels. Treatment with 15 mg/kg/day of sodium nitrite reversed the increase in BP in 2K1C rats (p<0.05, 2K1C:170.5±6.542; 2K1C+Nitrite15:162.4±6.712 mmHg), and improved renal function previously impaired by hypertension (urea, p<0.05; 2K1C:76.37±24.53; 2K1C+Nitrite15:47.82±13.86; creatinine, p<0.05; 2K1C:0.540±0.105; 2K1C+Nitrite15:0.3550±0.117). SOD activity decreased in the kidneys of hypertensive animals (p<0.05, Control:0.7176±0.06426; 2K1C:0.636±0.0888; 2K1C+Nitrite1:0.703±0.0866; 2K1C+Nitrite15:0.648±0.173). As for CAT and GSH, there was a decrease in activity in hypertensive animals, with improvement in the group treated with nitrite 15 mg/kg/day (CAT p<0.05, Control:0.651±0.255; 2K1C:0.2772±0.1837; 2K1C+Nitrite15: 0.6654±0.1440 and GSH: p<0.05, Control:44.80±10.59; 2K1C: 29,62±7,253 2K1C+Nitrite15:44.25±10.07). Lipid peroxidation increased by hypertension was reduced with treatment at the highest dosage (p<0.05, Control:0.314±0.158; 2K1C:0.497±0.113; 2K1C+Nitrite15:0.278±0.084). O2- levels were decreased in all groups treated with nitrite (p<0.05, 2K1C:3.844±1.598; 2K1C+Nitrite1:0.9643±0.2063; 2K1C+Nitrite15:0.4431±0.1838). Our results suggest that sodium nitrite treatment improves 2K1C renal damage through its antioxidant activity.

Acknowledgments: FAPEMIG# APQ-00946-23, CNPq# 302076/2022-0
P227 MACROPHAGE TO MYOFIBROBLAST TRANSITION IN THE DEVELOPMENT OF DIASTOLIC DYSFUNCTION
Authors: Mora Christoph , Deck Katherine , Liu Yunmeng , Guo Yunping , Rafferty Tonya , Benson Lance , Mu Shengyu
Published: September 2024

Diastolic dysfunction (DD) and heart failure (HF) ravage a significant portion of the world's population. These end-stage diseases are most often precluded by hypertension (HTN). Cardiac fibrosis is one of the major factors in the degradation of cardiac function. There are multiple cellular players involved in fibrosis—including, macrophages. Indeed, in the past decade these cells have been shown to differentiate into professional fibrotic cells, myofibroblasts, a process termed macrophage to myofibroblast transition (MMT), in models of kidney injury. Despite this, the role of MMT in fibrotic remodeling in HTN and DD remains unknown. As such, we seek to investigate this phenomenon in the HTN heart and determine the role it plays in the pathological progression of HTN to DD.

We utilized cardiac ultrasound and direct left ventricular (LV) pressure catheterization to gauge diastolic function. These gold-standard methods allowed us to assess cardiac function during HTN and investigate the heart at the transition to DD. Furthermore, flow cytometry was utilized to identify MMT cells (α-SMA+, CD68+) in the heart. These methods gave insight into the role that MMT plays in the degradation of heart function during HTN that inevitably leads to DD and HF.

Cardiac ultrasound revealed that E/A and deceleration time (DcT) were greatly decreased in DOCA mice 10 days after the start of HTN. Further, LV pressure catheterization revealed decreased cardiac function, as shown by decreased -dp/dt. Finally, HTN and normal hearts were harvested and leukocytes isolated. Indeed α-SMA and CD68 staining showed a significant increase in MMT cells in the HTN heart.

This study has shown a rapid onset of DD inside of DOCA + salt HTN mice. In addition, there was a significant increase of MMT cells in these same hearts, elucidating a novel mechanism of cardiac fibrosis. Future studies will aim to parse out the gravity of MMT in HTN to find new pharmaceutical targets against this debilitating disease.
Juvenile Behçet syndrome: a contemporary view and differential diagnosis in pediatric practice
Authors: Yildiz Mehmet , Koker Oya , Kasapcopur Ozgur
Published: September 2024

Purpose of review

This review aims to provide a comprehensive and contemporary overview of juvenile Behçet syndrome (jBS), highlighting its clinical manifestations, diagnostic challenges, and treatment strategies.

Recent findings

Behçet syndrome, with its intricate etiopathogenesis and diverse clinical phenotypes, is more aptly classified as a syndrome than a single disease. Its heterogeneous nature requires a broad diagnostic approach and sophisticated differential diagnosis capabilities. The relatively rare occurrence of Behçet syndrome, combined with incomplete clinical presentations and overlapping differential diagnoses, presents significant diagnostic challenges, particularly in pediatric cases. Nevertheless, substantial progress has been made in treatment, especially in managing inflammatory components and preventing complications. Juvenile patients, given their developmental stage, require distinct therapeutic strategies compared to adults, with careful consideration of treatment side effects on growth and psychosocial development.

