bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of the COVID-19 Pandemic on Injuries Related to Individual and Team Sports: An Analysis of the NEISS Database Between 2017 and 2021
Authors: Leipman Jessica , Shahriar Rajin
Published: October 2023

Background:

The first 2 years of the coronavirus 2019 (COVID-19) pandemic had a profound effect on youth sports participation.

Purpose:

The primary aim of this study was to explore the effect of the COVID-19 pandemic on youth sports injury patterns, with a secondary aim of comparing organized team and individual sport–related injuries in diverse age groups.

Study Design:

Descriptive epidemiology study.

Methods:

The National Electronic Injury Surveillance System (NEISS) was searched to identify injuries sustained by patients aged 11 to 23 years while playing organized team or individual sports from 2017 to 2021. We investigated reports of concussions, dislocations, fractures, and sprains/strains.

Results:

Between 2017 and 2021, there were 58,721 and 3778 team and individual sport–related injuries, respectively. When compared with the prepandemic years, there was a 57.07% decrease in 2020 and 22.31% decrease in 2021 for the number of organized team sport–related injuries. Organized individual sport–related injuries had a 56.24% and 35.18% decrease in number in 2020 and 2021, respectively. Male patients were most likely to be injured in team sports (81.0%), and female patients were most likely to be injured in individual sports (67.1%). High school athletes sustained the majority of injuries in team (57.0%) and individual (51.2%) sports. The years 2020 and 2021 saw a decrease in proportion of sprains/strains and an increase in proportion of fractures.

Conclusion:

The number of organized sport–related injuries reported to emergency departments decreased in 2020, and despite vaccinations and easing of social distancing, the 2021 value did not return to what it was prepandemic. As coronavirus-related restrictions have eased, there should be careful monitoring of sports injuries among youth athletes.
Mental Health Nurses’ Social Representations of People Who Experience Mental Illness: A Story of Paradoxes
Authors: Kallai Delphine , März Virginie , de Timary Philippe , De Mol Jan
Published: October 2023

Public representations of people who experience mental illness (PEMI) have been well documented within the stigma literature. However, studies about mental health nurses’ representations of PEMI are still scarce and characterized by contradictions. Using the theoretical concept of social representation instead of stigma, the current study aims to explore and understand mental health nurses’ social representations of PEMI. Qualitative research was conducted based on 13 semi-structured interviews with nurses from two psychiatric units in general hospitals. Data were analyzed using interpretative phenomenological analysis. Results showed that nurses’ social representations were characterized by paradoxes. They explicitly displayed positive social representations, while nuancing them from an implicit point of view. The nurses wanted to work toward a destigmatizing voice for PEMI while nuancing their assertions to sound honest and accurate, which led them to a state of cognitive dissonance.
Efficacy of Anakinra Treatment in two Moroccan Patients With Mevalonate Kinase Deficiency
Authors: Souali Manal , Sakhi Asmaa , Bousfiha Ahmed Aziz , Bouayed Kenza
Published: October 2023

Mevalonate kinase deficiency (MKD) is a rare hereditary autoinflammatory disease, with a widely variable clinical spectrum. It is characterized by febrile recurrent episodes and systemic inflammation. Data on therapeutic options for MKD are still limited and remain unknown in our country. We report Moroccan cases with MKD referred in our unit and treated with Anakinra, an interleukin-1 receptor antagonist. Through this study, we evaluate the efficacy of this bioagent, in our 2 MKD patients, in whom Anakinra has shown a complete clinical remission, with a remaining mild inflammation for one case, and normalization of growth with rare episodes of cervical adenopathies for the second case. Our experience provides an additional argument supporting the efficacy of Anakinra treatment, demonstrated previously but still lacks of objective data.
How to improve quality investing
Authors: Otero González Luis , Durán Santomil Pablo , Vieito João Paulo da Torre , Reboredo Juan Carlos
Published: October 2023

In this article, we evaluate the relationship between quality investing combined with Economic Moat, ESG (Environmental, Social and Governance) and analyst opinions over the period 2014–2020 based on a data set comprising 803 US stocks. Performance is evaluated using several metrics (returns and alphas). Our results show that quality stocks measured by return on invested capital (ROIC) exhibit superior performance. The incorporation of competitive advantages allows a better discrimination among the classic high-quality strategies. Investment in stocks with quality and high ESG entails the payment of a premium but buying quality companies with Economic Moat makes up for this negative aspect. The results show how quality companies that have competitive advantages obtain a better future performance and are recognized by the market with a higher valuation. However, the markets may take time to recognize this value since the incorporation of the average Price-to-Price target (Analyst consensus) increases the future performance.

JEL classification: G11; G14; G23
Recommended Changes to Standard of Care for Monitoring of Cortically Blind Fields
Authors: Willis Hanna E. , Cavanaugh Matthew R.
Published: October 2023

Global incidence of stroke has risen 70% in the last 30 years, affecting approximately 25% of adults throughout the course of their lives. Up to 60% of stroke survivors will suffer visual impairments, which significantly reduce quality of life and independence. Despite the high prevalence, patients are hugely underserved by the medical and research communities. Clinical care is variable throughout the United States and United Kingdom, with only 57% of patients receiving visual field assessments and 61% stating their need for support has not been fully met. Additionally, unlike stroke survivors with motor or language deficits, those with vision loss are rarely offered visual rehabilitation. This is despite recent research into the efficacy of visual training and the propensity for the visual deficit to worsen in the absence of an intervention. This article reviews common gaps in patient care and proposes policy changes to increase awareness of the condition, foster clinical and scientific advances in treatment, and enhance patient outcomes.
Project Prakash: Merging Basic Science and Societal Service in Vision Research
Authors: Gilad-Gutnick Sharon
Published: October 2023

