bluuebunny/crossref_metadata_2025 huggingface dataset:
Missing data and long-term outcomes from nutrition research in the critically ill
Authors: Schouteden Eline , Bels Julia L.M. , van de Poll Marcel C.G. , Presneill Jeffrey
Published: January 2025

Purpose of review

The use of functional outcomes in critical care nutrition research is increasingly advocated; however, this inevitably gives rise to missing data. Consequently there is a need to adopt modern approaches to the foreseeable problem of missing functional and survival outcomes in research trials.

Recent findings

Analyses that ignore unobserved or missing data will often return biased effect estimates. An improved approach is to routinely anticipate the types and extent of missing data, and consider the likely mechanisms of that missingness. The researcher and their statistical advisor may then choose from a number of modern strategies to assess the sensitivity of the research conclusions to the patterns of missingness contained in these research data. Methods widely employed include multiple imputation of missing observations, mixed regression models, use of composite outcome variables with patients who die being attributed a value reflecting the lack of ability to function, and selected Bayesian methodology.

Conclusions from clinical research in critical care nutrition will become more clinically interpretable and generalizable with the adoption of modern methods for the statistical handling of missing data.
Concurrent nutrition and physical rehabilitation interventions for patients with critical illness
Authors: González-Seguel Felipe , Mayer Kirby P. , Stapleton Renee D.
Published: January 2025

Purpose of review

The effects of either physical rehabilitation or nutrition on outcomes in patients with critical illness are variable and remain unclear. The potential for the combination of exercise and nutritional delivered concurrently to provide benefit is provocative, but data are only emerging. Herein, we provide a summary of evidence from 2023 and 2024 on combined physical rehabilitation and nutrition during and following critical illness.

Recent findings

While latest trials on physical rehabilitation alone reported conflicting findings, recent nutrition trials found no difference between higher and lower protein delivery and even suggested harm in patients with acute kidney injury. In 2023 and 2024, we identified four studies (one randomized controlled trial) combining physical rehabilitation and nutrition (mainly protein supplementation) within the ICU setting. Overall, these suggested benefits, including reduction of muscle size loss, ICU acquired weakness, delirium, and improved mobility levels, although these benefits did not extend to mortality and hospital length of stay. No recent trials combining physical rehabilitation and nutrition for patients after ICU were identified.

Current insights on combined physical rehabilitation and nutrition suggest improved clinically relevant outcomes, but further investigations across the continuum of care of patients with critical illness are warranted.
Engaging family members in nutrition care during recovery from critical illness
Authors: Marshall Andrea P. , Ridley Emma J. , Chapple Lee-anne S.
Published: January 2025

Purpose of review

The delivery of high-quality personalized nutrition care both during ICU and throughout post-ICU recovery is limited by multifactorial barriers. As families are often a present and consistent resource, family engagement may help to optimize nutrition support during hospitalization and after recovery from critical illness. In this review, we summarize the evidence base for family engagement in nutrition care and hypothesize future roles families may play, throughout the critical illness recovery trajectory.

Recent findings

Family members may be best placed to convey patients’ personal nutritional preferences, and premorbid nutrition intake and status, as well as promote and minimize barriers to nutrition intake. The engagement of families in nutrition care is an emerging concept, and as such, few studies have explored the role of family engagement in the delivery of nutritional care. Those that do have shown high levels of family engagement and feasibility but have not yet translated to improved clinical and patient-related outcomes.

Further research should identify how and where families may best engage to support, or advocate for, improved nutrition care.
Giant placental chorioangioma: Case report
Authors: Castro-Apodaca Francisco Javier , Murillo-Llanes Joel , Cortez-Hernández Jesús Alberto , Magaña-Gómez Javier Abednego , Amezquita-Lopez Bianca Anabel , Peña-García Gloría María , Medina-Gutierrez Ana Rosa , Ley-Peña Pedro Alfonso , Canizalez-Roman Adrian , León-Sicairos Nidia Maribel , Morgan-Ortíz Fred , Terán-Cabanillas Eli
Published: January 2025

Rationale:

The giant placental chorangioma is a non-trophoblastic tumor, characterized by vascular proliferation that invades the fetal side of the placenta. This can lead to uteroplacental insufficiency and a subsequent imbalance of proangiogenic and antiangiogenic factors, resulting in early-onset preeclampsia and becoming an imminent obstetric emergency. The diagnosis can be suspected during the prenatal stage through ultrasound and confirmed through histopathology.