To ensure early identification of jBS, it is imperative to refine and develop diagnostic criteria specifically tailored to pediatric populations. With a deeper understanding of the disease mechanisms, treatment protocols should be designed to address the developmental, psychosocial, and individual needs of patients, aiming to minimize long-term side effects. Additionally, comprehensive studies considering age, sex, and ethnic differences are necessary to fill gaps in the literature and resolve existing inconsistencies.
Association Between Inability to Stand at ICU Discharge and Readmission: A Historical Cohort Study*
Authors: Brosseau Marc , Shahin Jason , Fan Eddy , Amaral Andre , Wang Han Ting
Published: September 2024

OBJECTIVES:

The aim of this study was to determine if being unable to stand at ICU discharge was associated with an increased probability of ICU readmission.

DESIGN:

A multicenter retrospective cohort study was conducted using the Toronto Intensive Care Observational Registry (iCORE) project.

SETTING:

Nine tertiary academic ICUs in Toronto, Canada, affiliated with the University of Toronto.

PATIENTS:

All patients admitted to ICUs participating in iCORE from September 2014 to January 2020 were included. Patients had to be mechanically ventilated for more than 4 hours to be included in iCORE. Exclusion criteria were death during the initial ICU stay, transfer to another institution not included in iCORE at ICU discharge, and a short ICU stay defined as less than 2 days.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The main exposure in this study was the inability of the patient to stand at ICU discharge, documented daily in the database within the ICU Mobility Scale. The primary outcome of this study was readmission to the ICU. After adjusting for potential confounders, being unable to stand at ICU discharge was associated with increased odds of readmission (odds ratio, 1.85; 95% CI, 1.31–2.62; p < 0.001).

CONCLUSIONS:

In patients with an ICU stay of 2 days or more, being unable to stand at ICU discharge is associated with increased odds of readmission to the ICU.
Tranexamic acid in prevention of postpartum hemorrhage: a case-control study from Nepal
Authors: Pradhananga Smeena , Jha Meena , Shrestha Ashish , Karki Praju , Aryal Saurav
Published: September 2024

Introduction:

Postpartum hemorrhage (PPH) is the leading cause of maternal mortality in low-income countries. WHO recommends the use of tranexamic acid in addition to oxytocin for the prevention and treatment of PPH. However, it is not yet standardized. Our study aims to assess the effectiveness of tranexamic acid in preventing PPH in low-risk patients.

Method:

This hospital-based case-control study included 60 patients, 30 undergoing vaginal delivery and 30 cesarean delivery. Fifteen cases undergoing vaginal delivery received 1 g tranexamic acid in addition to 10 units of oxytocin, while 15 controls received only oxytocin. 15 cases undergoing cesarean section received 1 g tranexamic acid followed by 6 units of oxytocin after delivery, while 15 controls received only oxytocin. Blood loss after placental delivery and hemoglobin were measured 12 h postpartum.

Results:

Mean volume of blood loss was lower in the case as compared to the control group in both vaginal delivery (134.05 ± 8.7.85 mL vs. 334.22 ± 280.57 mL, P = 0.01) and cesarean delivery (333.35 ± 139.18 mL vs. 553.74 ± 321.37 mL, P = 0.03). The incidence of PPH was lower in the case as compared to the control group in both vaginal delivery (0% vs 16.66%, P = 0.01) and cesarean delivery (3.33% vs 23.33%, P = 0.02). Mean change in hemoglobin was lower in the case as compared to the control group in both vaginal delivery (0.50 ± 0.65 g/dl vs. 1.77 ± 2.11, P = 0.03) and cesarean section (1.52 ± 1.15 g/dL vs. 2.69 ± 1.81 g/dL, P = 0.00). Blood transfusion was lower in the case as compared to the control group in both vaginal delivery (0% vs. 13.33%, P = 0.03) and cesarean delivery (0% vs. 16.66%, P = 0.01).

