bluuebunny/crossref_metadata_2025 huggingface dataset:
Intracortical myelin across laminae in adult individuals with 47,XXX: a 7 Tesla MRI study
Authors: Serrarens Chaira , Ruiz-Fernandez Julia , Otter Maarten , Campforts Bea C M , Stumpel Constance T R M , Linden David E J , van Amelsvoort Therese A M J , Kashyap Sriranga , Vingerhoets Claudia
Published: August 2024

47,XXX (Triple X syndrome) is a sex chromosome aneuploidy characterized by the presence of a supernumerary X chromosome in affected females and is associated with a variable cognitive, behavioral, and psychiatric phenotype. The effect of a supernumerary X chromosome in affected females on intracortical microstructure is currently unknown. Therefore, we conducted 7 Tesla structural MRI and compared T1 (ms), as a proxy for intracortical myelin (ICM), across laminae of 21 adult women with 47,XXX and 22 age-matched typically developing females using laminar analyses. Relationships between phenotypic traits and T1 values in 47,XXX were also investigated. Adults with 47,XXX showed higher bilateral T1 across supragranular laminae in the banks of the superior temporal sulcus, and in the right inferior temporal gyrus, suggesting decreases of ICM primarily within the temporal cortex in 47,XXX. Higher social functioning in 47,XXX was related to larger inferior temporal gyrus ICM content. Our findings indicate an effect of a supernumerary X chromosome in adult-aged women on ICM across supragranular laminae within the temporal cortex. These findings provide insight into the role of X chromosome dosage on ICM across laminae. Future research is warranted to further explore the functional significance of altered ICM across laminae in 47,XXX.
Ferric carboxymaltose and exercise capacity in heart failure with preserved ejection fraction and iron deficiency: the FAIR-HFpEF trial
Authors: von Haehling Stephan , Doehner Wolfram , Evertz Ruben , Garfias-Veitl Tania , Derad Carlotta , Diek Monika , Karakas Mahir , Birkemeyer Ralf , Fillippatos Gerasimos , Lainscak Mitja , Butler Javed , Ponikowski Piotr , Böhm Michael , Friede Tim , Anker Stefan D
Published: August 2024

Background and Aims

Evidence is lacking that correcting iron deficiency (ID) has clinically important benefits for patients with heart failure with preserved ejection fraction (HFpEF).

Methods

FAIR-HFpEF was a multicentre, randomized, double-blind trial designed to compare intravenous ferric carboxymaltose (FCM) with placebo (saline) in 200 patients with symptomatic HFpEF and ID (serum ferritin < 100 ng/mL or ferritin 100–299 ng/mL with transferrin saturation < 20%). The primary endpoint was change in 6-min walking test distance (6MWTD) from baseline to week 24. Secondary endpoints included changes in New York Heart Association class, patient global assessment, and health-related quality of life (QoL).

Results

The trial was stopped because of slow recruitment after 39 patients had been included (median age 80 years, 62% women). The change in 6MWTD from baseline to week 24 was greater for those assigned to FCM compared to placebo [least square mean difference 49 m, 95% confidence interval (CI) 5–93; P = .029]. Changes in secondary endpoints were not significantly different between groups. The total number of adverse events (76 vs. 114) and serious adverse events (5 vs. 19; rate ratio 0.27, 95% CI 0.07–0.96; P = .043) was lower with FCM than placebo.

Conclusions

In patients with HFpEF and markers of ID, intravenous FCM improved 6MWTD and was associated with fewer serious adverse events. However, the trial lacked sufficient power to identify or refute effects on symptoms or QoL. The potential benefits of intravenous iron in HFpEF with ID should be investigated further in a larger cohort.
The impact of digital interventions on health insurance coverage for reproductive, maternal, newborn and child health services utilization in Kakamega, Kenya: a cluster randomized controlled trial
Authors: Abajobir Amanuel , de Groot Richard , Wainaina Caroline , Pradhan Menno , Janssens Wendy , Sidze Estelle M
Published: August 2024