Patient concerns:

This case concerns a 23-year-old female patient who was admitted to our hospital at 32.6 weeks of gestation with a fetus in breech presentation in active labor and a placental tumor of undetermined origin. The placenta, measuring approximately 10 × 10 cm, with a mass, was sent to the pathology diagnosis.

Diagnoses:

The histopathology confirmed the diagnosis of giant placental chorangioma.

Interventions:

This case underscores the critical importance of prompt and comprehensive management in pregnant patients with placental tumors. Timely diagnosis and initiation of appropriate treatments, including antihypertensive medications and vigilant monitoring, played a crucial role in the successful resolution of the patient’s condition. The confirmation of a giant placental chorangioma through histopathology emphasizes the significance of considering rare placental pathologies in clinical decision-making.

Outcomes:

This case contributes to the broader understanding of maternal-fetal health in the context of placental abnormalities and emphasizes the need for ongoing follow-up and management after discharge to ensure the well-being of both the mother and the infant.

Lessons:

Early ultrasound detection of placental abnormalities allows for timely intervention. Multidisciplinary care is crucial for managing these rare tumors. Histopathology confirms the diagnosis, guiding treatment decisions. Postpartum follow-up ensures maternal and fetal well-being.
Ewing's sarcoma of the head and neck: differential diagnosis, treatment and outcomes
Authors: Nair Deepa , Thomas Linu , Patil Vasundhara
Published: January 2025

Purpose of review

Ewing's sarcoma is a small round-cell tumour typically arising in the bones, and only rarely affecting soft tissues. These are rarely seen in the head and neck comprising 1–9% of all cases, making management of these tumours a challenge. This review aims to review the current literature to update the current diagnostic and treatment options in head and neck Ewing's sarcoma

Recent findings

The tumour is characterized in most cases by recurrent balanced translocations between the EWSR1 gene on chromosome 22 and genes belonging to the ETS family of transcription factors. Its main driver is the reciprocal translocation between the EWSR1 and FLI1 genes (EWSR1:FLI1). Molecular techniques for the detection of FET/ETS fusions are widely used to confirm the diagnosis. Newer entities like adamantinoma-like Ewing sarcoma have been recently described. The chemotherapy protocols also have changed following Euro Ewing 2012 study. Reclassification of margin status may help standardize treatment in these cases.

Head and neck Ewings sarcoma is an uncommon tumour, mainly affecting paediatric/adolescent male individuals. Histopathological diagnosis is often challenging and immunohistochemical markers and/or molecular tests are generally used. Several molecular techniques for the detection of FET/ETS fusions are widely used to confirm the diagnosis. Management of Ewing's consists of a multimodal treatment regimen, including surgical resection and/or local radiotherapy, as well as intensive multiagent chemotherapy. Increase in age and the presence of distant metastasis are associated with shorter survival times.
Antibody responses after COVID-19 vaccination: a cross sectional study among the Bangladeshi population
Authors: Das Moumita , Bhuiyan A.F.M. Tareq , Karim Md. Hasanul , Hossain Md. Amzad , Rob Md. Abdur , Khan Shamim , Wnaiza Jannatun , Shil Rony Chandra , Hossain Mohabbat , Rahman Nahidur , Sharmen Farjana , Tanni Afroza Akter , Islam S.M. Rafiqul , Mannan Adnan
Published: January 2025