Conclusion:

Tranexamic acid, in addition to oxytocin, reduces the mean amount of blood loss during delivery and helps prevent PPH.
Combination of Cultured Epidermal Autograft and Meshed Skin Graft Enables Full-thickness Excision of Giant Congenital Nevus
Authors: Kobori Chie , Hikosaka Makoto , Tsugu Wataru , Sakurai Koki , Nakajima Yukari , Kono Hikaru , Kikuchi Akira , Nakajima Yuki , Sumi Miho , Kuwahara Kosuke , Kaneko Tsuyoshi
Published: September 2024

Giant congenital melanocytic nevus (GCMN) is a skin condition characterized by an abnormally dark, noncancerous skin patch. Two main issues with GCMN are aesthetics and malignant transformation. Various methods of treatment are reported, but each method has its own disadvantages, such as risk of recurrence or restriction in the treatable area. We report three cases of GCMN treated with full-thickness excision and immediately covered with cultured epidermal autograft (CEA) combined with split-thickness skin graft (STSG). This is a single-center, single-arm, retrospective report of three cases. The nevus was excised at full skin thickness. Meshed STSG taken from scalp was grafted to the defect, and CEA was grafted over simultaneously. Two weeks later, CEA was applied again as a booster. The same procedures were performed until all nevi were excised. In all cases, nearly complete epithelialization was achieved at several weeks after operation. The reconstructed skin was elastic, and there was no persistent joint contracture. Vancouver Scar Scale score was 4–8. Mesh-like appearance was observed. A hypertrophic scar appeared in the area without meshed STSG. An intractable keloid was observed in one patient. No recurrence of the nevus was observed during the follow-up period. The donor site scar on the scalp was well hidden by the hair. Our method enables full-thickness resection and reconstruction of a wider area in a single operation while improving the take rate of CEA, with reasonable degree of scarring compared with conventional methods.
Remote Exercise Engagement Among Individuals With Cardiovascular Disease
Authors: Bomtempo Ana Paula Delgado , Main Emilia , Ghisi Gabriela Lima de Melo
Published: September 2024

Purpose:

To systematically review the literature regarding barriers and facilitators to remote exercise among individuals with cardiovascular diseases (CVD).

Review Methods:

Six databases were searched (inception—December 2023). Studies including barriers and facilitators for remote exercise reported by individuals living with CVD were considered. Quality was rated using the Mixed Methods Assessment Tool (MMAT). Results were synthesized following a thematic analysis approach. Characteristics of interventions were reported using the Template for Intervention Description and Replication (TIDieR).

From an initial pool of 8543 records, 18 studies met the inclusion criteria. Among these, 13 were qualitative studies, with individual interviews being the most frequent data extraction method. Nine studies received 5/5 MMAT scores (ie, high quality). Twelve studies reported remote exercise interventions, mostly delivered within cardiac rehabilitation, by physiotherapists, nurses, and dietitians, predominantly via telephone calls or videoconferences, with only one study incorporating text messages. Five key themes influencing remote exercise interventions were identified: technology (encompassing access and literacy, self-monitoring/motivation, and security concerns), individual health considerations (health/personal aspects and coronavirus disease-2019), social factors (support from health care team and family/social support), environment (facilities), and logistical factors (time and displacement). Several themes served as both facilitators and barriers. Key insights for remote exercise interventions included mobile accessibility, interactive chat sessions, minimal click interactions, short sessions, personalized feedback, and flexible timing. Results emphasize the importance of promoting social interaction and support between participants and health care teams to mitigate barriers and enhance facilitators in remote exercise interventions for individuals with CVD.
The Foundation to Advance Brain Rehabilitation: Organization, History, and Collaborative Database
Authors: Eicher Vicki , Salisbury David B. , Murphy Thomas F. , Shelton Jean A. , Altman Irwin M. , Malec James F.
Published: September 2024

Objective:

To describe the history, organization, goals, and data management procedures of the Foundation to Advance Brain Rehabilitation (FABR).

Setting:

Postacute brain injury rehabilitation following acute inpatient care.

Key Points:

FABR was incorporated in 2019 with a primary mission to advance brain rehabilitation through scientific and strategic analysis of industry-wide data. Contributing FABR member organizations include Bancroft NeuroRehab, Collage Rehabilitation Partners, On With Life, Pate NeuroRehabilitation, and Shepherd Center. These organizations contribute demographic, admission, discharge, and follow-up data on persons served in 5 types of intensive posthospital brain injury rehabilitation programs (neurobehavioral residential, neurorehabilitation residential, home and community neurorehabilitation, day treatment, and outpatient) and 3 types of supported living programs (neurobehavioral residential, residential, and community-based) to a collaborative database managed by Inventive Software Solutions. Inventive Software Solutions provides FABR researchers with a dataset that is de-identified both for participant and organizational identifying information.
A Synthetic View on Acanthamoeba Keratitis Host Immune Response: Potential Factors Influencing the Development of Chronic Inflammation
Authors: Prado-Costa Bianca , Pinto Larissa Fagundes , Fonseca Mariana Fernandes , de Freitas Denise , Alvarenga Larissa Magalhães
Published: September 2024

Purpose:

The purpose of this study was to compile the current knowledge concerning Acanthamoeba keratitis (AK) host immune response to better understand the elements involved in the chronification of inflammation and worse disease outcomes.