The National Hospital Insurance Fund (NHIF) of Kenya was upgraded to improve access to healthcare for impoverished households, expand universal health coverage, and boost the uptake of essential reproductive, maternal, newborn and child health (RMNCH) services. However, premiums may be unaffordable for the poorest households. The Innovative Partnership for Universal Sustainable Healthcare (i-PUSH) programme targets low-income women and their households to improve their access to and utilization of quality healthcare, including RMNCH services, by providing subsidized, mobile phone-based NHIF coverage in combination with enhanced, digital training of community health volunteers and upgrading of health facilities. This study evaluated whether expanded NHIF coverage increased the accessibility and utilization of quality basic RMNCH services in areas where i-PUSH was implemented using a longitudinal cluster randomized controlled trial in Kakamega, Kenya. A total of 24 pair-matched villages were randomly assigned either to the treatment or the control group. Within each village, 10 eligible households (i.e. with a woman aged 15–49 years who was either pregnant or with a child <4 years old) were randomly selected. The study applied a difference-in-difference methodology based on a pooled cross-sectional analysis of baseline, midline and endline data, with robustness checks based on balanced panels and Analysis of Covariance methods. The analysis sample included 346 women, of whom 248 had had a live birth in the 3 years prior to any of the surveys, and 424 children aged 0–59 months. Improved NHIF coverage did not have a statistically significant impact on any of the RMNCH outcome indicators at midline nor endline. Uptake of RMNCH services, however, improved substantially in both control and treatment areas at endline compared to baseline. For instance, significant increases were observed in the number of antenatal care visits from baseline to midline (mean = 2.62–2.92, P < 0.01) and delivery with a skilled birth attendant from baseline to midline (mean = 0.91–0.97, P < 0.01). Expanded NHIF coverage, providing enhanced access to RMNCH services of unlimited duration at both public and private facilities, did not result in an increased uptake of care, in a context where access to basic public RMNCH services was already widespread. However, the positive overall trend in RMNCH utilization indicators, in a period of constrained access due to the COVID-19 pandemic, suggests that the other components of the i-PUSH programme may have been beneficial. Further research is needed to better understand how the provision of insurance, enhanced community health volunteer training and improved healthcare quality interact to ensure pregnant women and young children can make full use of the continuum of care.
A realist evaluation of the implementation of a national tobacco control programme and policy in India
Authors: Hebbar Pragati B , Dsouza Vivek , Nagelhout Gera E , van Belle Sara , Srinivas Prashanth Nuggehalli , Schayck Onno C P van , Babu Giridhara R , Bhojani Upendra
Published: August 2024

There is a growing interest in studying and unpacking the implementation of policies and programmes as it provides an opportunity to reduce the policy translation time lag taken for research findings to translate into policies and be implemented and to understand why policies may fail. Realist evaluation is a theory-driven approach that embraces complexity and helps to identify the mechanisms generating the observed policy outcomes in a given context. We aimed to study facilitators and barriers while implementing the Cigarettes and Other Tobacco Products Act 2003 (COTPA), a comprehensive national tobacco control policy, and the National Tobacco Control Programme 2008 (NTCP), using realist evaluation. We developed an initial programme theory (IPT) based on a realist literature review of tobacco control policies in low- and middle-income countries. Three diverse states—Kerala, West Bengal and Arunachal Pradesh—with varying degrees of implementation of tobacco control laws and programmes were chosen as case studies. Within the three selected states, we conducted in-depth interviews with 48 state and district-level stakeholders and undertook non-participant observations to refine the IPT. Following this, we organized two regional consultations covering stakeholders from 20 Indian states for a second iteration to further refine the programme theory. A total of 300 intervention–context–actor–mechanism–outcome configurations were developed from the interview data, which were later synthesized into state-specific narrative programme theories for Kerala, West Bengal and Arunachal Pradesh. We identified five mechanisms: collective action, felt accountability, individual motivation, fear and prioritization that were (or were not) triggered leading to diverse implementation outcomes. We identified facilitators and barriers to implementing the COTPA and the NTCP, which have important research and practical implications for furthering the implementation of these policies as well as implementation research in India. In the future, researchers could build on the refined programme theory proposed in this study to develop a middle-range theory to explain tobacco control policy implementation in India and other low- and middle-income countries.
Changes from initial Posting to subsequent Posting and Transfer: a frontline perspective from India
Authors: Purohit Bhaskar , Hill Peter S
Published: August 2024

The deployment of the health workforce, carried out through initial and subsequent posting and transfer (PT), is a key element of health workforce management. However, the focus of the currently available PT literature is mostly on subsequent PT, and the distinction between initial and subsequent PT has received little research attention. Drawing on this gap, in this paper, we examine how doctors experience their subsequent PT compared with their initial postings in two states in India. The distinctions have been drawn using the prism of six norms that we developed as evidence for implied policy in the absence of documented policy. This mixed-methods study used in-depth interviews of doctors and key informants, with job histories providing quantitative data from their accounts of their PT experience. Based on the interviews of these frontline doctors and other key policy actors, this paper brings to light key differences between initial and subsequent postings as perceived by the doctors: compared with initial postings, where the State demands to meet service needs dominated, in subsequent postings, doctors exercised greater agency in determining outcomes, with native place a central preoccupation in their choices. Our analysis provides a nuanced understanding of PT environment through this shift in doctors’ perceptions of their own position and power within the system, with a significant change in the behaviour of doctors in subsequent PT compared with their initial postings. The paper brings to light the changing behaviour of doctors with subsequent PT, providing a deeper understanding of PT environment, expanding the notion of PT beyond the simple dichotomy between service needs and doctors’ requests.
Software application profile: tpc and micd—R packages for causal discovery with incomplete cohort data
Authors: Andrews Ryan M , Bang Christine W , Didelez Vanessa , Witte Janine , Foraita Ronja
Published: August 2024

Motivation

The Peter Clark (PC) algorithm is a popular causal discovery method to learn causal graphs in a data-driven way. Until recently, existing PC algorithm implementations in R had important limitations regarding missing values, temporal structure or mixed measurement scales (categorical/continuous), which are all common features of cohort data. The new R packages presented here, micd and tpc, fill these gaps.

Implementation

micd and tpc packages are R packages.

General features

The micd package provides add-on functionality for dealing with missing values to the existing pcalg R package, including methods for multiple imputations relying on the Missing At Random assumption. Also, micd allows for mixed measurement scales assuming conditional Gaussianity. The tpc package efficiently exploits temporal information in a way that results in a more informative output that is less prone to statistical errors.