The effectiveness of immunizations against coronavirus disease 2019 (COVID-19) varies greatly from one vaccine to the next. The same dose of the same vaccines will stimulate an individual's immune system to varying degrees in different persons because of a number of genetic and physiological variables. The study aimed to investigate the differences in antibody responses between COVID-19 vaccine recipients and nonrecipients. Data from 187 adult respondents were collected between November 2021 to February 2022, using a semi-structured and standardized questionnaire. For qualitative measurement of circulating neutralizing antibodies, fluorescent immunoassay was used. Whole genome sequencing of SARS CoV-2 isolates was done confirming the variants. The study found a substantial correlation between demographic factors and vaccine acceptance rates. Neutralizing antibody (NAbs) titer was higher in male participants than female participants (P = 0.024). Young and healthy participants (P = 0.505) exhibited greater antibody titers than participants with increased age or comorbid condition (P = 0.835). In comparison to other groups, increased level of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) NAbs for V1 (B.1.1.7 alpha-Kent) and V2 (B.1.351 beta-South African) were found in 82.35 and 64.71% of the vaccinated and previously infected individuals. Moreover, Moderna showed the highest mean Nab percentage of inhibition (%) antibody levels specific for V1 variant: 89.62% [95% confidence interval (CI) 76.07–103.17] whereas Pfizer BioNTech displayed the same for V2 variant: 87.20% (95% CI 34.09–140.34). This study signifies on the integration of antibody tests in vaccination programs in the healthcare system for maximizing benefit, particularly with the emergence of new SARS-CoV-2 variants over time.
The Effects of Ultrasound-guided Corticosteroid Injection Compared to Mesenchymal Stem Cell Injection in Patients with Grade II and III Knee Osteoarthritis: A Randomized Double-blind Controlled Trial.
Authors: ZoghAli Masoumeh , Amini Naser , Babaei-Ghazani Arash , Forogh Bijan , Joghataei Mohammad Taghi , Babaei Mohammad Reza , Rikhtehgar Masih , Abdolmaleki Khatereh
Published: January 2025

Objective

This study investigated the effects of a single dose injection of mesenchymal stem cells (MSCs) under ultrasound guidance for knee osteoarthritis (KOA).

Design

The study included 30 subjects in the intervention group, who received the MSC injection and 27 in the control group who received triamcinolone. Various outcome measures, including pain levels, range of motion (ROM), and MRI parameters, were evaluated before the intervention and at different time points after treatment.

Result

The results showed that the MSC group experienced more effective improvements in outcome measures compared to the control group. Pain improvement was significantly different in the MSC group at 2 weeks, 4 weeks, and 24 weeks after the treatment. ROM in extension improved significantly in the MSC group after 4 weeks. Physical function improved significantly in both groups at different time points. Furthermore, the MSC group showed some positive changes in MRI parameters, but it can't be said definitively that they led to an increase in cartilage thickness.

Conclusion

In conclusion, the study suggests that a single dose injection of MSCs is safe and holds promise for long-term treatment of KOA. No significant negative effects were reported in either group as a result of the study.
The Incidence and Aetiology of Maxillofacial Trauma and Concomitant Traumatic Brain Injury in a Johannesburg Tertiary Hospital
Authors: Khan Faheema , Rikhotso Risimati E.
Published: January 2025

Objective:

To investigate the incidence and etiology of maxillofacial trauma (MFT) and its association with traumatic brain injury (TBI).

Background:

Anecdotal evidence suggests that there is an association between MFT and TBI and that higher incidences of TBI are associated with frontal bone and mid-facial fractures. Despite the large volume of maxillofacial facial fractures treated in the authors' unit, no study has been undertaken to establish the relationship between TBI and maxillofacial fractures.

Methods:

This was a retrospective single-center cross-sectional study that was conducted on patients who presented at Charlotte Maxeke Academic Hospital emergency department with MFT and concomitant TBI over a period of 1 year (January 2019–January 2020). The primary predictor was maxillofacial fractures, which were classified into upper, middle, and lower thirds. The primary outcome variable was TBI indicated by the Glasgow Coma Scale (GCS) and Marshall computed tomography (CT) classification (radiological finding in CT).

Variables such as age, etiology, fracture type, and neurological injury indicated by the recorded GCS and Marshall CT classification (I–IV) were collected. Maxillofacial fractures were classified based on the anatomical location. The level of significance was set at P <0.05.

Results:

A total of 112 patients (102 males, 10 females) presented with MFT and concomitant TBI. The age group 30 to 39, followed by 20 to 29 years, was most affected. Respectively assault (n = 67), gunshots (n = 16), and falls (n = 16) were the main causes of injury. Supra-orbital rim fractures (P = 0.00193), frontal sinus fractures (P < 0.001,), and panfacial fractures (P < 0.001) were significantly associated with TBI. Severe TBI (GCS: 3–8) was associated with higher Marshall CT grading.