For nearly 20 years, Prakash has created a humanitarian-scientific synergy by treating congenitally blind children in rural India, then following their visual development to understand how the human brain learns to see. From solving a 300-year-old conundrum to deconstructing the “critical window” of neuroplasticity, Prakash has led to new ways of thinking about development. Unfortunately, many children suffering from treatable congenital blindness around the world remain untreated due to a persistent belief that improvements are not possible past a “critical age” of 5–7 years old. Here, a review of the data identifies an urgent need to engage with stakeholders across the global medical community to disseminate Prakash's findings and overturn these entrenched dogmas. Toward that end, recent partnerships with eye-health organizations expand the reach of this approach and cultivate a cohesive global network. Prakash exemplifies both evidence-based intervention and intervention-based scientific discovery.
Human-Centric Lighting Research and Policy in the Melanopsin Age
Authors: Spitschan Manuel , Joyce Daniel S.
Published: October 2023

Beyond visual function, specialized light-sensitive retinal circuits involving the photopigment melanopsin drive critical aspects of human physiology and behavior, including sleep–wake rhythms, hormone production, mood, and cognition. Fundamental discoveries of visual neurobiology dating back to the 1990s have given rise to strong interest from the lighting industry in optimizing lighting to benefit health. Consequently, evidence-based recommendations, regulations, and policies need to translate current knowledge of neurobiology into practice. Here, reviewing recent advances in understanding of NIF circuits in humans leads to proposed strategies to optimize electric lighting. Highlighted knowledge gaps must be addressed urgently, as well as the challenge of developing personalized, adaptive NIF lighting interventions accounting for complex individual differences in physiology, behavior, and environment. Finally, lighting equity issues appear in the context of marginalized groups, who have traditionally been underserved in research on both fundamental visual processes and applied lighting. Biologically optimal light is a fundamental environmental right.
CAR T cells and time-limited ibrutinib as treatment for relapsed/refractory mantle cell lymphoma: the phase 2 TARMAC study
Authors: Minson Adrian , Hamad Nada , Cheah Chan Y. , Tam Constantine , Blombery Piers , Westerman David , Ritchie David , Morgan Huw , Holzwart Nicholas , Lade Stephen , Anderson Mary Ann , Khot Amit , Seymour John F. , Robertson Molly , Caldwell Imogen , Ryland Georgina , Saghebi Javad , Sabahi Zahra , Xie Jing , Koldej Rachel , Dickinson Michael
Published: October 2023

CD19-directed chimeric antigen receptor T cells (CAR-T) achieve high response rates in patients with relapsed/refractory mantle cell lymphoma (MCL). However, their use is associated with significant toxicity, relapse concern, and unclear broad tractability. Preclinical and clinical data support a beneficial synergistic effect of ibrutinib on apheresis product fitness, CAR-T expansion, and toxicity. We evaluated the combination of time-limited ibrutinib and CTL019 CAR-T in 20 patients with MCL in the phase 2 TARMAC study. Ibrutinib commenced before leukapheresis and continued through CAR-T manufacture for a minimum of 6 months after CAR-T administration. The median prior lines of therapy was 2; 50% of patients were previously exposed to a Bruton tyrosine kinase inhibitor (BTKi). The primary end point was 4-month postinfusion complete response (CR) rate, and secondary end points included safety and subgroup analysis based on TP53 aberrancy. The primary end point was met; 80% of patients demonstrated CR, with 70% and 40% demonstrating measurable residual disease negativity by flow cytometry and molecular methods, respectively. At 13-month median follow-up, the estimated 12-month progression-free survival was 75% and overall survival 100%. Fifteen patients (75%) developed cytokine release syndrome; 12 (55%) with grade 1 to 2 and 3 (20%) with grade 3. Reversible grade 1 to 2 neurotoxicity was observed in 2 patients (10%). Efficacy was preserved irrespective of prior BTKi exposure or TP53 mutation. Deep responses correlated with robust CAR-T expansion and a less exhausted baseline T-cell phenotype. Overall, the safety and efficacy of the combination of BTKi and T-cell redirecting immunotherapy appears promising and merits further exploration. This trial was registered at www.ClinicalTrials.gov as #NCT04234061.
Cerebral hemodynamic changes after haploidentical hematopoietic stem cell transplant in adults with sickle cell disease
Authors: Aumann Megan A. , Richerson Wesley , Song Alexander K. , Davis L. Taylor , Pruthi Sumit , Davis Samantha , Patel Niral J. , Custer Chelsea , Kassim Adetola A. , DeBaun Michael R. , Donahue Manus J. , Jordan Lori C.
Published: October 2023