Availability

The tpc and micd packages are freely available on the Comprehensive R Archive Network (CRAN). Their source code is also available on GitHub (https://github.com/bips-hb/micd; https://github.com/bips-hb/tpc).
Computing Klein-Gordon Spectra
Authors: Rösler Frank , Tretter Christiane
Published: August 2024

We study the computational complexity of the eigenvalue problem for the Klein–Gordon equation in the framework of the Solvability Complexity Index Hierarchy. We prove that the eigenvalue of the Klein–Gordon equation with linearly decaying potential can be computed in a single limit with guaranteed error bounds from above. The proof is constructive, i.e. we obtain a numerical algorithm that can be implemented on a computer. Moreover, we prove abstract enclosures for the point spectrum of the Klein–Gordon equation and we compare our numerical results to these enclosures. Finally, we apply both the implemented algorithm and our abstract enclosures to several physically relevant potentials such as Sauter and cusp potentials and we provide a convergence and error analysis.
Ulk1 regulates T cell development and response to Listeria monocytogenes stimulation
Authors: Xu Yudai , Wang Zijian , Deng Jieping , Li Shumin , Gao Lijuan , Liu Guolong , Chen Guobing
Published: August 2024

T cells are crucial for the normal functioning of the immune system. The development and response of these cells to foreign antigens involve many complex stages and interactions between various types of cells. However, many details of these processes are still unclear. Our research revealed a key role for a protein called ULK1, a serine/threonine protein kinase, in regulating T-cell development and function. During T-cell maturation, the absence of Ulk1 (as in Ulk1−/− mice) leads to an increase in a cell type called DN3 in the thymus. We also found a reduction in the number of T cells in peripheral immune organs, such as the spleen, in Ulk1−/− mice. In response to Listeria infection, Ulk1−/− mice have a weaker ability to clear this bacterium, and their T cells also have defects in producing cytokines. However, the absence of Ulk1 did not affect the activation or apoptosis of naive CD4+ T cells in vitro. In a bone marrow chimeric mouse model, T cells from Ulk1−/− mice did not differ developmentally from those from control mice. Furthermore, RNA-seq revealed that Ulk1 deficiency affects the metabolic function of splenocytes and T-cell function in mice, potentially through the canonical Wnt signaling cascade and the ERK1/ERK2 signaling cascades. Overall, these results suggest that Ulk1 is essential for T-cell maturation in the thymus, the balance of peripheral T cells, and the functional response of T cells to antigens.
Causal estimators for incorporating external controls in randomized trials with longitudinal outcomes
Authors: Zhou Xiner , Zhu Jiawen , Drake Christiana , Pang Herbert
Published: August 2024

Incorporating external data, such as external controls, holds the promise of improving the efficiency of traditional randomized controlled trials especially when treating rare diseases or diseases with unmet needs. To this end, we propose novel weighting estimators grounded in the causal inference framework. As an alternative framework, Bayesian methods are also discussed. From trial design perspective, operating characteristics including Type I error and power are particularly important and are assessed in our realistic simulation studies representing a variety of practical scenarios. Our proposed weighting estimators achieve significant power gain, while maintaining Type I error close to the nominal value of 0.05. An empirical application of the methods is demonstrated through a Phase III clinical trial in rare disease.
Pornography use, problematic pornography use, impulsivity, and sensation seeking: a meta-analysis
Authors: Bocci Benucci Sara , Di Gesto Cristian , Ghinassi Simon , Casale Silvia , Fioravanti Giulia
Published: August 2024

Background

While some individuals engage in recreational pornography use (PU), others may develop an uncontrolled pattern of use termed problematic pornography use (PPU). PPU is characterized by persistent, excessive, or compulsive engagement with pornographic content, despite distress and adverse consequences. Impulsivity has been identified as a factor associated with PU and PPU.

Aim

The present meta-analysis aims to sum up the existing research on the relationship between impulsivity and PU/PPU and investigate whether age and gender could moderate this relationship.

Methods

A keyword-based systematic literature search was performed to identify articles that assessed PU/PPU and impulsivity. Extracted correlations were converted into Fisher’s Z. Meta-regression analyses were also performed. Publication bias was assessed by Egger’s regression intercept.

Outcomes

Outcomes included general impulsivity and its dimensions (ie, negative and positive urgency, lack of premeditation and perseverance), sensation seeking, PU, and PPU.

Results

Meta-analytic results of the random effects model showed a significant positive correlation between impulsivity as total score and PU (n = 1504, k = 4, Fisher’s Z = 0.21, P < .001) and PPU (n = 20174, k = 13, Fisher’s Z = 0.17, P < .001). Significant and positive associations were also found between sensation seeking and PU (n = 11707, k = 11, Fisher’s Z = 0.14, P < .001) and PPU (n = 20152, k = 9, Fisher’s Z = 0.06, P < .001). Concerning the relationship between PPU and different dimensions of impulsivity, almost all the associations were significant and positive. The dimension of positive urgency and attentional and nonplanning impulsivity showed the strongest association. Age (β = –0.50, Q = 101.26, df = 11, P < .001) and gender (female = 1; β = –0.46, Q = 102.54, df = 12, P < .001) moderated the association between general impulsivity and PPU. No risk of publication bias emerged.