Conclusions:

Facial fractures affecting the upper third and panfacial fractures pose a significant risk for TBI. To identify TBIs, a multidisciplinary evaluation of facial fractures is recommended, especially in high-risk groups.
Monocyte Anisocytosis is Associated with Sepsis in Children with Suspected Infection
Authors: Yonker Lael M. , Badaki-Makun Oluwakemi , Alvarez-Carcamo Bryan , Cross Cody , Okuducu Yanki , Appleman Lori , Greatorex Jaime , Onu Rosemary E. , Santos Christine , Petherbridge Rachel , Foy Brody H. , Cereaga Diana , Naiman Melissa , Castro Iris , Haller Logan , Guthrie Lauren B. , Higgins John M. , Lewandrowski Kent B. , Irimia Daniel
Published: January 2025

Background

Early, accurate determination of disease severity in an emergency setting is paramount for improving patient outcomes and healthcare costs. Monocyte anisocytosis, quantified as monocyte distribution width (MDW), has been shown to correspond with immune dysregulation. We hypothesize that MDW is broadly associated with illness severity related to sepsis and serious infection in children.

Methods

We designed a retrospective study to analyze MDW, as measured by UniCel DxH 900 analyzer, on whole blood samples that were collected from children presenting for medical care between 4/2020-9/2022. SIRS criteria and Pediatric Sequential Organ Failure Assessment (pSOFA) scores were calculated, and source of infection was documented. Outcomes were compared by t-test or ANOVA, and receiver operating characteristic (ROC) curves assessed accuracy of MDW in identifying sepsis in children.

Results

We analyzed samples from 394 children presenting with illness to two pediatric medical centers. MDW was significantly higher in children with sepsis (28.2 ± 7.8) than children with suspected or confirmed infection who did not display signs of sepsis (21.5 ± 5.2). A ROC curve comparing MDW of children with sepsis against infected children without sepsis displayed an area under the curve of 0.78, suggesting MDW may serve as a useful tool in identifying children with sepsis.

Discussion

When children present to the urgent care/emergency setting with signs of infection, MDW may serve as a prompt tool to aid clinicians in identifying those who are at high risk for severe illness and require closer monitoring/intervention compared to those who may be safely discharged home.
Effect and regulatory mechanism of SIRT6 on post-cardiac arrest brain injury in rats
Authors: Liu Jianxiong , Zhen Li , Yu Dihua , Wang Weiqing
Published: January 2025

Aims

Brain injury occupies the predominant cause of neurological dysfunction and mortality after successful cardiopulmonary resuscitation (CPR) from cardiac arrest (CA). This study investigates the role and mechanism of Sirtuin 6 (SIRT6) in post-cardiac arrest brain injury in rats.

Methods

All rats were subjected to asphyxial CA followed by CPR. Two weeks before modeling, rats were infected with lentivirus containing oe-SIRT6 and oe-FOXO1 through lateral ventricular injection. qRT-PCR and Western blot quantified SIRT6 and FOXO1 expressions in brain tissues. Neurological deficit scores evaluated the neural function of rats at different time points, and water maze test assessed the changes in short-term learning and memory abilities. The survival status of rats 7 days after modeling was recorded. The pathological changes in brain tissues, inflammatory factors, and apoptosis were evaluated by H&E staining, ELISA, and TUNEL, respectively. Ch-IP measured the enrichment of SIRT6 and H3K9ac in the FOXO1 promoter.

Results

SIRT6 was poorly expressed while FOXO1 was highly expressed in CA/CPR rats. Elevation of SIRT6 expression alleviated neural function, behavioral ability, and survival rate, as well as abated pathological damage, inflammatory responses, and cell apoptosis in CA/CPR rats. Mechanistically, SIRT6 curbed FOXO1 transcription and expression by lowering the H3K9ac level in the FOXO1 promoter; FOXO1 overexpression abolished the improvement effect of SIRT6 overexpression on brain injury in CA/CPR rats.

