bluuebunny/crossref_metadata_2025 huggingface dataset:
Management and outcomes after liver transplantation for progressive familial intrahepatic cholestasis: A systematic review and meta-analysis
Authors: Kavallar Anna Maria , Mayerhofer Christoph , Aldrian Denise , Okamoto Tatsuya , Müller Thomas , Vogel Georg Friedrich
Published: September 2023

Background:

Progressive familial intrahepatic cholestasis (PFIC) is a heterogeneous rare congenital cholestatic liver disease. Disease progression might necessitate liver transplantation (LT). The aim of this study was to describe the outcome of PFIC1-4 patients after LT.

Methods:

Electronic databases were searched to identify studies on PFIC and LT. Patients were categorized according to PFIC type, genotype, graft type, age at LT, time of follow-up, and complications and treatment during follow-up.

Results:

Seventy-nine studies with 507 patients met inclusion criteria; most patients were classified as PFIC1-3. The median age at LT was 50 months. The overall 5-year patient survival was 98.5%. PFIC1 patients with diarrhea after LT were at significant risk of developing graft steatosis (p < 0.0001). Meta-analysis showed an efficacy of 100% [95% CI: 73.9%–100%] for surgical biliary diversion to ameliorate steatosis and 94.9% [95% CI: 53.7%–100%] to improve diarrhea (n = 8). PFIC2 patients with bile salt export pump (BSEP)2 or BSEP3-genotype were at significant risk of developing antibody-induced BSEP deficiency (AIBD) (p < 0.0001), which was reported in 16.2% of patients at a median of 36.5 months after LT. Meta-analysis showed an efficacy of 81.1% [95% CI: 47.5%–100%] for rituximab-based treatment regimens to improve AIBD (n = 18). HCC was detected in 3.6% of PFIC2 and 13.8% of PFIC4 patients at LT.

Conclusions:

Fifty percent of PFIC1 patients develop diarrhea and steatosis after LT. Biliary diversion can protect the graft from injury. PFIC2 patients with BSEP2 and BSEP3 genotypes are at significant risk of developing AIBD, and rituximab-based treatment regimens effectively improve AIBD. PFIC3 patients have no PFIC-specific complications following LT.
CORRELATIONS BETWEEN SUSPENDED HYPERREFLECTIVE MATERIAL WITH THE MACULAR MICROSTRUCTURE AND SPONTANEOUS CLOSURE OF FULL-THICKNESS MACULAR HOLES
Authors: Yang Qian , Huang Xin , Peng Rui , Li Ruiwen , Xu Gezhi , Wang Ling , Chang Qing
Published: September 2023

Purpose:

To investigate the characteristics of spontaneously closed full-thickness macular holes (FTMHs) and to seek potential predictors for the spontaneous closure of FTMHs.

Methods:

In this retrospective cohort study, the clinical data and optical coherence tomography (OCT) images were reviewed from 19 eyes with spontaneously closed FTMHs (spontaneous closure group) and 37 control eyes with FTMHs that were delayed for non-medical reasons but ultimately requiring surgery (control group). The term, suspended hyperreflective material (SHM), was defined as hyperreflective material suspended within the FTMHs observed via OCT; the presence of SHM was evaluated in these eyes.

Results:

The median time from diagnosis to spontaneous closure of the FTMHs was 13.7 (range, 2.4-32.4) weeks in the spontaneous closure group. The mean diameter of FTMHs in the spontaneous closure group was significantly smaller than that in the control group (191.68±70.57 μm vs 401.68±162.19 μm, P<0.0001). The incidence of vitreomacular traction (VMT) was higher in the spontaneous closure group compared to the control group (9/19 vs 5/37, P=0.009, OR [95% CI], 5.76 [1.56–21.21]); in 7 of the 9 eyes with VMT from the spontaneous closure group, spontaneous VMT separation and subsequent FTMH closure was observed. SHM was observed in 9 eyes (47%) from the spontaneous closure group and 3 eyes (8%) from the control group (P=0.001, OR [95% CI], 10.20[2.31‒45.02]).

Conclusions:

Smaller diameters, VMT, and presence of SHM might be suggestive of the potential for spontaneous closure of FTMHs.
Evaluation of a new device to treat negative dysphotopsia
Authors: Roop Prakhyat , Nayak Shreya , Kittur Amogh , Roop Roop , Sharma Namrata
Published: September 2023

Purpose:

To evaluate the efficacy and safety of Negative Dysphotopsia (ND) Ring implantation for treating and preventing ND.

Setting:

Multicentric tertiary eye hospitals.

Design:

Prospective interventional cohort study.

Methods:

22 patients with ND were enrolled. Eyes with other ocular structural pathologies (corneal, macular, optic nerve head, retinal, neuro-ophthalmological) were excluded. In 15 eyes, the ring was implanted to treat ND (therapeutic group), and in 7 eyes, it was implanted during cataract surgery of the fellow eye as a prophylactic measure (prophylactic group) to prevent the occurrence of ND. Preoperative evaluation included video recording of the patients' complaints aside complete eye examination. Postoperatively, patients were interviewed to confirm resolution of complaints related to ND. The intraoperative difficulties and postoperative adverse events were recorded. A minimum follow-up of 1 year was completed for all eyes.

Results:

In the therapeutic group, 14 of 15 eyes (93.3%) patients reported complete resolution of ND on the first postoperative day while 1 patient reported persistence of a smaller and lighter temporal shadow. No ND was reported by any patient in any of the 7 eyes treated prophylactically. No significant adverse intraoperative event was recorded; however, vitreous upthrust was noted in 2 of 22 eyes (9.0%). No permanent drop in visual acuity was recorded in the therapeutic group.