Methods:

A scoping review of the literature on AK host immune response was written after a systematic literature search was performed on the PubMed, Latin American Caribbean Health Sciences Literature, Cochrane Library, Embase, Web of Science, and Scientific Electronic Library Online databases. Recovered articles were screened according to inclusion and exclusion criteria, and the selected studies were analyzed to compile the review.

Results:

The search strategy yielded a total of 768 articles from all searched databases. After the exclusion of duplicate records, 412 studies were screened according to inclusion and exclusion criteria. Finally, a total of 95 articles were selected to compile this review, of which 15 were included as additional bibliography. As for study type, 45 were experimental, 19 were observational, 23 were case reports, and 8 were reviews.

Conclusions:

From the literature, both innate and adaptive immune systems seem to play an important role in AK control and resolution. On the other hand, there is also abundant evidence pointing out that the development of chronic and extracorneal inflammation is immune mediated and is influenced by several factors such as individual patient genetic variability, inadequate treatment, and Acanthamoeba strain pathogenicity.
Optimizing Corneal Transplant Safety: The Impact of Mandatory Prion Protein Testing on Iatrogenic Creutzfeldt–Jakob Disease Prevention in the Czech Republic
Authors: Netuková Magdaléna , Okál Marián , Studený Pavel , Kolín Vojtěch , Matěj Radoslav
Published: September 2024

Purpose:

The purpose of this study was to assess the effectiveness of legally mandated testing for pathogenic prion proteins in corneal tissue donors in the Czech Republic, considering its impact on safety, financial, and temporal costs.

Methods:

Between January 2007 and December 2023, standardized brain regions were collected from all corneal tissue donors in the Czech Republic. Tissue samples were tested for the presence of pathogenic prion proteins by the Czech Reference Laboratory for Human Prion Diseases. The testing used a Western blot analysis, using 2 distinct monoclonal anti-PrP antibodies.

Results:

A total of 8030 donors were tested. Four tested samples were initially weakly positive. Subsequent testing conclusively determined these samples to be negative. The remaining 8026 tests yielded negative results confirming the safety of donor screening.

Conclusions:

We did not observe any cases of proven transmissible spongiform encephalopathies (TSEs). TSE testing has consistently confirmed that no patients with TSE have been selected into the corneal donor pool, solidifying the effectiveness of the active surveillance program and exclusion criteria. We propose that these mechanisms effectively prevent patients with TSEs from being included in the corneal tissue donor pool. However, the substantial financial costs and a 2-day delay in processing pose challenges, contributing to graft nonutilization and potential negative impacts on patients in acute need. Moreover, the unique requirement for pathogenic prion testing in the Czech Republic also makes importing any corneal grafts from other countries impossible, as those tissues do not fulfill Czech legal requirements.
Diagnostic model for spontaneous bacterial peritonitis in cirrhotic patients with ascites: a multicenter cohort study
Authors: Yin Xuehong , Qin Enqiang , Song Rui , Bao Xuli , Dong Jinling , Hou Wei , Hua Wei , Tu Bo , Zhang Yuening , Meng Qinghua
Published: September 2024

Introduction

Spontaneous bacterial peritonitis (SBP) is a potentially life-threatening complication of cirrhotic ascites. Early diagnosis and treatment of SBP are essential to improve the survival rates and prognosis of patients. We aimed to identify the predictors of SBP to establish a new noninvasive early diagnostic tool.

Methods

We screened 1618 patients who underwent paracentesis due to cirrhotic ascites between January 2017 and December 2018 in three hospitals. We evaluated the symptomatic, clinical, and laboratory parameters to identify the predictors of SBP. The primary diagnostic model was displayed as a nomogram.

Results

The model included abdominal pain, diarrhea, white blood cell count, neutrophil percentage, procalcitonin, C-reactive protein, lactate dehydrogenase, glucose, and Model for End-stage Liver Disease score. The model’s diagnostic performance was good, with an AUC of 0.84 [95% confidence interval (CI), 0.81–0.87] in the training cohort. In the validation cohort, the diagnostic ability was also good, with AUCs of 0.87 (95% CI, 0.83–0.91) and 0.90 (95% CI, 0.87–0.94) for inner and outer validation queues, respectively. Moreover, the decision curve analysis confirmed the clinical utility of the nomogram model. In addition, we developed a Microsoft Excel calculation model to allow convenient adoption of the model in clinical practice.