Clinical Implications

Prevention programs of PPU should focus on impulsivity and certain key dimensions (eg, positive urgency, attentional and nonplanning impulsivity) and be tailored to individual impulsivity profiles, considering age and gender differences.

Strengths and Limitations

The primary strength of this meta-analysis is that it considers various conceptualizations of impulsivity. However, the results are to be interpreted with caution since >30% of relevant studies had to be excluded because information could not be gathered from the study authors.

Conclusion

These results suggest that general impulsivity is linked to PU and PPU and that specific dimensions of impulsivity (ie, attentional impulsivity, nonplanning impulsivity, and positive urgency) can serve as risk factors for PPU.
Epstein–Barr virus-encoded RNA-positive lymphocytes in bone marrow and lymph nodes in an autopsy case of TAFRO syndrome
Authors: Tsugita Nao , Miyagawa Ippei , Nakayamada Shingo , Nawata Aya , Kosaka Shumpei , Ueno Masanobu , Tanaka Yoshiya
Published: August 2024

A 55-year-old man was admitted to the hospital with vomiting, diarrhoea, and chest pain. Upon examination, he exhibited signs of increased inflammatory response, acute kidney injury, and thrombocytopenia, leading to a diagnosis of TAFRO syndrome, which was supported by the clinical evidence of generalised lymphadenopathy, pleural effusion, and hepatosplenomegaly. Despite receiving intensive multimodal immunosuppressive therapy, including glucocorticoid pulse therapy (methylprednisolone 1000 mg/day), tocilizumab, and cyclosporine in the intensive care unit, the patient showed minimal response and succumbed to the disease on the seventh day of hospitalisation. Histopathological analysis of the lymph nodes revealed idiopathic multicentric Castleman disease-like features, and Epstein–Barr virus-encoded RNA (EBER) in situ hybridisation identified multiple EBER-positive cells. These findings highlight the elusive pathogenic mechanism of TAFRO syndrome and the potential resistance of some patients to standard treatments such as tocilizumab. The presence of EBER-positive cells in lymph nodes or bone marrow may serve as an indicator of disease severity and treatment resistance. Therefore, histopathological detection of EBER-positive cells may help predict responsiveness to conventional treatments, disease severity, and prognosis in patients with TAFRO syndrome.
Successful treatment of aggressive AA amyloidosis with tocilizumab in a patient with polymyalgia rheumatica
Authors: Atas Nuh , Çalışkan Ali Rıza , Akatlı Ayşenur
Published: August 2024

Polymyalgia rheumatic (PMR) associated amyloidosis is an extremely rare condition that can be rapidly progressive with high morbidity and mortality and management is challenging. Tocilizumab is a monoclonal anti–IL-6 receptor antibody, which is in the therapeutic arsenal of PMR. The efficiency of tocilizumab in improvement of PMR activity score and decreasing steroid dose is well-established, while efficiency in PMR–associated amyloidosis has not been published. Herein, we reported a PMR patient with amyloid A amyloidosis who was treated effectively with tocilizumab.
Belief in living a meaningful life and adjustment to chronic pain
Authors: Reed David E , Day Melissa A , Ferreira-Valente Alexandra , Jensen Mark P
Published: August 2024

Objective

Chronic pain is a global health concern and often interferes with multiple aspects of individuals’ lives (eg, physical activities), diminishing a person’s ability to engage in activities that promote meaning in life. However, it is not well understood how believing that one can live a meaningful life despite pain could contribute to improved function among individuals with chronic pain. The aim of the present study was to better understand the role that belief in living a meaningful life despite pain might have on adjustment to chronic pain.

Methods

Participants (n = 164) were individuals with chronic pain who completed baseline data from 2 closely related randomized clinical trials. Hierarchical regression analyses were used to examine the hypotheses that one’s belief in living a meaningful life despite pain will be associated with function (pain interference and symptoms of posttraumatic stress disorder, depression, and anxiety) and that the belief in living a meaningful life despite pain would moderate the associations between pain intensity and function.

Results

Belief in living a meaningful life despite pain was significantly associated with less pain interference and less severe symptoms of posttraumatic stress disorder, anxiety, and depression, supporting the potential role of this variable in adaptive adjustment to chronic pain. However, one’s belief in living a meaningful life despite pain did not moderate the associations between pain intensity and function.

Conclusions

Results provide important theoretical and clinical information about how believing that one can live a meaningful life despite pain might serve as an important process for adjustment to chronic pain.
Sexual dysfunction in women living with HIV: an updated narrative review
Authors: Tiecco Giorgio , Salvi Martina , Delbarba Andrea , Di Gregorio Marco , Colangelo Cosimo , Castelli Francesco , Quiros-Roldan Eugenia
Published: August 2024

Introduction

Female sexual dysfunction is a significant concern for many women worldwide, with chronic health conditions such as HIV infection contributing to its prevalence. However, there is a paucity of studies focusing this subject in the available literature.

Objectives

This narrative review aimed to provide a comprehensive and updated overview of the current state of knowledge regarding sexual dysfunction in women living with HIV (WLWH).