Conclusions:

ND Ring implantation was an easy, safe, and effective approach for both treating and preventing ND.
Overview of the economic burden of musculoskeletal pain in children and adolescents: a systematic review with meta-analysis
Authors: Espirito Santo Caique de Melo , Santos Verônica S. , Kamper Steven J. , Williams Christopher M. , Miyamoto Gisela C. , Yamato Tiê P.
Published: September 2023

Studies suggest a high economic burden among children and adolescents with musculoskeletal pain. There is no summary in the literature on the overall economic burden of musculoskeletal pain in children and adolescents. The aim of this systematic review of cost-of-illness studies was to synthesize the economic burden of musculoskeletal pain in children and adolescents. We conducted electronic searches on MEDLINE, EMBASE, CINAHL, EconLit, NHSEED, and HTA databases. We included cost-of-illness studies that estimated healthcare, patient/family, lost productivity, and/or societal costs in children and adolescents with musculoskeletal pain. The risk of bias was assessed with the Consolidated Health Economic Evaluation Reporting Standards checklist. All values were adjusted to the same reference year (2021) and converted to American Dollar. We included 45 cost-of-illness studies (n = 665,623). Twenty-two studies estimated the annual healthcare costs that ranged from $143 to $41,379 per patient. Nine studies estimated the annual patient/family costs that ranged from $287 to $27,972 per patient. Seven studies estimated the annual lost productivity costs that ranged from $124 to $4671 per patient. Nine studies estimated the annual societal costs that ranged from $1095 to $69,351 per patient. Children and adolescents with juvenile idiopathic arthritis and musculoskeletal pain had higher annual incremental healthcare costs than those without these conditions (mean difference: $3800 higher, 95% confidence interval [CI]: 50-7550; mean difference: $740 higher, 95% CI: 470-1,010, respectively). In conclusion, the estimated annual economic burden of children and adolescents with musculoskeletal pain ranged from $124 to $69,351.
The Role and Value of Corporate Medical Directors in Employer Benefits Management
Authors: Stave Gregg M. , Burton Wayne N.
Published: September 2023

Objective

Knowledge of health-related employer benefits is considered a core competency by the American College of Occupational and Environmental Medicine. This study seeks to understand how this translates into practice.

Methods

An electronic survey was e-mailed to members of American College of Occupational and Environmental Medicine Corporate Medicine and Health and Human Performance Sections; Integrated Benefits Institute; and Employer Health Innovation Roundtable.

Results

One hundred nineteen responses were received, including 54 from corporate medical directors (CMDs) and 43 from employee benefits professionals, from a variety of industries. Fifty percent of CMDs reported expertise in designing benefits, but only 25% are engaged with health benefits. The majority of CMDs thought that their involvement was important, while the majority of benefits professionals thought that it was not important.

Conclusions

Many CMDs report having benefits expertise but being underutilized while others report not having expertise.
The benefits of R anastomotic technique for Billroth-II reconstruction with Braun anastomosis during totally laparoscopic distal gastrectomy: a propensity score matching analysis
Authors: Zhou Jiajie , Zhang Qi , Wang Wei , Sun Longhe , Li Ruiqi , Zhao Shuai , Wang Daorong
Published: September 2023

Background:

Currently, there is no consensus on the most appropriate anastomotic site, anastomotic line, and direction for Billroth-II reconstruction with Braun anastomosis (B-II-B anastomosis) during totally laparoscopic distal gastrectomy (TLDG). Herein, the authors presented a novel anastomotic technique called R anastomosis for B-II-B anastomosis and compared it with the conventional B-II-B anastomosis technique to assess its feasibility, safety, and effectiveness.

Methods:

Between March 2019 and September 2022 in our centre, R anastomosis was performed on 123 patients undergoing TLDG for distal gastric cancer. A retrospective review of a prospectively collected database identified patients who underwent TLDG between January 2010 and September 2022. Patients who underwent R anastomosis were matched in a 1:1 ratio with patients who underwent conventional anastomosis using a propensity score based on age, sex, preoperative BMI, American Society of Anesthesiologists (ASA) score, and the history of abdominal surgery. Surgical and postoperative outcomes and clinicopathological data were analyzed for both groups.

Results:

During the study period, 246 patients were included, 123 in each group. No intraoperative complications associated with digestive tract reconstruction and no cases of conversion to open surgery were reported in either group; furthermore, no incidences of perioperative mortality were noted in either group. The R group had a significantly reduced anastomotic time compared to the control group (30 ± 4.1 vs. 36 ± 5.3 min, P < 0.001). Perioperatively, the incidences of Clavien–Dindo grade II or higher complications were 6.5% (8/123) and 12.2% (15/123) in the R and control groups with no significant difference between the two groups. Postoperative gastric emptying dysfunction was found in five and one patient in the control and R groups, respectively.