Preliminary evidence from a series of 4 adults with sickle cell disease (SCD) suggests that hematopoietic stem cell transplant (HSCT) improves cerebral hemodynamics. HSCT largely normalizes cerebral hemodynamics in children with SCD. We tested the hypothesis in adults with SCD that cerebral blood flow (CBF), oxygen extraction fraction (OEF), and cerebral metabolic rate of oxygen (CMRO2) measured using magnetic resonance imaging, normalized to healthy values, comparing measurements from ∼1 month before to 12 to 24 months after HSCT (n = 11; age, 33.3 ± 8.9 years; 389 ± 150 days after HSCT) with age-, race- and sex-matched values from healthy adults without sickle trait (n = 28; age, 30.2 ± 5.6 years). Before transplant, 7 patients had neurological indications for transplant (eg, overt stroke) and 4 had nonneurological reasons for haploidentical bone marrow transplant (haplo-BMT). All received haplo-BMT from first-degree relatives (parent, sibling, or child donor) with reduced-intensity preparation and maintained engraftment. Before transplant, CBF was elevated (CBF, 69.11 ± 24.7 mL/100 g/min) compared with that of controls (P = .004). Mean CBF declined significantly after haplo-BMT (posttransplant CBF, 48.2 ± 13.9 mL/100 g/min; P = .003). OEF was not different from that of controls at baseline and did not change significantly after haplo-BMT (pretransplant, 43.1 ± 6.7%; posttransplant, 39.6 ± 7.0%; P = .34). After transplant, CBF and OEF were not significantly different from controls (CBF, 48.2 ± 13.4 mL/100 g/min; P = .78; and OEF, 39.6 ± 7.0%; P > .99). CMRO2 did not change significantly after haplo-BMT (pretransplant, 3.18 ± 0.87 mL O2/100 g/min; posttransplant, 2.95 ± 0.83; P = .56). Major complications of haplo-BMT included 1 infection-related death and 1 severe chronic graft-versus-host disease. Haplo-BMT in adults with SCD reduces CBF to that of control values and maintains OEF and CMRO2 on average at levels observed in healthy adult controls. The trial was registered at www.clinicaltrials.gov as #NCT01850108.
Real-world characteristics of “super-responders” to mepolizumab and benralizumab in severe eosinophilic asthma and eosinophilic granulomatosis with polyangiitis
Authors: Portacci Andrea , Campisi Raffaele , Buonamico Enrico , Nolasco Santi , Pelaia Corrado , Crimi Nunzio , Benfante Alida , Triggiani Massimo , Spadaro Giuseppe , Caiaffa Maria Filomena , Scioscia Giulia , Detoraki Aikaterini , Valenti Giuseppe , Papia Francesco , Tomasello Alessandra , Scichilone Nicola , Pelaia Girolamo , Crimi Claudia , Carpagnano Giovanna Elisiana
Published: October 2023

Background

The current definition of severe eosinophilic asthma (SEA) super-responders to biologic treatment does not include patients with other eosinophil-based comorbidities. Although eosinophilic granulomatosis with polyangiitis (EGPA) is frequently associated with SEA, we lack data on a possible super-response to biologic treatments in patients suffering from these two diseases. We aim to assess super-responder features in real-life patients with SEA and EGPA treated with mepolizumab and benralizumab.

Methods

We enrolled 39 patients with SEA and EGPA eligible for treatment with mepolizumab or benralizumab. Super-responder assessment was performed considering oral corticosteroid (OCS) cessation, lack of exacerbations, forced expiratory volume in 1 s and Asthma Control Test (ACT) improvement.

Results

Super-responders showed worse clinical baseline characteristics than non-super-responder patients, with a greater improvement in severe asthma exacerbations, OCS dose reduction and ACT score increase. Definition of super-responders was consistent only considering a 12-month course of monoclonal antibody, lacking sensitivity in earlier evaluations.

Conclusion

Mepolizumab and benralizumab are safe and effective in patients with EGPA and SEA, since a consistent proportion of patients show a super-response after 12 months of treatment. Further studies will address specific criteria for super-responder assessment in these patients.
Integrative genome-scale analyses reveal post-transcriptional signatures of early human small intestinal development in a directed differentiation organoid model
Authors: Hung Yu-Han , Capeling Meghan , Villanueva Jonathan W. , Kanke Matt , Shanahan Michael T. , Huang Sha , Cubitt Rebecca , Rinaldi Vera D. , Schimenti John C. , Spence Jason R. , Sethupathy Praveen
Published: October 2023

Background

MicroRNAs (miRNAs) are important post-transcriptional gene regulators controlling cellular lineage specification and differentiation during embryonic development, including the gastrointestinal system. However, miRNA-mediated regulatory mechanisms involved in early embryonic development of human small intestine (SI) remains underexplored. To explore candidate roles for miRNAs in prenatal SI lineage specification in humans, we used a multi-omic analysis strategy in a directed differentiation model that programs human pluripotent stem cells toward the SI lineage.

Results

We leveraged small RNA-seq to define the changing miRNA landscape, and integrated chromatin run-on sequencing (ChRO-seq) and RNA-seq to define genes subject to significant post-transcriptional regulation across the different stages of differentiation. Small RNA-seq profiling revealed temporal dynamics of miRNA signatures across different developmental events of the model, including definitive endoderm formation, SI lineage specification and SI regional patterning. Our multi-omic, integrative analyses showed further that the elevation of miR-182 and reduction of miR-375 are key events during SI lineage specification. We demonstrated that loss of miR-182 leads to an increase in the foregut master marker SOX2. We also used single-cell analyses in murine adult intestinal crypts to support a life-long role for miR-375 in the regulation of Zfp36l2. Finally, we uncovered opposing roles of SMAD4 and WNT signaling in regulating miR-375 expression during SI lineage specification. Beyond the mechanisms highlighted in this study, we also present a web-based application for exploration of post-transcriptional regulation and miRNA-mediated control in the context of early human SI development.