Methods

References for this review were identified from MEDLINE, Embase, and Cochrane databases using the search terms “sexual dysfunction” AND “HIV” AND “female” OR “woman.” The final reference list was generated based on the timeline, originality, and relevance to the scope of this narrative review.

Results

In the general population, female sexual function is influenced by various factors, including biological, psychological, physiological, sociocultural, and relational ones. In WLWH, the role of antiretroviral therapy in female sexual dysfunction is controversial. Although current international guidelines recommend collecting a thorough sexual life anamnesis during routine outpatient visits, sexual difficulties are often inadequately addressed.

Conclusion

A tailored clinical approach that focuses on the multidimensional domains of sexual dysfunction may improve the sexual health and quality of life in WLWH.
Untargeted Metabolomic Analysis Reveals a Potential Role of Saponins in the Partial Resistance of Pea (Pisum sativum) Against a Root Rot Pathogen, Aphanomyces euteiches
Authors: Goyal Ravinder K. , Hui Joseph P. M. , Ranches Jeffrey , Stefanova Roumiana , Jones Alysson , Banskota Arjun H. , Burton Ian , Yu Bianyun , Berrue Fabrice , Hannig Albert , Clark Shawn , Chatterton Syama , Dhaubhadel Sangeeta , Zhang Junzeng
Published: August 2024

In soilborne diseases, the plant–pathogen interaction begins as soon as the seed germinates and develops into a seedling. Aphanomyces euteiches, an oomycete, stays dormant in soil and is activated by sensing the host through chemical signals present in the root exudates. The composition of plant exudates may, thus, play an important role during the early phase of infection. To better understand the role of root exudates in plant resistance, we investigated the interaction between partially resistant lines (PI660736 and PI557500) and susceptible pea cultivars (CDC Meadow and AAC Chrome) against A. euteiches during the pre-invasion phase. The root exudates of the two sets of cultivars clearly differed from each other in inducing oospore germination. PI557500 root exudate not only had diminished induction but also inhibited the oospore germination. The contrast between the root exudates of resistant and susceptible cultivars was reflected in their metabolic profiles. Data from fractionation and oospore germination inhibitory experiments identified a group of saponins that accumulated differentially in susceptible and resistant cultivars. We detected 56 saponins and quantified 44 of them in pea root and 30 from root exudate; the majority of them, especially soyasaponin I and dehydrosoyasaponin I with potent in vitro inhibitory activities, were present in significantly higher amounts in both roots and root exudates of PI660736 and PI557500 compared with Meadow and Chrome. Our results provide evidence for saponins as deterrents against A. euteiches, which might have contributed to the resistance against root rot in the studied pea cultivars.

[Formula: see text] Copyright © 2024 His Majesty the King in Right of Canada, as represented by the Minister of Agriculture and Agri-Food Canada and the National Research Council of Canada. This is an open access article distributed under the CC BY 4.0 International license .
Science of Unitary Human Beings
Authors: Leveille-Tulce Anne Marie Berthe , Hopkins-Walsh Jane
Published: August 2024

Rogers’ Science of Unitary Human Beings (SUHB) and several theories that emanate from Rogers’ work contain foundational concepts that may lend themselves toward nursing actions to address important social justice mandates, to advocate and to act for equity, and to uproot systems of oppression and racism in nursing. However, at the same time, theoretical concepts such as power arising from ascendant theories of SUHB are often used with little to no critical reflection for past and present-day histories of racism and power inequities in nursing and in society writ large. Using concepts related to SUHB such as integrality, turbulence, power, and patterning, we critically explore the potential of developing anti-racism reflections and actions through 3 theories: Barrett’s Knowing Participation in Change; Butcher’s Kaleidoscoping in Life’s Turbulence; and Smith’s Turbulence-Ease in the Rhythmic Flow of Patterning. We acknowledge that SUHB was/is largely developed within a framework of whiteness by scholars who were/are working from academic positions and social identities of societal safety and privilege. This requires nurses to reflect on how that history shapes SUHB. We also acknowledge the urgent need for ongoing anti-racism and justice work by nurses. As a call to action, we suggest a start by critically building upon existing theoretical foundations in SUHB to develop a more explicit anti-racist theorizing-praxis in nursing for the wellbecoming of humans and nonhumans alike.
The Effect of Intravenous Tranexamic Acid on Postoperative Ecchymoses after Upper Blepharoplasty
Authors: Vogt Ashtyn Z. , Kivanany Pouriska B. , De Niear Matthew A. , Vrcek Ivan M. , Homer Natalie A.
Published: August 2024

Background:

Tranexamic acid has been increasingly used in facial plastic surgery to improve perioperative hemostasis. While subcutaneous tranexamic acid has been found to not significantly decrease postoperative ecchymoses following upper blepharoplasty, systemic administration has not previously been studied.

Methods:

A total of 325 patients undergoing upper blepharoplasty were randomly assigned to either receive intravenous tranexamic acid or serve as a control. Patients in the experimental group were administered 1 g of tranexamic acid intravenously 10 minutes before surgical incision. A similar upper blepharoplasty technique was performed by two American Society of Ophthalmic Plastic and Reconstructive Surgery-trained surgeons. Follow-up was conducted at a median of 8 days postsurgery. Patient photographs were evaluated by two independent graders to rate ecchymoses on a scale of 0 (least) to 10 (most).