Conclusion:

R anastomosis is a safe and effective technique for B-II-B anastomosis following TLDG. This novel technique enhances the convenience of performing anastomosis and can reduce postoperative gastric emptying dysfunction.
Evaluation of acquired and hereditary risk factors for the development of thromboembolism in patients with systemic lupus erythematosus
Authors: Gürsoy Vildan , Sadri Sevil , Ermurat Selime
Published: September 2023

Although the contribution of antiphospholipid antibodies (aPL) to thrombolembolism in systemic lupus erythematosus (SLE) is well known, there is not enough data on the contribution of various hereditary thrombophilic factors. In this study, we aimed to determine acquired and hereditary thrombophilic factors in adult patients with SLE. A total of 93 SLE patients (87 women and 6 men) were included. Data on clinical, demographic and laboratory characteristics, and disease activity scores (SLEDAI) of the patients were evaluated. The patients were analyzed with a screen, including lupus anticoagulant, anticardiolipin antibodies (aCL), antithrombin III, protein C, protein S, and homocysteine levels; factor V Leiden (FVL), methylenetetrahydrofolate reductase (MTHFR) and prothrombin G20210A gene mutations. A total of 23 thromboembolic events were reported in 17 (18.3%) of the patients. The frequency of pregnancy complications and SLEDAI scores were significantly higher in SLE patients who had a thromboembolism event (P < 0.05). Thromboembolism was detected in 12 (32.4%) of 37 patients with positive aPL antibody and 5 (8.9%) of 56 patients with negative aPL antibody (P = 0.006). In addition, thromboembolism developed in 11 (32.3%) of 34 lupus anticoagulant-positive patients and 6 (10.1%) of 59 lupus anticoagulant-negative patients (P = 0.012). Moreover, protein C levels were significantly lower in patients who developed thromboembolism (P < 0.05). Patients with and without thromboembolism were similar in terms of genetic thrombophilia factors (MTHFR A1298C, MTHFR C677T, FVL and Prothrombin G20210A) (P > 0.05). In conclusion, in the current study, some acquired (aPL, lupus anticoagulant and cCL IGG) and hereditary (protein C deficiency) thrombophilic factors were shown to be associated with the development of thrombosis in SLE patients. However, the effect of other hereditary factors on the development of thromboembolism could not be demonstrated. According to the data of this study, genetic screening seems inappropriate in terms of the risk of thromboembolism in patients with SLE.
Quantifying time from last dose: do direct oral anticoagulant assays correlate with patient's reported last dose
Authors: Stretton Brandon , Kovoor Joshua , Bacchi Stephen , Gupta Aashray , Edwards Suzanne , Boey Jir Ping , Gluck Samuel , Reddi Benjamin , Maddern Guy , Boyd Mark
Published: September 2023

Introduction

In the absence of a patient's last direct oral anticoagulant (DOAC) dose time, best practice regarding preoperative DOAC cessation remains unclear. The aim of this study was to investigate, in a real-life patient cohort, if there was an association between subjective patient recall and objective DOAC assay titre.

Methods/Materials

A multicentre cohort study of consecutive surgical inpatients was conducted. DOAC assays were ‘expected’ if they satisfied both time and titre-based guidelines.

Results

Patient-recalled last dose and DOAC assay was available in 285 individuals. DOAC assay titres correlated strongly with the expected levels based on a patient's reported last dose time(rho = 0.70, P value < 0.0001). However, underweight (<50 kg; P = 0.0339) and elderly (>80 years; P = 0.0134) were more likely to have an unexpectedly high assay titre.

Conclusions

A significant portion (∼25%) of patients had unexpected DOAC titres. DOAC levels can be clinically impactful in a significant percentage of patients, particularly in elderly and/or underweight.
Current opinion in quantitative lung ultrasound for the nephrologist
Authors: Reisinger Nathaniel , Koratala Abhilash
Published: September 2023

Purpose of review

Volume overload mediates worse cardiovascular outcomes in patients with end-stage kidney disease (ESKD) on hemodialysis (HD), leading to increased acute care utilization. Understanding the presence of pulmonary congestion, which is often clinically silent, could be instrumental in predicting acute care needs and mitigating risks through appropriate therapy. This review provides an overview of the existing literature on lung ultrasound in ESKD patients.

Recent findings

Quantitative lung ultrasound predicts adverse cardiovascular outcomes in ESKD patients on HD. The largest randomized controlled trial of a lung ultrasound-guided ultrafiltration strategy demonstrated control of pulmonary congestion without an increased risk of intradialytic hypotension, arrhythmia, or access thrombosis. Despite this, the study was negative in the incidence of the primary composite endpoint of all-cause death, nonfatal myocardial infarction, and decompensated heart failure. A post hoc analysis showed promise with reductions in recurrent acute care utilization and cardiovascular events. Recent research has focused on simplification of the 28-zone lung ultrasound, and abbreviated protocols have been shown to retain prognostic ability.

Lung ultrasound is a valuable tool for nephrologists to diagnose and manage pulmonary congestion. However, its optimal integration with other hemodynamic parameters to formulate effective management strategies remains elusive. Future studies should address these gaps and find solutions to the training inadequacies in clinician-performed ultrasound.
Proximal and Distal Factors Distinguishing Between Individuals With Suicidal Ideation Only and Suicide Attempters
Authors: Serebriakova Jana , Kemmler Georg , Deisenhammer Eberhard A.
Published: September 2023

Prior studies identifying variables that may differentiate suicide attempters from suicidal ideators mostly focused on distal risk factors and have not included the severity of suicidal ideation. The aim of this study was to consider the extent to which proximal (consumption of alcohol and psychotropic substances, intake of medication, interpersonal contact during the suicidal phase) and distal (resilience, sense of coherence, reasons for living) factors differ among nonideators, suicidal ideators (graded with regard to each individual's self-assessed mental distance to a suicidal act), and suicide attempters. A sample of 464 individuals recruited via an online link were compared by using RS-13, SOC-13, RFLI, and questions concerning the suicidal phase. There was a gradual decrease respectively increase in proximal and distal factors, as well as significant differences among the groups. Sense of coherence and reasons for living were independent protective factors, whereas consumption of alcohol and intake of medication were independent risk factors.
Comfort Levels of Outpatient Health Care Professionals When Asking About Substance Use–Related Sexual Activity: A Pilot Survey
Authors: Argenyi Michael S. , Evans Joni K. , Veach Laura J. , McNeil Candice J.
Published: September 2023

Background

Screening, brief intervention, and referral to treatment (SBIRT) is an evidence-based intervention for substance use. Health care professionals may not receive SBIRT training or know of substance use's intersection with sexual activity. This pilot survey inquired about SBIRT training history, attitudes, and comfort among outpatient health care professionals, including assessing sexual activity–related use.