Conclusion

The present study uncovers a novel facet of miRNAs in regulating prenatal SI development. We leveraged multi-omic, systems biology approaches to discover candidate miRNA regulators associated with early SI developmental events in a human organoid model. In this study, we highlighted miRNA-mediated post-transcriptional regulation relevant to the event of SI lineage specification. The candidate miRNA regulators that we identified for the other stages of SI development also warrant detailed characterization in the future.
Transcriptomic analysis reveals a tissue-specific loss of identity during ageing and cancer
Authors: dos Santos Gabriel Arantes , Chatsirisupachai Kasit , Avelar Roberto A. , de Magalhães João Pedro
Published: October 2023

Introduction

Understanding changes in cell identity in cancer and ageing is of great importance. In this work, we analyzed how gene expression changes in human tissues are associated with tissue specificity during cancer and ageing using transcriptome data from TCGA and GTEx.

Results

We found significant downregulation of tissue-specific genes during ageing in 40% of the tissues analyzed, which suggests loss of tissue identity with age. For most cancer types, we have noted a consistent pattern of downregulation in genes that are specific to the tissue from which the tumor originated. Moreover, we observed in cancer an activation of genes not usually expressed in the tissue of origin as well as an upregulation of genes specific to other tissues. These patterns in cancer were associated with patient survival. The age of the patient, however, did not influence these patterns.

Conclusion

We identified loss of cellular identity in 40% of the tissues analysed during human ageing, and a clear pattern in cancer, where during tumorigenesis cells express genes specific to other organs while suppressing the expression of genes from their original tissue. The loss of cellular identity observed in cancer is associated with prognosis and is not influenced by age, suggesting that it is a crucial stage in carcinogenesis.
Antimicrobial resistance profiles of salmonella spp. and escherichia coli isolated from fresh nile tilapia (oreochromis niloticus) fish marketed for human consumption
Authors: Mumbo Millicent T. , Nyaboga Evans N. , Kinyua Johnson K. , Muge Edward K. , Mathenge Scholastica G. K. , Rotich Henry , Muriira Geoffrey , Njiraini Bernard , Njiru Joshua M.
Published: October 2023

Background

Salmonellaspp. and pathogenic strains ofEscherichia coliare among the major foodborne zoonotic pathogens. These bacterial pathogens cause human illnesses characterized by hemorrhagic colitis, vomiting, nausea, and other agent-related symptoms. The increasing occurrence of antimicrobial resistance in these pathogens is also a serious public health concern globally. Regular surveillance of phenotypes and genotypes ofSalmonellaspp. andEscherichia colifrom animal-derived foods is necessary for effective reduction and control of these foodborne pathogens. This study was conducted to assess the occurrence, antimicrobial resistance, virulence genes and genetic diversity ofSalmonellaspp. andE. coliisolates from fresh Nile tilapia obtained from retail markets in Nairobi, Kenya.

Methods

A total of 68 fresh Nile tilapia fish samples were collected from retail markets and used for isolation ofSalmonellaspp. andE. coli. Antimicrobial susceptibilities of the isolates weretested by Kirby-Bauer agar disc diffusion method. According to the antimicrobial resistance profiles, the multi-drug resistant isolates were identified by 16 S rRNA sequencing and phylogenetic analysis using the Bayesian inference method. The MDRSalmonellaspp. andE. coliisolates were subjected to PCR-based screening for the detection virulence and antibiotic resistance genes.

Results

The prevalence of contamination of the fish samples withSalmonellaspp. andE.coliwas 26.47% and 35.29% respectively. Overall phenotypic resistance among theSalmonellaspp. ranged from 5.5% for ceftazidime, chloramphenicol, meropenem, nitrofurantoin and streptomycin and 22.2% for penicillin-G. ForE. coliphenotypic resistance ranged from 4.2% for ceftazidime and chloramphenicol and 25% for rifampicin. Multi-drug resistance was observed in threeSalmonellaspp. and twoE. coliisolates. Results of 16 S rRNA sequences, sequence alignment and phylogenic trees confirmed the identified MDR isolates asS. typhymuriumWES-09,S. typhymuriumMAK-22,S. typhimuriumEMB-32 andE. coliMAK-26 andE. coliLAN-35. The presence of antibiotic-resistance genes belonging to β-lactamases, tetracycline, sulfonamide, trimethoprim and aminoglycosides-resistant genes were detected in all the identified MDR isolates.

Conclusions

The findings from this study indicate that Nile tilapia (Oreochromis niloticus) sold in retail markets can acts as reservoirs ofSalmonellaspp. andE.colipathogens linked to human disease, some of which were multidrug resistance to critically important antimicrobials. Both microorganisms are of zoonotic significance and represent a significant public health risk to the society.
Bacterial colony size growth estimation by deep learning
Authors: Nagy Sára Ágnes , Makrai László , Csabai István , Tőzsér Dóra , Szita Géza , Solymosi Norbert
Published: October 2023

The bacterial growth rate is important for pathogenicity and food safety. Therefore, the study of bacterial growth rate over time can provide important data from a medical and veterinary point of view. We trained convolutional neural networks (CNNs) on manually annotated solid medium cultures to detect bacterial colonies as accurately as possible. Predictions of bacterial colony size and growth rate were estimated from image sequences of independent Staphylococcus aureus cultures using trained CNNs. A simple linear model for control cultures with less than 150 colonies estimated that the mean growth rate was 60.3 $$\mu m/h$$

μ
m
/
h

for the first 24 h. Analyzing with a mixed effect model that also takes into account the effect of culture, smaller values of change in colony size were obtained (control: 51.0 $$\mu m/h$$