Conclusion

We developed good performing diagnostic models for SBP.
Motivational Enhancement System for Adherence for Adolescents and Young Adults Newly Recommended to Start Antiretroviral Therapy
Authors: Outlaw Angulique Y. , Templin Thomas , MacDonell Karen , Jones Monique , Secord Elizabeth , Naar Sylvie
Published: September 2024

Background:

Adolescents and young adults (AYAs) (age 13–24 years) accounted for 20% of HIV diagnoses in the United States and 6 dependent areas in 2020. Optimal treatment adherence during adolescence and young adulthood decreases the pool of infectious individuals during the risky sexual activity commonly reported among AYAs living with HIV.

Methods:

Adolescents and young adults newly recommended to start antiretroviral therapy (ART) were recruited, nationally, from 7 clinical sites. At each clinical site, participants were randomized to receive a 2-session (baseline and 1 month) online intervention. For the Motivational Enhancement System for Health (MESA) intervention condition, based on the principles of motivational interviewing, participants received ART information and personalized feedback + ART standard of care (n = 86), while for the System for Health (SH) control condition, participants received information on healthy eating and physical activity + ART standard of care (n = 66).

Results:

Adherence was 21% greater in the MESA intervention group compared with the SH control group at 6 months. In addition, the MESA intervention group was significantly more adherent during the postintervention, and was more likely to maintain viral suppression up to 12 months after initiating ART if both doses of the intervention were received compared with the SH control group.

Conclusions:

A brief, scalable online computer-delivered intervention shows promise for achieving long-term health outcomes because of improved adherence when intervention occurs early in the course of treatment.

Trial Registration:

NCT02761746.
Impact of COVID-19 Pandemic on HIV Testing, Recent Infections, and Annualized Incidence Among Cisgender Men Who Have Sex With Men and Transgender Women in Brazil
Authors: Jalil Cristina M. , Teixeira Sylvia L. M. , Coutinho Carolina , Nazer Sandro C. , Carvalheira Eduardo , Hoagland Brenda , Cardoso Sandra W. , Luz Paula M. , Veloso Valdilea G. , Grinsztejn Beatriz , Jalil Emilia M. , Torres Thiago S.
Published: September 2024

Background:

The COVID-19 pandemic had great impact on HIV care and prevention worldwide, including in Brazil. We compared HIV testing, recent infection, and annualized incidence according to the COVID-19 pandemic period among cisgender men who have sex with men (MSM) and transgender women (TGW).

Setting:

HIV and sexually transmitted infection testing, prevention, and treatment referral service in Rio de Janeiro, Brazil.

Methods:

We used Maxim HIV-1 Limiting Antigen Avidity EIA as part of a recent infection testing algorithm to identify recent HIV infection cases and estimate annualized HIV incidences in the pre- (March 2018–February 2020) and post-COVID-19 pandemic onset period (March 2020–January 2022). Multivariable logistic regression model assessed factors associated with recent HIV infection.

Results:

Among 3814 MSM and 776 TGW, 593 (12.9%) tested positive for HIV and 119 (2.6%) were identified as having recent infection. Percentage of recent HIV infection did not differ between the COVID-19 periods. Overall annualized HIV incidence rates were 6.0% (95% confidence interval [CI]: 4.2 to 7.7) and 6.6% (95% CI: 4.3 to 9.0) in the pre- and post-COVID-19 periods, respectively. During the post-COVID-19 period, higher incidence rates were observed among TGW (8.4% [95% CI: 2.9 to 13.9]), those aged 18–24 years (7.8% [95% CI: 4.0 to 11.7]), of Black race (7.9% [95% CI: 3.8 to 12.0]), and those with <12 years of schooling (7.8% [95% CI: 4.8 to 10.8]). Compared to the pre-COVID-19 period, incidence rates were significantly higher in the post-COVID-19 period for those aged >30 years and TGW, while being lower for those with more years of schooling.

Conclusion:

HIV incidence estimates remain high among MSM and TGW in Brazil, especially among the most vulnerable. The consequences of the COVID-19 pandemic on the HIV epidemic will likely persist and contribute to worsening HIV outcomes.
Review of Clinical Applications of Sonazoid Ultrasound Contrast for Liver Evaluation
Authors: Luo Yunhao , Huang Qiuyun , Wen Danlin , Yan Jiaojun , Liu Fangqin , Qiao Lang
Published: September 2024

Sonazoid is a new ultrasound contrast agent with unique Kupffer phase imaging advantages and high mechanical index stability. This paper introduces the basic theories and advantages of Sonazoid ultrasound. Then, the application and latest advances of Sonazoid in the diagnosis and treatment of liver diseases are reviewed in detail. In addition, the advantages and disadvantages of Sonazoid ultrasound and its future directions are discussed. Sonazoid is expected to become an important tool for clinical ultrasound diagnosis and treatment.
The Impact of Area Deprivation Index, Geography, and Mechanism on Incidence of Ballistic Injury to the Upper Extremity
Authors: Brown Danielle J. , Van Handel Amelia C. , Shim Kevin G. , Payne Rachael M. , Tandon Damini , Chi David , Evans Adam G. , Pet Mitchell A.
Published: September 2024