Methods

We conducted a snowball cross-sectional survey of outpatient health care professionals at a large southeastern academic medical center in June 2021 with 4-point Likert questions covering demographics, substance use attitudes, SBIRT training history, and comfort implementing SBIRT. Analysis used descriptive statistics and stratification by demographic and practice characteristics.

Results

Seventy-three professionals responded, of whom 82% were White and 66% were female. Forty-seven percent were 30 to 39 years old, 33% were internal medicine professionals, and 59% reported previous SBIRT training. All participants reported believing substance use is a significant health issue. Most reported that they were comfortable or somewhat comfortable assessing patients for substance use (85%), dropping to 60% discussing sexual activity. Advanced practice providers and physicians identified more comfort with rapport building around substance use than other health care respondents. Professionals in infectious diseases and psychiatry reported the greatest comfort assessing substance use with concurrent sexual activity.

Conclusions

There are gaps in SBIRT training and beliefs among health care professionals. Although health care workers report that assessing substance use is important, some professionals endorsed more comfort discussing substance use with patients than others, especially when inquiring about sexual activity. Future work could replicate the pilot to inform increasing comfort through training in the intersection of substance use and sexuality.
Predictive Factors of Intra-articular Corticosteroid Injections with Ultrasound-Guided Posterior Capsule Approach for Patients with Primary Adhesive Capsulitis
Authors: Lin Che-Li , Lee Yu-Hao , Chen Yi-Wen , Liao Chun-De , Huang Shih-Wei
Published: September 2023

Background

Adhesive capsulitis (AC) affects the shoulder joint, causing pain and limiting motion. In clinical practice, the effectiveness of injections varies, and the factors influencing their success remain unclear. This study investigates the predictors of effective corticosteroid injections in patients with primary AC.

Design

This retrospective study enrolled AC patients aged >35 years who received intra-articular corticosteroid injections. The response was determined based on patients' pain and range-of-motion (ROM) three months after the injection. Demographic data, medical comorbidities, and radiographic parameters (critical shoulder angle [CSA] and acromial index [AI]) were compared between the effective and noneffective groups. Receiver operating-characteristic (ROC) curves and logistic regression were used to identify the predictors of injection effectiveness.

Results

This study included 325 patients with primary AC, who were divided into responder (189 patients, 58.2%) and non-responder (136 patients, 41.8%) groups. The ROC curve revealed that the AI score indicated favorable discrimination for predicting a poor response to injections, whereas the CSA score did not. Logistic regression revealed that the pain period, diabetes mellitus, and AI are predictors of non-responders to injections.

Conclusion

Long pain duration, the presence of diabetes mellitus, and an AI score of >0.711 were predictors of non-response to corticosteroid injections for primary AC patients.
Ultrasound Guided Pes Anserine Bursitis Injection Choices; Prolotherapy or Oxygen-Ozone or Corticosteroid: A Randomized Multicenter Clinical Trial
Authors: Babaei-Ghazani Arash , Eftekharsadat Bina , Soleymanzadeh Hosnieh , ZoghAli Masoumeh
Published: September 2023

Objective

Pes anserine bursitis (PAB) is the most common cause of periarticular knee pain. The aim of the study was to evaluate the efficacy of local injection-based therapies with different materials.

Design

The enrolled patients were randomly allocated to three groups to receive different interventions. Outcome measures included pain severity using the visual analog scale (VAS) and the Western Ontario McMaster Universities osteoarthritis index (WOMAC) that was evaluated before the intervention, one and eight weeks after that.

Results

This trial was performed on 72 participants, with male to female ratio of 0.14 and with a mean age of 61.49 ± 9.35 years old. In the first group, corticosteroids in the second group, oxygen–ozone (O2–O3), and in the third group, dextrose 20% was injected into the pes anserine bursa under ultrasound guidance. Interaction between time and group showed a statistically significant improvement in VAS and WOMAC (P ≤ 0.05) in favor of corticosteroids and O2–O3 groups after one week and in favor of O2–O3 and prolotherapy groups after eight weeks.

Conclusion

All three treatment options are effective for patients with PAB. This study showed that the effects of O2–O3 injection and prolotherapy last longer than those of corticosteroid injection.
Is HIV positive a risk factor or contraindication in dental implant therapy?
Authors: Barros Ana Waleska Pessôa , Sales Pedro Henrique da Hora , Feitosa Larissa Silva Gomes , Carvalho Alessandra Albuquerque Tavares , Leão Jair Carneiro
Published: September 2023

HIV pathogenesis affects TCD4+ lymphocytes, causing impairment of the immune system. Thus, the consequent immunological fragility of individuals with the disease and the absence of studies that serve as a guide for clinicians’ decision-making make many healthcare professionals recognize it as a synonym of contraindication for oral rehabilitation treatments with dental implants.
DELIVER: A Safety Study of a Dapivirine Vaginal Ring and Oral PrEP for the Prevention of HIV During Pregnancy
Authors: Bunge Katherine , Balkus Jennifer E. , Fairlie Lee , Mayo Ashley J. , Nakabiito Clemensia , Mgodi Nyaradzo , Gadama Luis , Matrimbira Moleen , Chappell Catherine Anne , Piper Jeanna , Chakhtoura Nahida , Szydlo Daniel W. , Richardson Barbra , Hillier Sharon L.
Published: September 2023

Background:

Pregnancy represents a period of high HIV acquisition risk. Safety data for the monthly dapivirine vaginal ring (DVR) during pregnancy are limited. Here, we report data from the first 2 cohorts of pregnant participants in MTN-042/DELIVER, a phase 3b, randomized, open-label safety trial of DVR and oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC). MTN-042 is being conducted in 3 cohorts beginning with later gestational ages when risks of drug exposure are less.