Conclusions

Elevation of SIRT6 expression restrained the FOXO1 expression by diminishing the H3K9ac level in the FOXO1 promoter, thereby mitigating post-cardiac arrest brain injury in rats.
Monocytes and B cells Mediate Alterations in the Genetic Association Between Platelets and Sepsis via CLEC signaling pathway
Authors: Yang Hang , Feng Lin , Jiang Zhenjie , Xiao Yirong , Zeng Kai
Published: January 2025

Background Sepsis is a life-threatening condition characterized by multiple organ dysfunction. Blood cells abnormalities play a significant role in the onset and progression of sepsis; however, the potential causal relationship between platelets and sepsis remains unclear, as does whether immune cells mediate the interaction between platelets and sepsis. This study aims to explore the potential causal relationship between platelets and sepsis and analyze the mediating effect of immune cells. In addition, cell-to-cell communication was analyzed to explore the interaction between blood cells and immune cells.

Material and methods In this study, genome-wide association study (GWAS) data were utilized to examine the association between blood cells and sepsis. Two-sample mendelian randomisation (MR) and reverse MR were performed to investigate the potential causal relationship between blood cells and sepsis, with a specific focus on the relationship between platelets and sepsis. Subsequently, two-step MR was employed to identify the immune cells that mediate the interaction between platelets and sepsis and to assess their potential mediating effects. Cellchat software was used to analyze cell-to-cell communication.

Results The results of two-sample MR indicated that platelets were negatively correlated with sepsis (OR = 0.976, 95% CI 0.959-0.993, p = 0.005), suggesting that platelets have a protective effect against sepsis. Additionally, reverse MR demonstrated that sepsis had no significant effect on platelets (OR = 0.909, 95% CI 0.156-5.296, p = 0.916). The mediating effect analysis revealed that monocytes and B cells were important mediators in the relationship between platelets and sepsis. Notably, the correlation between platelets and sepsis shifted from negative to positive with the involvement of monocytes and B cells. The number and strength of cell-cell interactions were decreased in sepsis. Monocytes and B cells primarily regulate platelets through the CLEC signaling pathway, contributing to the pathogenesis of sepsis.

Conclusion This study confirmed the protective role of platelets in sepsis. Monocytes and B cells mediate changes in the genetic association between platelets and sepsis. Monocytes and B cells primarily interact with platelets via the CLEC pathway, thereby modulating the genetic association between platelets and sepsis. These findings indicate that thrombocytopenia, especially when accompanied by elevated monocytes and B cells, may serve as a potential marker for sepsis.
Solution AFM imaging and coarse-grained molecular modeling of yeast condensin structural variation coupled to the ATP hydrolysis cycle
Authors: Koide Hiroki , Kodera Noriyuki , Takada Shoji , Terakawa Tsuyoshi
Published: January 2025

Condensin is a protein complex that regulates chromatin structural changes during mitosis. It varies the molecular conformation through the ATP hydrolysis cycle and extrudes DNA loops into its ring-like structure as a molecular motor. Condensin contains Smc2 and Smc4, in which a coiled-coil arm tethers the hinge and head domains and dimerizes at the hinge. ATPs bind between the heads, induce their engagement, and are hydrolyzed to promote their disengagement. In the previous study, we performed solution atomic force microscopy (AFM) imaging of yeast condensin holo-complex in the presence of ATP and conducted flexible molecular fitting to the AFM image, obtaining the hinge structure with open conformation. However, it has yet to be clarified how the opening/closing of the hinge is coupled to the ATP hydrolysis cycle. In this study, we performed solution AFM imaging in the presence and absence of varying nucleotides, including AMP-PNP, ATPγS, and ADP. Furthermore, we conducted coarse-grained molecular dynamics simulations of a Smc2/4 heterodimer and selected the molecular structure that best represented each AFM image. Our results suggested that head engagement upon ATP binding is coupled to hinge opening. Also, the results indicated that the N-terminal region of Brn1, one of the accessory subunits, re-associates to the Smc2 head after ADP release. This study deepens our understanding of the conformational variation of yeast condensin driven by the ATP hydrolysis cycle.
Introducing and Testing Maternal Vulnerability Segmentation Tool (MVST) for Essential Service Utilization: Initial Evidence from Implementation Research in Oromia, Ethiopia
Authors: Lakew Yihunie , Tamene Habtamu , Kang Bee-Ah , Kapadia-Kundu Nandita , Kuka S. H , Rimal Rajiv
Published: January 2025