Results:

Of the 325 included patients, 138 patients received intravenous tranexamic acid and 187 patients did not. The average ecchymosis rating for the control group at day 8 was 5.8 ± 1.7, while the average rating for the tranexamic acid group at the same time point was 4.1 ± 1.6 (P < 0.0001). There was a trend toward decreased ecchymoses in the tranexamic acid group at earlier and later postoperative timepoints that did not reach statistical significance. No hemorrhagic or systemic embolic complications occurred.

Conclusions:

Systemic tranexamic acid may reduce postoperative ecchymoses after upper blepharoplasty surgery, reaching significance at the eighth postoperative day, which may lead to improved patient satisfaction and decreased occupational downtime.
Effects of Isometric Handgrip Training on Ambulatory Blood Pressure in Individuals Over 18 Years Old
Authors: Oliveira Marcelo de Santana , Melo Paulo Henrique , Correia Marilia de Almeida , Gerage Aline Mendes , Ritti-Dias Raphael Mendes , Farah Breno Quintella
Published: August 2024

Purpose:

The aim of this study was to analyze the effects of isometric handgrip training (IHT) on ambulatory blood pressure (BP) in individuals aged 18 yr and older.

Review Methods:

A systematic review and meta-analysis was performed in Medline and Web of Science, encompassing studies published until July 2023, as well as the gray literature. We calculated the mean difference (MD) and 95% CI using an inverse variance method with a random effects model.

Considering both published and unpublished studies, we observed an effect of IHT on awake diastolic BP (MD = −2.02; 95% CI, −3.89 to −0.15 mmHg; P = .03). There were no significant effects on 24-hr systolic BP (MD = −1.31; 95% CI, −3.84 to 1.22 mmHg; P = .31), asleep systolic BP (MD = −0.84; 95% CI, −3.31 to 1.63 mmHg; P = .50), awake systolic BP (MD = −0.93: 95% CI, −3.10 to 1.23 mmHg; P = .40), 24-hr diastolic BP (MD = −0.96; 95% CI, −2.65 to 0.74 mmHg; P = .27), or asleep diastolic BP (MD = −1.27; 95% CI, −3.22 to 0.67 mmHg; P = .20). In conclusion, the effects of IHT on ambulatory BP were observed primarily in awake diastolic BP among individuals over 18 yr of age.
Comparison of different tracers in sentinel lymph node detection for endometrial cancer: a systematic review and network meta-analysis
Authors: Feng Chuanli , Jiang Xuji , Feng Lianlian , Sun Wanying , Liu Qingqing , Hao Yiping , Cui Baoxia
Published: August 2024

Background:

In the realm of endometrial cancer (EC) therapeutics and prognostic assessments, lymph nodes’ status is paramount. The sentinel lymph node (SLN) detection, recognized for its reliability, has been progressively adopted as a standard procedure, posing a compelling alternative to conventional systematic lymphadenectomy. However, there remains a lack of agreement on the most effective choice of tracers for this procedure.

Objective:

This investigation was dedicated to a comparative analysis of various tracers to identify the most effective combination that achieves the highest detection rate. This endeavor sought to enhance the efficacy of SLN biopsy in the surgical management of EC.

Methods:

A systematic review was conducted across multiple databases, including the Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Embase, and clinicaltrials.gov, to analyze studies employing different tracers for SLN biopsy during surgery in EC. Using Bayesian network meta-analysis, the authors compared the total and bilateral detection rates of various tracers.

Results:

After screening 1431 articles, 11 studies, including 2699 participants, were selected in this network meta-analysis. The combination of radioactive isotopes and indocyanine green (ICG) emerged as the most efficacious method in total and bilateral detection rates, with the Surface Under the Cumulative Ranking Curve (SUCRA) scores of 80.00 and 86.36%, respectively. Additionally, carbon nanoparticles (CNPs) demonstrated superior performance in the detection of para-aortic lymph nodes with an SUCRA score of 97.77%.

Conclusion:

Network meta-analysis shows that the application of radioactive isotopes and ICG is the optimal tracer combination for SLN biopsy during surgery in EC.
Radiation-induced liver disease mimicking liver metastasis after low-dose hepatic irradiation during radiotherapy for gastric mucosa-assisted lymphoid tissue lymphoma: A case report
Authors: Park Hyeli , Lee Sun Young
Published: August 2024

Rationale:

Radiation-induced liver disease (RILD) is an established complication of hepatic irradiation that is typically reported in patients receiving high-dose radiotherapy for hepatocellular carcinoma or liver metastases. However, RILD can also occur after unintentional low-dose liver exposure during radiotherapy for other gastrointestinal malignancies when careful precautions are not taken.

Patient concerns:

We report the case of a 44-year-old woman with gastric mucosa-associated lymphoid tissue lymphoma who underwent salvage radiotherapy administered to the entire stomach. One month after completing this radiotherapy, computed tomography and magnetic resonance imaging of the patient’s abdomen revealed a 4 cm lesion in the left lateral liver segment, suggestive of metastasis.

Diagnoses:

An ultrasound-guided biopsy was performed, and the histopathological findings were consistent with those of RILD.

Interventions:

Conservative management was pursued with close monitoring of liver function tests.