Methods:

Eligible pregnant individuals aged 18–40 years in Malawi, South Africa, Uganda, and Zimbabwe were randomized 2:1 to monthly DVR or daily TDF/FTC. Participants in cohort 1 initiated product use between 36 weeks 0 days (36 0/7 weeks) and 37 6/7 weeks gestation; participants in cohort 2 initiated product use between 30 0/7 and 35 6/7 weeks gestation. All participants continued product use until delivery or 41 6/7 weeks gestation. Pregnancy outcomes and complications were assessed and summarized using descriptive statistics and compared with local background rates obtained through a separate chart review.

Results:

One-hundred and fifty participants were enrolled into cohort 1 with 101 randomized to DVR and 49 to TDF/FTC. One-hundred and fifty-seven participants were enrolled into cohort 2 with 106 randomized to DVR and 51 to TDF/FTC. In both cohorts, pregnancy complications were rare and similar to local background rates.

Conclusion:

In this first study of a long-acting HIV prevention agent in pregnancy, adverse pregnancy outcomes and complications were uncommon when DVR and TDF/FTC were used in the third trimester of pregnancy, suggesting a favorable safety profile for both prevention products.
Surgical site infection prophylaxis: what have we learned and are we making progress?
Authors: Ierano Courtney , Hall Lisa , James Rod
Published: September 2023

Purpose of review

This review aims to discuss the current state of surgical antimicrobial prophylaxis (SAP) evidence for surgical site infection prevention. Despite decades of research, knowledge gaps persist in identifying optimal SAP regimens.

Recent findings

Recent randomised controlled trials highlight ongoing heterogeneity in study design. Key new findings support the use of oral preoperative SAP for colorectal surgery and advise against the use of SAP for transperineal prostate biopsy. There is growing evidence for culture-based SAP over empiric use for transrectal prostate biopsy.

Contentious issues remain regarding topical antimicrobials for cardiac procedures involving sternotomy, the necessity of SAP for wire lumpectomy and laparoscopic cholecystectomy for both mild or moderate acute cholecystitis. Procedures where SAP is not indicated, yet research is still being conducted on this topic include dental implants and clean orthopaedic procedures.

Research efforts continue with numerous trials published and registered to determine optimal SAP regimens. However, many efforts are suboptimal due to poor statistical design and redundant questions already answered by existing literature. To improve practice and influence surgeons prescribing behaviour future RCTs should be well powered, with large sample sizes across multiple sites, focusing on clinically relevant questions.
A Novel Interpretable Radiomics Model to Distinguish Nodular Goiter From Malignant Thyroid Nodules
Authors: Zhang Hao , Yang Yun-Feng , Yang Chao , Yang Yuan-Yuan , He Xin-Hong , Chen Chao , Song Xue-Lin , Ying Lei-Lei , Wang Ying , Xu Li-Chao , Li Wen-Tao
Published: September 2023

Objectives

The purpose of this study is to inquire about the potential association between radiomics features and the pathological nature of thyroid nodules (TNs), and to propose an interpretable radiomics-based model for predicting the risk of malignant TN.

Methods

In this retrospective study, computed tomography (CT) imaging and pathological data from 141 patients with TN were collected. The data were randomly stratified into a training group (n = 112) and a validation group (n = 29) at a ratio of 4:1. A total of 1316 radiomics features were extracted by using the pyradiomics tool. The redundant features were removed through correlation testing, and the least absolute shrinkage and selection operator (LASSO) or the minimum redundancy maximum relevance standard was used to select features. Finally, 4 different machine learning models (RF Hybrid Feature, SVM Hybrid Feature, RF, and LASSO) were constructed. The performance of the 4 models was evaluated using the receiver operating characteristic curve. The calibration curve, decision curve analysis, and SHapley Additive exPlanations method were used to evaluate or explain the best radiomics machine learning model.

Results

The optimal radiomics model (RF Hybrid Feature model) demonstrated a relatively high degree of discrimination with an area under the receiver operating characteristic curve (AUC) of 0.87 (95% CI, 0.70–0.97; P < 0.001) for the validation cohort. Compared with the commonly used LASSO model (AUC, 0.78; 95% CI, 0.60–0.91; P < 0.01), there is a significant improvement in AUC in the validation set, net reclassification improvement, 0.79 (95% CI, 0.13–1.46; P < 0.05), and integrated discrimination improvement, 0. 20 (95% CI, 0.10–0.30; P < 0.001).

Conclusion

The interpretable radiomics model based on CT performs well in predicting benign and malignant TNs by using quantitative radiomics features of the unilateral total thyroid. In addition, the data preprocessing method incorporating different layers of features has achieved excellent experimental results.

Clinical relevance statement

As the detection rate of TNs continues to increase, so does the diagnostic burden on radiologists. This study establishes a noninvasive, interpretable and accurate machine learning model to rapidly identify the nature of TN found in CT.
Head-to-Head Comparison of 18F-FDG and 68Ga-FAPI-04 PET/CT for Radiological Evaluation of Cervical Cancer
Authors: Shu Qiaoqiao , He Xubing , Chen Xi , Liu Mengna , Chen Yue , Cai Liang
Published: September 2023

Purpose

We aimed to compare the potential value of 68Ga-FAPI-04 and 18F-FDG PET/CT in primary cervical cancer and lymph node metastases.