μ
m
/
h

, rifampicin pretreated: 36.5$$\mu m/h$$

μ
m
/
h

). An increase in the number of neighboring colonies clearly reduces the colony growth rate in the control group but less typically in the rifampicin-pretreated group. Based on our results, CNN-based bacterial colony detection and the subsequent analysis of bacterial colony growth dynamics might become an accurate and efficient tool for bacteriological work and research.
Prehospital factors associated with out-of-hospital cardiac arrest outcomes in a metropolitan city: a 4-year multicenter study
Authors: Ahn Jae Yun , Ryoo Hyun Wook , Moon Sungbae , Jung Haewon , Park Jungbae , Lee Won Kee , Kim Jong-yeon , Lee Dong Eun , Kim Jung Ho , Lee Sang-Hun
Published: October 2023

Background

Prehospital factors play a vital role in out-of-hospital cardiac arrest (OHCA) survivability, and they vary between countries and regions. We investigated the prehospital factors associated with OHCA outcomes in a single metropolitan city in the Republic of Korea.

Methods

This study included adult medical OHCA patients enrolled prospectively, using data from the citywide OHCA registry for patients registered between 2018 and 2021. The primary outcome was survival to hospital discharge. Multivariable logistic regression analysis was conducted to determine the factors associated with the study population’s clinical outcomes, adjusting for covariates. We performed a sensitivity analysis for clinical outcomes only for patients without prehospital return of spontaneous circulation prior to emergency medical service departure from the scene.

Results

In multivariable logistic regression analysis, older age (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.95–0.97), endotracheal intubation (adjusted odds ratio [aOR] 0.29; 95% [CIs] 0.17–0.51), supraglottic airway (aOR 0.29; 95% CI 0.17–0.51), prehospital mechanical chest compression device use (OR 0.13; 95% CI 0.08–0.18), and longer scene time interval (OR 0.96; 95% CI 0.93–1.00) were negatively associated with survival. Shockable rhythm (OR 24.54; 95% CI 12.99–42.00), pulseless electrical activity (OR 3.11; 95% CI 1.74–5.67), and witnessed cardiac arrest (OR 1.59; 95% CI 1.07–2.38) were positively associated with survival. In the sensitivity analysis, endotracheal intubation, supraglottic airway, prehospital mechanical chest compression device use, and longer scene time intervals were associated with significantly lower survival to hospital discharge.

Conclusions

Regional resuscitation protocol should be revised based on the results of this study, and modifiable prehospital factors associated with lower survival of OHCA should be improved.
Imaging findings and clinical relevance of 68Ga-Pentixafor PET in atherosclerosis: a systematic review
Authors: Wang Min , Zhang Jiayu , Ma Jiao , Liu Liyi , Wang Jia , Zhang Chunyin
Published: October 2023

Objective

We aimed to perform a qualitative synthesis of evidence on the role of 68Ga-Pentixafor PET in atherosclerosis.

Methods

A systematic search of the PubMed and Embase databases for studies reporting the evaluation of atherosclerotic lesions by 68Ga-Pentixafor PET was performed with a search time frame from database creation to 2022-12-26. The diagnostic test evaluation tool QUADAS-2 was used to evaluate the quality of the included literature and to perform descriptive analyses of relevant outcome indicators.

Results

A total of 6 studies with 280 patients were included. One study reported only imaging outcome metrics, while the other five studies reported imaging outcome metrics and clinical correlation metrics. For imaging outcomes, three studies reported imaging results for 68Ga-Pentixafor PET only, and the other three studies reported imaging results for comparative analysis of 68Ga-Pentixafor PET with 18F-FDG PET. For clinical correlation, three studies reported the correlation between tracer uptake and cardiovascular risk factors, one study reported the correlation between tracer uptake and plaque calcification, and one study reported the correlation between all three: tracer uptake, cardiovascular risk factors, and plaque calcification.

Conclusion

68Ga-Pentixafor PET has a good imaging effect on atherosclerotic lesions, and it is a promising imaging modality that may replace 18F-FDG PET for atherosclerosis imaging in the future. In patients with atherosclerosis, there is a clear clinical correlation between cardiovascular risk factors, tracer uptake, and plaque calcification.
Non-contrast low-dose CT can be used for volumetry of ADPKD
Authors: Yoo Jaeyeong , Kim Jin up , Kim Jisu , Jeon Sohyun , Song Young-jin , Choi Kwang-ho , Kim Seok-hyung , Yoon Jong-woo , Kim Hyunsuk
Published: October 2023

Background

Kidney volume provides important information for the diagnosis and prognosis of autosomal dominant polycystic kidney disease (ADPKD), as well as for the evaluation of the effects of drugs such as tolvaptan. Non-contrast computed tomography (CT) is commonly used for volumetry, and this study examined the correspondence and correlation of kidney volume measured by standard-dose or low-dose CT.

Methods

Axial standard-dose and low-dose CT images with 1-mm slices were obtained from 24 ADPKD patients. The kidney was segmented in the Synapse 3D software and the kidney volume was calculated using stereology. The kidney volume was compared between the two sets of images using R2, Bland-Altman plots, coefficient of variation, and intra-class correlation coefficients (ICCs).