In Ethiopia, utilization of maternal health services, including antenatal care and health facility delivery remain low. This is particularly acute among women living with individual, social, and environmental vulnerabilities. This study aimed to develop and test a maternal vulnerability segmentation tool to enable community workers to identify pregnant women least likely to access maternal care services. Guided by Project Pathways’ Vulnerability Framework, predictors of maternal health service utilization were identified, and a 20-item questionnaire was developed from identified predictors. We employed exploratory and confirmatory factor analysis to create a latent variable called maternal vulnerability. Vulnerability items with acceptable internal reliability were tested to confirm association with antenatal care and institutional delivery through mediation regression analysis. A factor with eigenvalue greater than one was identified, which were further reduced and refined to 10, four for urban-rural residents, and six for a rural sample. This resulted in a root mean square error of approximation (RMSEA) values of between 0.01 to 0.08, comparative fit index (CFI) > 0.90, and Tucker Lewis index (TLI) value > 0.90. Women with higher vulnerability score were less likely to access antenatal care visits and more likely to deliver at home (p<0.01). Our data-driven work leveraging this tool provide guidance to effective programs in identifying underprivileged pregnant women to enable community workers to narrow maternal health service gaps in Ethiopia.

What is already known on this topic

Nearly half of pregnant women are not using essential maternal services such as antenatal care and health facility delivery, placing their delivery and own health at risk.

Pregnant women are least likely to use those services because of individual, social, economic, and environmental factors

What this study adds

This study provides new maternal vulnerability segmentation tools to identify women living with vulnerabilities for targeted interventions. It explains the extent to which intersecting vulnerability scores affect essential maternal service utilization.

How this study might affect research, practice or policy

This study enables community health workers to classify pregnant women according to their degree of vulnerability, thus paving the way for developing well-targeted interventions

It also calls for further research aimed at generating more validated vulnerability segmentation tools that effectively and efficiently address maternal vulnerabilities across different contexts in low-income and middle-income countries.
Spot Urine Protein to Creatinine Ratio in Patients with Urinary Tract Infection
Authors: Chauhan Mukesh , Suresh Babu SV
Published: January 2025

Introduction

Untreated urinary tract infections (UTIs) can lead to complications, including renal deterioration due to upper urinary tract involvement. Proteinuria, characterized by excessive protein in the urine, is often indicative of kidney damage. The protein-to-creatinine ratio (P/C ratio) test is a convenient and reliable method for assessing proteinuria. This study aimed to evaluate the urine protein-to-creatinine ratio (UPCR) in UTI patients and its association with renal impairment.

Materials and Methods

Eighty patients with confirmed UTI and suspected proteinuria were recruited. Urine screening included pyuria (white blood cell presence) as an initial indicator of UTI, followed by microscopic examination of centrifuged urinary sediments. The urine supernatant was analyzed for protein using the urine strip method.

Results

After applying exclusion criteria, forty-six patients (n=46) were included in the statistical analysis. Of these, 26% had normal proteinuria (<15 mg/mM Cr), 35% had moderate proteinuria (15-50 mg/mM Cr), and 39% exhibited severe proteinuria (>50 mg/mM Cr). Patients were categorized into three stages (I, II, and III) with mean creatinine excretion values of 33.9 +/-13.9 mg/dL, 31.2 +/-17.2 mg/dL, and 29 +/-13.6 mg/dL, respectively, all significantly below the reference interval (168 +/-132 mg/dL).

Conclusion

Increased urinary protein excretion correlates with heightened risk of renal complications, a leading factor in mortality. Urinary protein excretion was markedly elevated in Stage III patients. The P/C ratio proved to be a more accurate diagnostic marker within the urine profile, highlighting proteinuria in UTI patients as a potential risk factor for renal impairment.
Efficient Classification of Pulmonary Pneumonia and Tuberculosis Alongside Normal and Non-X-ray Images with Minimal Resources and Maximum Accuracy
Authors: Majumder Rifatul Islam
Published: January 2025

1.1)