Introduction

This study investigates the intersection of ballistic injuries, geography, and Area Deprivation Index (ADI). We hypothesized that both ADI and geography are correlated with incidence of upper extremity ballistic injuries. Further, we characterize and compare 2 distinct upper extremity gunshot injury populations presenting to our institution: those sustaining violent ballistic injuries and those who suffer an accidental, self-inflicted injury. Our purpose is to evaluate the impact of geography and ADI on the pattern of upper extremity gunshot injuries in Illinois and Missouri.

Materials and Methods

This was a retrospective review of adult patients sustaining ballistic injury to the upper extremity at a single urban level I trauma center over 10 years (n = 797). Seven hundred thirty patients had home addresses in Illinois or Missouri; these addresses were geocoded and included for analysis. Mechanism of injury was self-reported. ADI was measured from the 2019 Neighborhood Atlas, in which deprivation increases from 1 to 100. Comparisons between groups were conducted with unpaired t tests, Fisher exact test, or χ
2 testing, where appropriate.

Results

Addresses constituted 259 unique census tracts, and the average number of upper extremity gunshot wound incidents per tract was 3, with a maximum of 22; 15.4% of census block tracts made up almost half (48.4%) of the total ballistic injuries in the study period; 97.7% of violent injuries occurred in Urban areas, as compared with only 60% of accidental injuries (P < 0.05). ADI and incidence of upper extremity ballistic injury were positively correlated. ADI varied significantly between patients sustaining violent (median, 94; mean, 86.1) versus accidental self-inflicted (median, 79; mean, 70.9) injuries (P < 0.05). Fifty percent of violent injuries in our data set occurred in block groups from the 2 most deprived quintiles.

Conclusions

Upper extremity gunshot wounds in general are concentrated in census blocks with high ADI. Violent injuries in particular are more likely to occur in urban areas with high ADI, whereas patients with accidental, self-inflicted injuries are more geographically and socioeconomically diverse. These differing populations require unique approaches to reduce incidence and morbidity.
Adipose-derived stem cell transplantation enhances spinal cord regeneration by upregulating PGRN expression
Authors: Zhang Qiongchi , Wu Jingtao , Guo Dong , Ji Ning , Liu Weidong , Li Xinyu , Liu Hao , Zhang Chengyi , Zhao Minchao , Li Haopeng , Jin Hongxu , Chang Su’e , Wang Dong
Published: September 2024

This study aims to investigate the effect of adipose-derived stem cells (ADSCs) transplantation on progranulin (PGRN) expression and functional recovery in rats with spinal cord injury (SCI). ADSCs were isolated from the inguinal adipose tissue of rats. A SCI model was created, and ADSCs were injected into the injured area. Various techniques were used to assess the effects of ADSCs transplantation, including hematoxylin-eosin staining, Masson staining, immunofluorescence staining, electron microscopy, MRI, and motor function assessment. The potential mechanisms of ADSC transplantation were investigated using gene expression analysis and protein analysis. Finally, the safety of this therapy was evaluated through hematoxylin-eosin staining and indicators of liver and kidney damage in serum. PGRN expression increased in the injured spinal cord, and ADSCs transplantation further enhanced PGRN levels. The group that received ADSCs transplantation showed reduced inflammation, decreased scar formation, increased nerve regeneration, and faster recovery of bladder function. Importantly, motor function significantly improved in the ADSC transplantation group. ADSCs transplantation enhances functional regeneration in SCI by upregulating PGRN expression, reducing inflammation and scar formation, and promoting nerve regeneration and myelin repair. These findings suggest that ADSC transplantation is a potential therapy for SCI.
Synergism of salvianolic acid B and ginsenoside Rg1 magnifies the therapeutic potency against ischemic stroke
Authors: Shen Haishang , Zhang Yuhan , Shao Yanan , Chen Siqi , Yin Ping , Liu Xin , Wang Linlin , Zhang Lingxiao , Jin Yi , Wang Yiyu , Xing Rongrong , Cho Kenka , Jiang Baohong
Published: September 2024