Outcomes:

The patient’s imaging findings and liver enzyme levels normalized approximately 3 months after the initial diagnosis.

Lessons:

This case highlights the importance of considering RILD in the differential diagnosis of new hepatic lesions detected after radiotherapy, even in patients with low-dose liver exposure within generally acceptable limits. Careful correlation with the radiotherapy plan is crucial to avoid misdiagnosing RILD as metastatic disease and to guide appropriate management.
Real-world efficacy and safety of durvalumab–tremelimumab as second-line systemic therapy after atezolizumab–bevacizumab in unresectable hepatocellular carcinoma
Authors: Miura Ryoichi , Ono Atsushi , Yano Shigeki , Amioka Kei , Naruto Kensuke , Yamaoka Kenji , Fujii Yasutoshi , Uchikawa Shinsuke , Fujino Hatsue , Nakahara Takashi , Murakami Eisuke , Kawaoka Tomokazu , Miki Daiki , Tsuge Masataka , Hayes C. Nelson , Oka Shiro
Published: August 2024

The efficacy and safety of immune-checkpoint inhibitors (ICI) for the treatment of unresectable hepatocellular carcinoma are known. We explored ICI rechallenges with direct switching from 1 ICI regimen to another. This retrospective study included 16 patients who received atezolizumab–bevacizumab (Atezo+Bev) and durvalumab–tremelimumab (Dur+Tre) as the first-line and second-line combination therapy, respectively, at Hiroshima University Hospital. The radiological response and adverse event were evaluated in all patients. Of the 16 patients, 12 were male, and the median age at Atezo+Bev induction was 71 years. The reasons for medication changes were disease progression in 11 patients and adverse events in 5 patients. With Atezo+Bev and Dur+Tre initiation, the Barcelona-Clinic Liver-Cancer stage (A/B/C) progressed in 9/6/3 and 3/4/9 patients and the Child–Pugh classification (A/B/C) progressed in 12/4/0 and 9/6/3 patients, respectively. The disease control rate and overall response rate of Atezo+Bev were 87.5% and 58.3%, respectively, and of Dur+Tre were 62.5% and 0%, respectively. The most common immune-related adverse event in both the Atezo+Bev and Dur+Tre groups was colitis; 3 of the 5 patients with colitis on Atezo+Bev treatment had colitis with Dur+Tre, and 2 had exacerbations. Regarding liver function, ALBI score significantly decreased during Atezo+Bev, but not Dur+Tre, treatment. In patients with colitis following Atezo+Bev, subsequent Dur+Tre treatment may induce colitis recurrence or exacerbation. For immune-related adverse events other than colitis, Dur+Tre could provide relatively safe disease control while maintaining liver function.
A disulfidptosis-associated long noncoding RNA signature to predict low-grade glioma classification, prognosis, tumor microenvironment, and therapy regimens: Observational study
Authors: Qin Xiaohong , Chen Zhibiao , Wu Liquan , Ding Rui
Published: August 2024

This study aimed to investigate the function of disulfidptosis-associated long noncoding RNAs (DAlncRNAs) in low-grade gliomas (LGG) through bioinformatics analysis and construct a signature to predict the classification, prognosis, tumor microenvironment, and selection of immunotherapy and chemotherapy in LGG. Genomic, clinical, and mutational information of 526 patients with LGG was retrieved from The Cancer Genome Atlas repository. A nonnegative matrix factorization algorithm was applied to classify patients with LGG. Univariate, LASSO regression, and multivariate Cox regression analyses were performed to determine prognostic DAlncRNAs. Following the median risk score, we defined the sample as a high-risk (HR) or low-risk group. Finally, survival, receiver operating characteristic curve, risk curve, principal component, independent prognosis, risk difference, functional enrichment, tumor microenvironment, immune cell infiltration, mutation, and drug sensitivity analyses were performed. Patients were classified into C1 and C2 subtypes associated with disulfidptosis. Eight prognostic DAlncRNAs (AC003035.2, AC010157.2, AC010273.3, AC011444.3, AC092667.1, AL450270.1, AL645608.2, and LINC01571) were identified, and a prognostic signature of LGG was developed. The DAlncRNA-based signature was found to be an independent prognostic factor in patients with LGG, thereby constructing a nomogram. In addition, in the HR group, immune function was more active and the tumor mutation burden was higher. The patients were mainly composed of subtype C2, and their prognosis was worse. Immunotherapy and chemotherapy were predicted in the HR and low-risk groups, respectively. Our study, based on DAlncRNAs, highlights 2 disulfidptosis-associated LGG subtypes with different prognostic and immune characteristics and creates a novel disulfidptosis-associated prognostic signature, which may inform the classification, prognosis, molecular pathogenesis, and therapeutic strategies for patients with LGG.
Shenghua decoction for postpartum hemorrhage attributed to uterine atony: An observational study
Authors: Yu Xi-Wen , Wang Cheng-Si , Zhang Gui-Mei
Published: August 2024