Methods

Patients with cervical cancer underwent both 68Ga-FAPI-04 and 18F-FDG PET/CT. Histopathology and follow-up CT or MRI results (at least 3 months of follow-up) were used as reference criteria. Paired-sample t test was used to compare the SUVmax of 18F-FDG and 68Ga-FAPI-04 PET/CT for cervical cancer primary lesions and metastatic lymph nodes.

Results

A total of 35 patients with a mean age of 53 ± 11 years (range, 30–76 years) were included. The detection rate of both tracers for primary tumors was 100%. There was no significant correlation between 18F-FDG and 68Ga-FAPI-04 for SUVmax (14.5 ± 5.7 vs 15.1 ± 6.2; P = 0.645). In addition, the detection rates of 68Ga-FAPI-04 and 18F-FDG for lymph node metastasis were 100% and 98%, respectively. No significant difference was found in SUVmax between 18F-FDG and 68Ga-FAPI-04 groups (7.6 ± 4.0 vs 7.0 ± 3.5; P = 0.572). Twelve false-positive lymph nodes were detected in 8 patients with 18F-FDG PET/CT, none of which were developed on 68Ga-FAPI-04 PET/CT.

Conclusion

68Ga-FAPI-04 PET/CT has a high tracer rate for the diagnosis of primary cervical cancer and lymph node metastases. Moreover, 68Ga-FAPI-04 PET/CT also showed good results in distinguishing metastatic lymph nodes from reactive lymph nodes of cervical cancer.
Increased Uptake in Microcystic Serous Cystadenoma Mimicking Pancreatic Neuroendocrine Tumor on 68Ga-DOTATATE PET/MRI
Authors: Gao Jing , Liu Chang , Zhou Jinxin , Lin Xiaozhu , Zhang Yifan
Published: September 2023

A 2.6-cm solid cystic lesion in the pancreatic head was found in a 51-year-old woman on CT. A pancreatic neuroendocrine tumor was suspected, and a 68Ga-DOTATATE PET/MRI was performed, which showed increased tracer uptake in the lesion. However, postsurgical pathologic examination indicated a pancreatic serous cystadenoma. Here, we reported a case of microcystic pancreatic serous cystadenoma that could be misdiagnosed as a pancreatic neuroendocrine tumor on a 68Ga-DOTATATE PET/MRI.
A Retrospective Analysis of Ultrasonic Diagnosis of Neonatal Respiratory Distress Syndrome
Authors: Hu Ling , Zhu Shuo
Published: September 2023

The aim of the study was to investigate ultrasound's diagnostic capabilities for infant respiratory distress syndrome. Retrospective analysis was performed on the clinical information of 96 newborns with respiratory distress syndrome who were treated at our hospital between July 2015 and October 2017. The patients were split into the mild group (n = 55) and the severe group based on the findings of the chest x-ray examinations (n = 41). All neonates underwent an ultrasound examination at baseline, 12 hours after treatment and 24 hours after treatment of pulmonary surfactant (PS). Between the 2 groups, ultrasonographic characteristics and imaging scores were compared between infants with and without PS treatment. When compared with the severe group, the ultrasound score in the mild group was lower (P < 0.05). Before treatment, there was no statistically significant difference in ultrasound score between the PS treatment group and the non-PS treatment group (P > 0.05). At each time point after treatment, the ultrasonography score of the non-PS treatment group was greater than that of the PS treatment group (P < 0.05). Neonatal respiratory distress syndrome severity may be accurately assessed using ultrasound technology. Furthermore, the results of ultrasonography examinations may serve as a significant marker for assessing and measuring the severity of newborn respiratory distress syndrome.
New Sarculator Prognostic Nomograms for Patients with Primary Retroperitoneal Sarcoma
Authors: Callegaro Dario , Barretta Francesco , Raut Chandrajit P , Johnston Wendy , Strauss Dirk C , Honoré Charles , Bonvalot Sylvie , Fairweather Mark , Rutkowski Piotr , van Houdt Winan J. , Gladdy Rebecca A. , Tirotta Fabio , Tzanis Dimitiri , Skoczylas Jacek , Haas Rick L. , Miceli Rosalba , Swallow Carol J. , Gronchi Alessandro
Published: September 2023

Objective:

To update the current Sarculator retroperitoneal sarcoma (RPS) prognostic nomograms considering the improvement in patient prognosis and the case volume effect.

Summary Background Data:

Survival of patients with primary RPS has been increasing over time, and the volume-outcome relationship has been well recognized. Nevertheless, the specific impact on prognostic nomograms is unknown.

Methods:

All consecutive adult patients with primary localized RPS treated at 8 European and North American sarcoma reference centers between 2010 and 2017 were included. Patients were divided in two groups: high volume centers (HVC, ≥13 cases/year) and low volume centers (LVC, <13 cases/year). Primary endpoints were overall survival (OS) and disease free-survival (DFS). Multivariable analyses for OS and DFS were performed. The nomograms were updated by recalibration. Nomograms performance was assessed in terms of discrimination (Harrell C index) and calibration (calibration plot).