Even though considerable progress has been made to reduce insult, ischemic stroke is still a significant cause of mortality and morbidity in the world, and new therapeutic strategies are urgently needed. In the present study, the magnesium salt of salvianolic acid B (SalB) and ginsenoside Rg1 (Rg1) combination as a multicomponent strategy against stroke was evaluated. The synergistic effect of Sa1B and Rg1 was evaluated by Bliss independence analysis on the middle cerebral artery occlusion model. The infarct volume, neuroethology, cerebral structure, and neurocyte number were evaluated by 3,5-triphenyltetrazolium chloride staining, Longa score, Garcia score, hematoxylin–eosin staining, and Nissl staining, respectively. Metabolomics was used to search for potential biomarkers and explore the mechanism of Sa1B/Rg1. First, the superior effects of SalB/Rg1 than SalB or Rg1 at the same dose were evaluated. Compared with SalB (P < 0.001) or Rg1 (P < 0.01), SalB/Rg1 significantly decreased infarct volume through 3,5-triphenyltetrazolium chloride staining and protected the structural integrity of cortex and striatum. The superior effect of SalB/Rg1 on neurological behavior was also detected compared with SalB or Rg1 significantly. Accompanying behavioral improvement, a considerable increase of SalB/Rg1 on neurons detected by Nissl staining was found on the cortex compared with SalB (P < 0.05) or Rg1 (P < 0.01). Second, the synergistic effect between SalB and Rg1 was strictly verified by Bliss independence analysis (P < 0.01) based on infarct volume. Finally, alleviation of cerebral metabolic disorders may be the possible mechanism of SalB/Rg1. Our study provided a multicomponent strategy against ischemic stroke, with not only dose reduction but also improved efficacy relative to single agents.
Assessing bnAb potency in the context of HIV-1 Envelope conformational plasticity
Authors: Foulkes Caio , Friedrich Nikolas , Ivan Branislav , Stiegeler Emanuel , Magnus Carsten , Schmidt Daniel , Karakus Umut , Weber Jacqueline , Günthard Huldrych F. , Pasin Chloé , Rusert Peter , Trkola Alexandra
Published: September 2024

The ability of broadly neutralizing antibodies (bnAbs) to interact with the closed, pre-fusion HIV-1 envelope (Env) trimer distinguishes them from weakly neutralizing antibodies (weak-nAbs) that depend on trimer opening to bind. Comparative analysis of neutralization data from the CATNAP database revealed a nuanced relationship between bnAb activity and Env conformational plasticity, with substantial epitope-specific variation of bnAb potency ranging from increased to decreased activity against open, neutralization-sensitive Env. To systematically investigate the impact of Env conformational dynamics on bnAb potency we screened 126 JR-CSF point mutants for generalized neutralization sensitivity to weak-nAbs and plasma from people with chronic HIV-1 infection. 23 mutations at highly conserved sites resulted in neutralization phenotype with high Tier 1 sensitivity, which was associated with destabilization of the closed, prefusion conformation. Including 19 of these mutants into a Sensitivity Env mutant panel (SENSE-19), we classified bnAbs according to potency variations in response to trimer opening. To verify that these sensitivity patterns are independent of the in vitro assay system, replication-competent SENSE-19 mutant viruses were tested on primary CD4 T cells. While loss of potency on SENSE-19 was registered for bnAbs recognizing quaternary epitopes on pre-triggered Env, structural destabilization benefitted MPER bnAbs and other inhibitors known to have post-CD4 attachment neutralization activity. Importantly, for certain bnAbs targeting CD4bs, V3-glycan and interface epitopes, particularly low potency variation was noted, suggesting that Env conformational tolerance can be achieved but is not the rule. In summary, SENSE-19 screens revealed distinct Env flexibility tolerance levels between bnAb types that provide mechanistic insights in their function and broaden current neutralization breadth assessments.

Author summary

Consistently high potency and neutralizing breadth against genetically divergent strains circulating worldwide are central to the applicability of HIV-1 broadly neutralizing antibodies (bnAbs) for prevention and therapy. The trimeric Envelope protein complex on these viruses is the target for nAbs and because of its inherent flexibility can be presented in different shapes. However, the activity of nAbs depends to different degree on the presentation of certain shapes, limiting their potency and breadth. Here we assemble a virus panel that can be used to estimate this dependence, enabling the identification of bnAbs tolerating the presentation of different shapes.
Investigating the right heart hemodynamics in the Tetralogy of Fallot: a computational study
Authors: Renzi Francesca , Puppini Giovanni , Luciani Giovanni Battista , Vergara Christian
Published: September 2024