Results

The mean age of the 24 patients was 48.4 ± 10.9 years, and 45.8% were men (n = 11). The mean total kidney volume on standard-dose CT was 1501 ± 838.2 mL. The R2 of volume between standard-dose and low-dose CT was 0.995. In the Bland-Altman plot, except for one case with a large kidney volume, the two measurements were consistent, and the coefficient of variation and ICC were also good (0.02, 0.998). The CT radiation dose (dose-length product) was 229 ± 68 mGy·cm for standard-dose CT and 50 ± 19 mGy·cm for low-dose CT. A comparable volume was obtained with 20% of the radiation dose of standard-dose CT.

Conclusions

Standard-dose and low-dose CT showed comparable kidney volume in ADPKD. Therefore, low-dose CT can substitute for ADPKD volumetry while minimizing radiation exposure.
Qualitative assessment of the patient experience of primary hyperoxaluria type 1: an observational study
Authors: Danese David , Goss Diana , Romano Carla , Gupta Catherine
Published: October 2023

Background

Without effective intervention, primary hyperoxaluria type 1 (PH1) causes oxalate-induced kidney damage, leading to end-stage kidney disease and serious complications throughout the body. Although PH1 carries a heavy burden that impacts quality of life, literature on the experiences of those living with PH1 and caring for patients with PH1 is limited. This study aimed to describe the diagnostic journey in PH1 and characterize patients’ and caregivers’ self-reported experiences throughout the disease course.

Methods

This was an observational study involving in-depth, semi-structured telephone interviews. Dominant trends were assessed using constant comparative analysis to identify themes in interviewees’ descriptions of their experiences. Individuals aged ≥ 12 years and caregivers of children aged 6–17 years with genetically confirmed PH1 were eligible. Informed consent/assent and ability to read and speak English were required.

Results

Interviewees (16 patients, 12 caregivers) reported a prolonged diagnostic journey due to low disease awareness, among other factors. Upon diagnosis, PH1 was frequently symptomatic, typically involving kidney stone-related symptoms but also potentially symptoms arising beyond the kidneys. PH1 most commonly led to worry and social impairment in adolescents, impaired physical function in adults, and a range of impacts on caregivers. In late-stage disease, dialysis was the most burdensome aspect of living with PH1 (due to time requirements, limitations from living with a catheter, etc.), and this burden was exacerbated by the COVID-19 pandemic. Benefits desired from PH1 management included reductions in laboratory measures of oxalate burden, kidney stone and urination frequency, and oxalate-related skin ulcers.

Conclusions

PH1 greatly impacts patients’ and caregivers’ lives, primarily due to burdensome disease manifestations and associated emotional, physical, and practical impacts, as well as disease management challenges – particularly those related to dialysis in late-stage disease.
Estimating the association between systemic Interleukin-6 and mortality in the dialysis population. Re-analysis of the global fluid study, systematic review and meta-analysis
Authors: Istanbuly Obaida , Belcher John , Tabinor Matthew , Solis-Trapala Ivonne , Lambie Mark , Davies Simon J
Published: October 2023

Background

Systemic inflammation, measured as circulating Interleukin-6 (IL-6) levels, is associated with cardiovascular and all-cause mortality in chronic kidney disease. However, this has not been convincingly demonstrated in a systematic review or a meta-analysis in the dialysis population. We provide such evidence, including a re-analysis of the GLOBAL Fluid Study.

Methods

Mortality in the GLOBAL fluid study was re-analysed using Cox proportional hazards regression with IL-6 levels as a covariate using a continuous non-logarithmic scale. Literature searches of the association of IL-6 levels with mortality were conducted on MEDLINE, EMBASE, PyschINFO and CENTRAL. All studies were assessed for risk of bias using the QUIPS tool. To calculate a pooled effect size, studies were grouped by use of IL-6 scale and included in the meta-analysis if IL-6 was analysed as a continuous linear covariate, either per unit or per 10 pg/ml, in both unadjusted or adjusted for other patient characteristics (e.g. age, comorbidity) models. Funnel plot was used to identify potential publication bias.

Results

Of 1886 citations identified from the electronic search, 60 were included in the qualitative analyses, and 12 had sufficient information to proceed to meta-analysis after full paper screening. Random effects meta-analysis of 11 articles yielded a pooled hazard ratio (HR) per pg/ml of 1.03, (95% CI 1.01, 1.03),$${I}^{2}$$= 81%. When the analysis was confined to seven articles reporting a non-adjusted HR the result was similar: 1.03, per pg/ml (95% CI: 1.03, 1.06),$${I}^{2}$$=92%. Most of the heterogeneity could be attributed to three of the included studies. Publication bias could not be determined due to the limited number of studies.

Conclusion

This systematic review confirms the adverse association between systemic IL-6 levels and survival in people treated with dialysis. The heterogeneity that we observed may reflect differences in study case mix.

Systematic Review Registration

PROSPERO - CRD42020214198.
Perceptions and attitudes of kidney supportive care among elderly patients with advanced chronic kidney disease and dialysis healthcare professionals in China: a qualitative study
Authors: Li Xue , Luo Jin Kai
Published: October 2023

Purpose

Kidney supportive care (KSC) represents a novel approach wherein a multidisciplinary team of nephrology experts offers active symptom management, advance care planning, shared decision-making, conservative treatment, and end-of-life care. This study is aimed at providing comprehensive insights and evaluations regarding the understanding and perspectives of Chinese healthcare professionals, including nephrologists and dialysis nurses, as well as elderly individuals aged 60 and above who are afflicted with chronic kidney disease. The primary goal is to furnish substantial information support for a better comprehension of KSC within the Chinese context, with the ultimate aim of facilitating its effective implementation in this region.