Results:

The HVC and LVC groups comprised 857 and 244 patients, respectively. Median annual primary RPS case volume (interquartile range) was 24.0 in HVC (15.0-41.3) and 9.0 in LVC (1.8-10.3). Five-year OS was 71.4% (95% CI 68.3-74.7%) in the HVC cohort and 63.3% (56.8-70.5%) in the LVC cohort (P=0.012). Case volume was associated with both OS (LVC vs. HVC HR 1.40, 95%CI 1.08-1.82, P=0.011) and DFS (HR 1.93, 95%CI 1.57-2.37, P<0.001) at multivariable analyses. When applied to the study cohorts, the Sarculator nomograms showed good discrimination (Harrell C index between 0.68 and 0.73). The recalibrated nomograms showed good calibration in the HVC group while the original nomograms showed good calibration in the LVC group.

Conclusions:

New nomograms for patients with primary RPS treated with surgery at high-volume versus low-volume sarcoma reference centers are available in the Sarculator app.
Survival bias in pediatric hemorrhagic shock: Are we misrepresenting the data?
Authors: Sullivan Travis M. , Sippel Genevieve J. , Gestrich-Thompson Waverly V. , Jensen Aaron R. , Burd Randall S.
Published: September 2023

BACKGROUND

Studies of hemorrhage following pediatric injury often use the occurrence of transfusion as a surrogate definition for the clinical need for a transfusion. Using this approach, patients who are bleeding but die before receiving a transfusion are misclassified as not needing a transfusion. In this study, we aimed to evaluate the potential for this survival bias and to estimate its presence among a retrospective observational cohort of children and adolescents who died from injury.

METHODS

We obtained patient, injury, and resuscitation characteristics from the 2017 to 2020 Trauma Quality Improvement Program database of children and adolescents (younger than 18 years) who arrived with or without signs of life and died. We performed univariate analysis and a multivariable logistic regression to analyze the association between the time to death and the occurrence of transfusion within 4 hours after hospital arrival controlling for initial vital signs, injury type, body regions injured, and scene versus transfer status.

RESULTS

We included 6,063 children who died from either a blunt or penetrating injury. We observed that children who died within 15 minutes had lower odds of receiving a transfusion (odds ratio, 0.1; 95% confidence interval, 0.1–0.2) compared with those who survived longer. We estimated that survival bias that occurs when using transfusion administration alone to define hemorrhagic shock may occur in up to 11% of all children who died following a blunt or penetrating injury but less than 1% of all children managed as trauma activations.

CONCLUSION

Using the occurrence of transfusion alone may underestimate the number of children who die from uncontrolled hemorrhage early after injury. Additional variables than just transfusion administration are needed to more accurately identify the presence of hemorrhagic shock among injured children and adolescents.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
Diagnostic Value of Intermittent Photic Stimulation Among Adult Patients in a Tertiary Referral Epilepsy Center: A Retrospective Study
Authors: Steinhoff Bernhard J. , Intravooth Tassanai , Gupta Jitender , Bernedo-Paredes Viviane , Mahn Patricia , Stockinger Jakob , Martin Peter , Staack Anke M.
Published: September 2023

Purpose:

Photosensitivity is a phenomenon that may be elicited by standardized intermittent photic stimulation during EEG recording and is detected more frequently in children and adolescents. Nevertheless, at our Epilepsy Center, we routinely assess photosensitivity in all newly referred adult patients. In this investigation, we sought to address the diagnostic yield under the prerequisites described.

Methods:

We reanalyzed all routine EEG recordings among referrals to the department of adults during the first six months of 2019, including a simultaneous video that is always coregistered in our center. The prevalence of abnormal findings during photic stimulation was assessed.

Results:

Intermittent photic stimulation was performed on 344 patients. Photoparoxysmal response were detected in five subjects (1.5%). All patients were female. Four patients were diagnosed with idiopathic generalized epilepsy, and one with Doose syndrome. Photomyogenic responses were recorded in 1.1% and only in patients with psychogenic nonepileptic seizures. In two subjects with psychogenic nonepileptic seizures, the typical seizure was provoked by intermittent photic stimulation (8.7% of all subjects with psychogenic nonepileptic seizures in this cohort). Photoparoxysmal response was not detected in any subject with focal epilepsy, syncope, or other nonepileptic paroxysmal events. In every case of photoparoxysmal responses, increased photosensitivity had already been reported before recording.

Conclusions:

In our study, photoparoxysmal responses was a rare phenomenon among adults with a preponderance of females and idiopathic generalized epilepsies. Intermittent photic stimulation may be helpful in provoking typical psychogenic nonepileptic seizures and thus abbreviate the diagnostic process. Provided a careful history, routine intermittent photic stimulation in adults with epilepsy does not appear to be mandatory.
Correlation Between Quantitative Background Suppression on EEG and Serum NSE in Patients With Hypoxic-ischemic Encephalopathy
Authors: Lee Dong Ah , Sohn Gyeong Mo , Kim Byung Joon , Yoo Byung Chul , Lee Jae Hyeok , Choi Hyun Ju , Kim Sung Eun
Published: September 2023

Purpose:

We evaluated the correlation between quantitative background activities on electroencephalography (EEG) and serum neuron specific enolase (NSE) in patients with hypoxic-ischemic encephalopathy as well as a diagnostic value of prognostication.

Methods:

This retrospective cohort study enrolled patients with return of spontaneous circulation after cardiac arrest from March 2010 to March 2020. The inclusion criteria were (1) older than the age of 16 years and (2) patients who had both EEG and NSE. The median time for EEG and NSE were 3 days (interquartile range 2–5 days) and 3 days (interquartile range 2–4 days), respectively. The quantification of background activity was conducted with the suppression ratio (SR). We used a machine learning (eXtreme Gradient Boosting algorithm) to evaluate whether the SR could improve the accuracy of prognostication.