Characterizing flow within the right heart (RH) is particularly challenging due to its complex geometries. However, gaining insight into RH fluid dynamics is of extreme diagnostic importance given the high prevalence of acquired and congenital heart diseases with impaired RH functionality. In this study, we present a comprehensive, patient-specific, image-based computational analysis of the hemodynamics of the RH in healthy and repaired-ToF (ToF) cases. From multi-series cine-MTRI, we reconstruct the geometry and motion of the patient's right atrium, ventricle, and pulmonary and tricuspid valves. For this purpose, we develop a novel and flexible reconstruction procedure that enables us, for the first time, to integrate fully patient-specific tricuspid valve dynamics into a computational model, enhancing the accuracy of our RH blood flow simulations. This work provides novel insight into the altered hemodynamics of repaired-ToF RH with severe pulmonary regurgitation and into the hemodynamics changes induced by the pulmonary valve replacement intervention. Modelling the whole RH enables us to understand the contribution of the superior and inferior vena cava inflows to the ventricular filling, as well as the impact of the impaired right atrial function on the ventricular diastole. We analyze the turbulent and transitional behaviour by including the Large-Eddies Simulation sigma model in our computational framework. This highlights how the contribution of the smallest scales in the dissipation of the turbulent energy changes among health and disease.
Off-Equilibrium Fluctuation-Dissipation Theorem Paves the Way in Alzheimer’s Disease Research
Authors: Patow Gustavo , Monti Juan , Acero-Pousa Irene , Idesis Sebastián , Escrichs Anira , Perl Yonatan Sanz , Ritter Petra , Kringelbach Morten , Deco Gustavo ,   the Alzheimer’s Disease Neuroimaging Initiative
Published: September 2024

INTRODUCTION

Alzheimer’s disease (AD) is a neurodegenerative disorder characterized by progressive cognitive decline. Although traditional methods have provided insights into brain dynamics in AD, they have limitations in capturing non-equilibrium dynamics across disease stages. Recent studies suggest that dynamic functional connectivity in resting-state networks (RSNs) may serve as a biomarker for AD, but the role of deviations from dynamical equilibrium remains underexplored.

OBJECTIVE

This study applies the off-equilibrium fluctuation-dissipation theorem (FDT)1to analyze brain dynamics in AD, aiming to compare deviations from equilibrium in healthy controls, patients with mild cognitive impairment (MCI), and those with AD. The goal is to identify potential biomarkers for early AD detection and understand disease progression’s mechanisms.

METHODS

We employed a model-free approach based on FDT to analyze functional magnetic resonance imaging (fMRI) data, including healthy controls, MCI patients, and AD patients. Deviations from equilibrium in resting-state brain activity were quantified using fMRI scans. In addition, we performed model-based simulations incorporating Amyloid-Beta (Aβ), tau burdens, and Generative Effective Connectivity (GEC) for each subject.

RESULTS

Our findings show that deviations from equilibrium increase during the MCI stage, indicating hyperexcitability, followed by a significant decline in later stages of AD, reflecting neuronal damage. Model-based simulations incorporating Aβand tau burdens closely replicated these dynamics, especially in AD patients, highlighting their role in disease progression. Healthy controls exhibited lower deviations, while AD patients showed the most significant disruptions in brain dynamics.

DISCUSSION

The study demonstrates that the off-equilibrium FDT framework can accurately characterize brain dynamics in AD, providing a potential biomarker for early detection. The increase in non-equilibrium deviations during the MCI stage followed by their decline in AD offers a mechanistic explanation for disease progression. Future research should explore how combining this framework with other dynamic brain measures could further refine diagnostic tools and therapeutic strategies for AD and other neurodegenerative diseases.
Neurophysiological signatures of default mode network dysfunction and cognitive decline in Alzheimer’s disease
Authors: Ozdemir Recep A. , Passera Brice , Fried Peter J. , Press Daniel , Shaughnessy Lynn W. , Buss Stephanie , Shafi Mouhsin M.
Published: September 2024

Neural hyper-excitability and network dysfunction are neurophysiological hallmarks of Alzheimer’s disease (AD) in animal studies, but their presence and clinical relevance in humans remain poorly understood. We introduce a novel perturbation-based approach combining transcranial magnetic stimulation and electroencephalography (TMS-EEG), alongside resting-state EEG (rsEEG), to investigate neurophysiological basis of default mode network (DMN) dysfunction in early AD. While rsEEG revealed global neural slowing and disrupted synchrony, these measures reflected widespread changes in brain neurophysiology without network-specific insights. In contrast, TMS-EEG identified network-specific local hyper-excitability in the parietal DMN and disrupted connectivity with frontal DMN regions, which uniquely predicted distinct cognitive impairments and mediated the link between structural brain integrity and cognition. Our findings provide mechanistic insights into how network-specific neurophysiological disruptions contribute to AD-related cognitive dysfunction. Perturbation-based assessments hold promise as novel markers of early detection, disease progression, and target engagement for disease-modifying therapies aiming to restore abnormal neurophysiology in AD.