Methods

Employing a phenomenological framework, this qualitative research generated data using semi-structured interviews with 18 elderly patients diagnosed with advanced chronic kidney disease and 10 healthcare professionals across two Class III Grade A medical institutions. The Colaizzi’s analytical method was utilized for coding and analyzing the interview data.

Results

Distinct interviews were executed with patients and healthcare professionals to delineate specific themes for each group. For elderly dialysis patients, the following themes were formed: (1) Lack of understanding of KSC; (2) Concerns of how KSC is perceived; and (3) Perceived benefits of KSC. Within the healthcare professionals cohort, two salient themes emerged: (1) Prospective clinical merits of KSC ; and (2) Mltiple difficulties encountered.

Conclusions

This study goes some way in furnishing a holistic understanding of perceptions surrounding KSC among elderly patients undergoing dialysis and healthcare professionals in China. The overarching Chinese cultural ethos poses substantial challenges to the widespread assimilation of KSC. While healthcare professionals advocate for KSC, there remains a limit in the patients’ comprehension of this therapeutic paradigm. There is a compelling imperative to cultivate this strategy, grounded in the prevailing medical landscape.
Acute lower extremity arterial thrombosis associated with nephrotic syndrome in adults: case series and literature review
Authors: Han Xinqiang , Zhao Peng , Wang Zhu , Ji Xingang , Zhao Mengpeng
Published: October 2023

Background

Nephrotic syndrome (NS) is a condition associated with hypercoagulability. Thromboembolic events are a well-recognized complication of NS. Venous thrombosis is well known, while arterial thrombosis, which is more severe, occurs less frequently and is mainly reported in children in the literature. The aim of this study was to understand these rare adult cases of NS associated with acute lower extremity arterial thrombosis and draw attention to them to prevent misdiagnosis and delayed treatment.

Methods

From January 2011 and October 2022, we conducted a retrospective study of patients with NS and arterial thrombosis. Their clinical manifestations, imaging characteristics, treatments and outcomes were analyzed and compared, and a literature review was performed.

Results

Nine adults with NS and acute lower limb arterial thrombosis were described. In seven of these patients, six had fresh thrombi that preceded the NS diagnosis, while one had a history of NS for 14 years and previously underwent an emergency thrombectomy. Three of the seven patients eventually underwent above-knee amputations, and the other four underwent arterial revascularization with satisfactory recovery of lower-extremity perfusion. In addition to the seven patients mentioned above, the other two received successful anticoagulant treatment, as the thrombosis was present only in the popliteal artery.

Conclusion

Acute lower extremity arterial thrombosis is a rare but serious and potentially lethal complication in patients with NS, and early recognition and appropriate management are crucial for good patient outcomes.
Maternal complications and risk factors associated with assisted vaginal delivery
Authors: Chawanpaiboon Saifon , Titapant Vitaya , Pooliam Julaporn
Published: October 2023

Objective

This study aimed to elucidate the maternal complications and risk factors linked with assisted vaginal delivery.

Methods

We conducted a retrospective, descriptive analysis of hospital records, identifying 3500 cases of vaginal delivery between 2020 and 2022. Data encompassing demographics, complications from the vaginal delivery including post-partum haemorrhage, birth passage injuries, puerperal infection and other pertinent details were documented. Various critical factors, including the duration of the second stage of labor, maternal anemia, underlying maternal health conditions such as diabetes mellitus and hypertension, neonatal birth weight, maternal weight, the expertise of the attending surgeon, and the timing of deliveries were considered.

Results

The rates for assisted vacuum and forceps delivery were 6.0% (211/3500 cases) and 0.3% (12/3500), respectively. Postpartum haemorrhage emerged as the predominant complication in vaginal deliveries, with a rate of 7.3% (256/3500; P < 0.001). Notably, postpartum haemorrhage had significant associations with gestational diabetes mellitus class A1 (adjusted odds ratio [AOR] 1.46; 95% confidence interval [CI] 1.01–2.11; P = 0.045), assisted vaginal delivery (AOR 5.11; 95% CI 1.30–20.1; P = 0.020), prolonged second stage of labour (AOR 2.68; 95% CI 1.09–6.58; P = 0.032), elevated maternal weight (71.4 ± 12.2 kg; AOR 1.02; 95% CI 1.01–1.03; P = 0.003) and neonates being large for their gestational age (AOR 3.02; 95% CI 1.23–7.43; P = 0.016).

Conclusions

The primary complication arising from assisted vaginal delivery was postpartum haemorrhage. Associated factors were a prolonged second stage of labour, foetal distress, large-for-gestational-age neonates and elevated maternal weight. Cervical and labial injuries correlated with neonates being large for their gestational age. Notably, puerperal infections were related to maternal anaemia (haematocrit levels < 33%).

Clinical trial registration

Thai Clinical Trials Registry: 20220126004.
“Sorry for laughing, but it’s scary”: humor and silence in discussions of Colorectal Cancer with Urban American Indians
Authors: Buchwald Dedra S. , Bassett Deborah R. , Van Dyke Emily R. , Harris Raymond M. , Hanson Jessica D. , Tu Shin-Ping
Published: October 2023

Background

Given high rates of cancer mortality in Native communities, we examined how urban American Indian and Alaska Native elders talk about colorectal cancer (CRC) and CRC screening.