Results:

We enrolled 151 patients. The receiver operating characteristic analysis revealed a cut-off value of serum NSE and the SR for poor outcome, serum NSE (>31.9 μg/L, area under curve [AUC] = 0.88), and the SR (>21.5%, AUC = 0.75 in the right hemisphere, >34.4%, AUC = 0.76 in the left hemisphere). There was a significant positive correlation between the severity of SR and the level of NSE (ρ = 0.57, p < 0.0001 for the right hemisphere, ρ = 0.58, p < 0.0001 for the left hemisphere). The SR showed an excellent diagnostic value for predicting poor outcome (93% specificity, 60% sensitivity in the right hemisphere and 93% specificity, 58% sensitivity in the left hemisphere). With machine learning analysis, there was an increment in distinguishing the neurological outcome by adding SR on clinical factors.

Conclusions:

The SR showed a positive correlation with the level of serum NSE. The diagnostic value of the SR for predicting poor outcome was excellent, suggesting that it can be a possible biomarker for neuroprognostication in patients with hypoxic-ischemic encephalopathy.
Genome-wide association study of antisocial personality disorder diagnostic criteria provides evidence for shared risk factors across disorders
Authors: Li Wenqianglong , Zhou Hang , Thygesen Johan H. , Heydtmann Mathis , Smith Iain , Degenhardt Franziska , Nöthen Markus , Morgan Marsha Y. , Kranzler Henry R. , Gelernter Joel , Bass Nicholas , McQuillin Andrew
Published: September 2023

Introduction

While progress has been made in determining the genetic basis of antisocial behaviour, little progress has been made for antisocial personality disorder (ASPD), a condition that often co-occurs with other psychiatric conditions including substance use disorders, attention deficit hyperactivity disorder (ADHD), and anxiety disorders. This study aims to improve the understanding of the genetic risk for ASPD and its relationship with other disorders and traits.

Methods

We conducted a genome-wide association study (GWAS) of the number of ASPD diagnostic criteria data from 3217 alcohol-dependent participants recruited in the UK (UCL, N = 644) and the USA (Yale-Penn, N = 2573).

Results

We identified rs9806493, a chromosome 15 variant, that showed a genome-wide significant association (Z-score = −5.501, P = 3.77 × 10−8) with ASPD criteria. rs9806493 is an eQTL for SLCO3A1 (Solute Carrier Organic Anion Transporter Family Member 3A1), a ubiquitously expressed gene with strong expression in brain regions that include the anterior cingulate and frontal cortices. Polygenic risk score analysis identified positive correlations between ASPD and smoking, ADHD, depression traits, and posttraumatic stress disorder. Negative correlations were observed between ASPD PRS and alcohol intake frequency, reproductive traits, and level of educational attainment.

Conclusion

This study provides evidence for an association between ASPD risk and SLCO3A1 and provides insight into the genetic architecture and pleiotropic associations of ASPD.
Visual feedback influences the consistency of the locomotor pattern in Asian elephants (
Elephas maximus
)
Authors: Kurz Max J. , Hutchinson John R.
Published: September 2023

Elephants are atypical of most quadrupeds in that they maintain the same lateral sequence footfall pattern across all locomotor speeds. It has been speculated that the preservation of the footfall patterns is necessary to maintain a statically stable support polygon. This should be a particularly important constraint in large, relatively slow animals. This suggests that elephants must rely on available sensory feedback mechanisms to actively control their massive pillar-like limbs for proper foot placement and sequencing. How the nervous system of elephants integrates the available sensory information for a stable gait is unknown. Here we explored the role that visual feedback plays in the control of the locomotor pattern in Asian elephants. Four Asian elephants (
Elephas maximus)
walked with and without a blindfold as we measured their stride time intervals. Coefficient of variation was used to assess changes in the overall variability of the stride time intervals, while approximate entropy was used to measure the stride-to-stride consistency of the time intervals. We show that visual feedback plays a role in the stride-to-stride consistency of the locomotor pattern in Asian elephants. These results suggest that elephants use visual feedback to correct and maintain proper sequencing of the limbs during locomotion.
Mitochondrial uniparental inheritance achieved after fertilization challenges the nuclear–cytoplasmic conflict hypothesis for anisogamy evolution
Authors: Togashi Tatsuya , Parker Geoff A. , Horinouchi Yusuke
Published: September 2023

In eukaryotes, a fundamental phenomenon underlying sexual selection is the evolution of gamete size dimorphism between the sexes (anisogamy) from an ancestral gametic system with gametes of the same size in both mating types (isogamy). The nuclear–cytoplasmic conflict hypothesis has been one of the major theoretical hypotheses for the evolution of anisogamy. It proposes that anisogamy evolved as an adaptation for preventing nuclear–cytoplasmic conflict by minimizing male gamete size to inherit organelles uniparentally. In ulvophycean green algae, biparental inheritance of organelles is observed in isogamous species, as the hypothesis assumes. So we tested the hypothesis by examining whether cytoplasmic inheritance is biparental in
Monostroma angicava
, a slightly anisogamous ulvophycean that produces large male gametes. We tracked the fates of mitochondria in intraspecific crosses with PCR-RFLP markers. We confirmed that mitochondria are maternally inherited. However, paternal mitochondria enter the zygote, where their DNA can be detected for over 14 days. This indicates that uniparental inheritance is enforced by eliminating paternal mitochondrial DNA in the zygote, rather than by decreasing male gamete size to the minimum. Thus, uniparental cytoplasmic inheritance is achieved by an entirely different mechanism, and is unlikely to drive the evolution of anisogamy in ulvophyceans.