This retrospective study aimed to investigate the preventive effects of Shenghua decoction (SHD) for postpartum hemorrhage (PPH) attributed to uterine atony (UA). Records of 84 patients were retrospectively analyzed, with 42 assigned to the treatment group and 42 to the control group. Both groups received carbetocin, and patients in the treatment group additionally underwent SHD. Primary endpoints included blood loss and changes in hemoglobin levels. Secondary endpoints encompassed the number of patients requiring uterine massage, additional oxytocic drugs, pulse rate, respiratory rate, systolic blood pressure, and treatment-related adverse events. Patients in the treatment group exhibited superior outcomes in terms of blood loss (P < .01), hemoglobin levels (P = .03), and pulse rate (P < .01) compared to those in the control group. However, no significant differences were observed in the number of patients requiring uterine massage (P = .13), the number of patients needing additional oxytocic drugs (P = .19), respiratory rate (P = .05), and systolic blood pressure (P = .80) between the 2 groups. There were no significant disparities in treatment-related adverse events between the 2 groups. The findings of this study suggest that the preventive effects of SHD combined with carbetocin were superior to those of carbetocin alone for preventing postpartum hemorrhage. However, high-quality prospective studies are needed to validate and confirm these results.
Unveiling a rare BRAF mutation in minimally invasive follicular thyroid carcinoma: A case report
Authors: Lee Po-Sheng , Chen Jui-Yu , Pan Li-Hsin , Hwu Chii-Min , Hang Jen-Fan , Kuo Chin-Sung
Published: August 2024

Rationale:

Molecular testing is becoming more widely used; however, the accuracy of diagnostic testing remains a primary consideration, especially for molecular testing that detects specific mutations associated with cancers.

Patient concerns:

A 45-year-old female without documented comorbidities presented a thyroid nodule during a routine health examination. Initial evaluation revealed a 3.8-cm nodule in the left lobe of thyroid, classified as Bethesda System category III on fine needle aspiration cytology. Genetic molecular testing detected the BRAF V600E mutation via quantitative polymerase chain reaction assay, raising concern for papillary thyroid cancer (PTC).

Diagnoses:

The preoperative impression was PTC based on the detection of BRAF V600E mutation.

Interventions:

The patient underwent thyroidectomy as well as lymph node dissection with the expectation to treat PTC.

Outcomes:

The final pathology unexpectedly revealed minimally invasive follicular carcinoma. Confirmatory Sanger sequencing unveiled a novel sequence variation involving nucleotide duplication within the range of 1794 to 1802, a non-V600E BRAF mutation not previously reported in follicular thyroid carcinoma.

Lessons:

This case study demonstrates the clinical relevance of exercising caution in molecular testing and its interpretation of results. For genetic testing used for diagnostic purposes, rigorous validation or cross-checking using different methods should always be considered to ensure appropriate interpretation of molecular results.
Predictive clinical indicators of refractory Mycoplasma pneumoniae pneumonia in children: A retrospective cohort study
Authors: Pei Hong , Luo Hongli
Published: August 2024

To determine the clinical indicators predictive of refractory Mycoplasma pneumoniae pneumonia (RMPP) in children and develop a robust predictive model to aid in early identification and management. A retrospective cohort study was conducted on 338 children diagnosed with RMPP out of a total of 1500 cases of Mycoplasma pneumoniae at a single tertiary hospital from May 2021 to November 2023. Clinical and demographic data analyzed included age, gender, parents’ educational level, household income, body mass index, allergic constitution, and laboratory findings such as white blood cell count, neutrophil and lymphocyte counts, platelet count, and levels of C-reactive protein (CRP), D-dimer, and procalcitonin. Univariate and multivariate logistic regression analyses were performed to identify significant predictors of RMPP, and a predictive model was developed. Among the RMPP cohort, 52.4% were female, with a mean age of 6.07 ± 2.78 years. Multivariate analysis identified several significant predictors of poor prognosis, including higher body mass index, longer duration of fever, elevated white blood cell count, neutrophil count, C-reactive protein levels, and increased neutrophil to lymphocyte ratio and platelet to lymphocyte ratio. The model demonstrated outstanding diagnostic performance, with an area under the receiver operating characteristic curve of 0.963 (95% confidence interval: 0.946–0.981). Our study identifies key clinical indicators with significant diagnostic accuracy for predicting RMPP in children. The predictive model established offers a valuable tool for clinicians, potentially improving RMPP outcomes through timely intervention.
Development and application of a serious adverse events risk model for concurrent chemoradiotherapy in patients with nasopharyngeal carcinoma
Authors: Li Jiahui , Liu Qianwen , Qin Huiying
Published: August 2024

The objective of this study was to construct a concise prediction model for serious adverse events (SAEs) in order to assess the likelihood of SAE occurrence among hospitalized patients undergoing concurrent chemoradiotherapy. An electronic database of a Cancer Centre was utilized to conduct a cross-sectional review survey. Our research involved the recruitment of 239 patients who were undergoing concurrent chemoradiotherapy in the Department of Nasopharynx and Radiotherapy. The clinical prediction rule was derived using logistic regression analysis, with SAE serving as the primary outcome. Internal verification was conducted. The occurrence rate of SAE in the derivation cohort was 59.4%. The ultimate model used had 3 variables, namely cystatin C, C-reactive protein, and serum amyloid A. The model exhibited an area under the curve of 0.626 (95% CI: 0.555–0.696; P < .001). The model accurately predicts the occurrence of SAE, and the variable data can be easily obtained, and the assessment technique is straightforward.