Methods

We conducted seven focus groups with a total of 46 participants in two urban clinics in the Pacific Northwest to assess participant awareness, perceptions, and concerns about CRC and CRC screening. Using speech codes theory, we identified norms that govern when and how to talk about CRC in this population.

Results

Our analyses revealed that male participants often avoided screening because they perceived it as emasculating, whereas women often avoided screening because of embarrassment and past trauma resulting from sexual abuse. Both men and women used humor to mitigate the threatening nature of discussions about CRC and CRC screening.

Conclusions

We offer our analytic results to assist others in developing culturally appropriate interventions to promote CRC screening among American Indians and Alaska Natives.
Graph Neural Network for representation learning of lung cancer
Authors: Aftab Rukhma , Qiang Yan , Zhao Juanjuan , Urrehman Zia , Zhao Zijuan
Published: October 2023

The emergence of image-based systems to improve diagnostic pathology precision, involving the intent to label sets or bags of instances, greatly hinges on Multiple Instance Learning for Whole Slide Images(WSIs). Contemporary works have shown excellent performance for a neural network in MIL settings. Here, we examine a graph-based model to facilitate end-to-end learning and sample suitable patches using a tile-based approach. We propose MIL-GNN to employ a graph-based Variational Auto-encoder with a Gaussian mixture model to discover relations between sample patches for the purposes to aggregate patch details into an individual vector representation. Using the classical MIL dataset MUSK and distinguishing two lung cancer sub-types, lung cancer called adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC), we exhibit the efficacy of our technique. We achieved a 97.42% accuracy on the MUSK dataset and a 94.3% AUC on the classification of lung cancer sub-types utilizing features.
Searching for airways biomarkers useful to identify progressive pulmonary fibrosis
Authors: Soccio Piera , Moriondo Giorgia , Scioscia Giulia , Leo Valentina , Tondo Pasquale , Salerno Luciana , Palange Paolo , Barbaro Maria Pia Foschino , Lacedonia Donato
Published: October 2023

Background

Idiopathic pulmonary fibrosis (IPF) is a chronic and progressive disorder with unknown etiology. To date, the identification of new diagnostic, prognostic and progression biomarkers of IPF turns out to be necessary.

MicroRNA (miRNA) are small non-coding RNAs which negatively regulate gene expression at the post-transcriptional level in several biological and pathological processes. An aberrant regulation of gene expression by miRNA is often associated with various diseases, including IPF. As result, miRNAs have emerged as potential biomarkers with relevance to pulmonary fibrosis.

Several reports suggested that miRNAs are secreted as microvesicles or exosome, and hance they are stable and can be readily detected in the circulation. In the contest of miRNAs as circulating biomarkers, different studies show their role in various types of interstitial lung diseases and suggest that these small molecules could be used as prognostic markers of the disease.

Exosomes are small, lipid-bound vesicles able to carry various elements of the naïve cells such as proteins, lipids, mRNAs and miRNA to facilitate cell communication under normal and diseases condition. Exosomal miRNAs (exo-miRNA) have been studied in relation to many diseases. However, there is little or no knowledge regarding exo-miRNA in bronchoalveolar lavage (BAL) in IPF.

Our study's aim is to evaluate the changes in the expression of two exo-miRNAs in BAL, respectively miR-21 and miR-92a, through highlighting the differences between IPF, progressive pulmonary fibrosis (PPF) and not-progressive pulmonary fibrosis (nPPF).

Methods

Exosomes were characterized by Western Blot and Multiplex Surface Marker Analysis. Exosomal miRNA expression was performed by qRT-PCR. ANOVA or Kruskal–Wallis test, based on data normality, was used to compare the differential expression between groups.

Results

MiR-21 expression was significantly higher in the nPPF group than in both IPF and PPF. A result that could point above a possible role of miR-21, as a biomarker in the differential diagnosis between PPF and nPPF. MiR-92a, indeed, was down regulated in PPF compared to IPF and down regulated in PPF compared to nPPF.

Conclusions

This study demonstrated the putative role of both miR-21 and miR-92a as possible biomarkers of pulmonary fibrosis progression. Moreover, the role of exo-miRNAs is examined as a possible future direction that could lead to new therapeutic strategies for the treatment of progressive and non-progressive pulmonary fibrosis.
Impact of antigen identification on transplant free survival in interstitial lung disease
Authors: Kypreos Margaret , Batra Kiran , Glazer Craig S. , Adams Traci N.
Published: October 2023

Introduction

Antigen identification impacts diagnosis as well as prognosis in patients with hypersensitivity pneumonitis. An antigen may also be present in other etiologies of interstitial lung disease, however it is unknown whether identification impacts survival.

Methods

We evaluated a retrospective cohort in order to determine if antigen identification affects transplant free survival in patients with hypersensitivity pneumonitis, idiopathic pulmonary fibrosis, connective tissue disease interstitial lung disease, and interstitial pneumonia with autoimmune features. Only patients with definite or high probability of hypersensitivity pneumonitis by American Thoracic Society guidelines were included in the analysis.

Results

Transplant free survival was improved with antigen identification in patients with hypersensitivity pneumonitis but not in patients with idiopathic pulmonary fibrosis, connective tissue disease interstitial lung disease, and interstitial pneumonia with autoimmune features.

Conclusion

Our study suggests that removal of identified antigen in interstitial lung diseases other than hypersensitivity pneumonitis may not be impactful. Additionally, it further suggests that definitive diagnosis of hypersensitivity pneumonitis with bronchoalveolar lavage and transbronchial biopsy may be beneficial prior to recommending antigen removal.