Pneumonia, primarily caused byStreptococcus pneumoniae, and tuberculosis (TB), caused byMycobacterium tuberculosis, continue to present significant global health challenges. Pneumonia is responsible for 14% of deaths among children under five, resulting in 740,180 fatalities annually [1]. Similarly, TB caused 1.25 million deaths in 2022, including 161,000 among individuals with HIV [2]. Misdiagnosis is a critical issue, with 22.3% of pneumonia cases being misidentified as TB [3], highlighting the need for accurate diagnostic tools. This study proposes a novel classification framework for chest X-ray (CXR) images, designed to identify four categories: normal, pneumonia, tuberculosis, and non-X-ray. By incorporating the “non-X-ray” class, the model enhances robustness by detecting outliers and unseen anomalies. The framework utilizes a pre-trained ResNet-18 convolutional neural network and a fine-tuned DenseNet-121, both trained with and without weighted loss function. The best-performing model achieved exceptional results, with 98.76% accuracy, 99.01% precision, and 99.03% recall, maintaining or surpassing class-wise performance. The model was trained on a curated dataset from multiple valid sources, containing 5,489 normal, 4,273 pneumonia, 4,197 tuberculosis, and 1,357 non-X-ray images. This framework has the potential to reduce misdiagnosis and improve healthcare delivery, particularly in resource-limited environments.
Sex differences in the coherence of PCL-5 and CAPS-5 assessments for Post-Traumatic Stress Disorder
Authors: Bakshi Bhavya , Nalloor Rebecca , McCall Vaughn , Vazdarjanova Almira
Published: January 2025

The clinician-administered Post Traumatic Stress Disorder (PTSD) scale (CAPS) is a clinical tool for the diagnosis and assessment of the severity of PTSD symptoms. It is widely accepted as the gold standard against which self-assessment tools, such as PCL, are usually evaluated. However, the clinician administered interviews are time and resource intensive, thus utilizing self-report measures is adopted as quicker and more practical to assess symptom severity. Although there have been demonstrations of the validity of PCL for PTSD diagnosis and assessment of symptom severity, PCL (including PCL-5 which is based on DSM-5 criteria) scores tend to overreport symptom severity sometimes leading to higher prevalence of PTSD diagnosis. The contributing factors for such discrepancies in reporting are poorly understood. Here we examined whether there are sex differences in the alignment of PCL-5 with CAPS-5. Our findings indicate that males often report higher PTSD symptom severity on PCL-5 which significantly deviates from a predicted correlation line based on their CAPS-5 scores. Female participants had no deviation from the predicted correlation line. Accordingly, 26.8% of males and only 11.4% of females had inaccurate PTSD status if they were evaluated on PCL-5 alone. Our data also shows that participants with military trauma have poor correlation when compared to participants with civilian trauma. These findings have important implications for appropriate PTSD symptom severity assessment especially for males and military populations. This has significant downstream implications as treatment adjustments, therapy recommendations, and disease management, relying heavily on symptom severity assessed by self-reported tools.
Bioimpedance Spectroscopy in Acute Decompensated Heart Failure: Insights on Fluid Status and Outcomes
Authors: Yang Shang-Feng , Liu I-Fan , Chang Hung-Yu , Teng Hsin-I , Tsao Tien-Ping , Tsai Shin-Hung
Published: January 2025

Background

Acute decompensated heart failure (ADHF) is a leading cause of hospitalization, driven by fluid overload and associated with poor outcomes. Bioimpedance spectroscopy (BIS) provides a non-invasive method to assess fluid status, but its utility in predicting clinical outcomes, especially in chronic kidney disease (CKD) and heart failure with preserved ejection fraction (HFpEF), remains unclear.

Methods

This prospective study enrolled 157 patients hospitalized for ADHF. BIS was performed at admission and discharge to measure overhydration (OH) and the OH-to-extracellular water (OH/ECW) ratio. Patients were stratified into subgroups by CKD and heart failure with reduced ejection fraction (HFrEF). Outcomes included major adverse cardiovascular events (MACE) and heart failure hospitalization (HHF). Cox proportional hazards models, adjusted for age, sex, NT-proBNP, and ejection fraction, were used to evaluate the prognostic value of BIS parameters.

Results

Among the 157 patients, 72 (45.9%) had CKD, and 111 (70.7%) had HFrEF. CKD patients exhibited significantly higher OH and OH/ECW ratios at admission but showed no association with MACE or HHF. Greater reductions in OH/ECW were observed in HFrEF patients compared to non-HFrEF (P = 0.036), indicating better response to diuresis. However, these changes did not translate into improved clinical outcomes. Across all subgroups, OH, OH/ECW, and changes in these parameters were not significant predictors of MACE or HHF during the 10.7 ± 7.1-month follow-up.

Conclusions

BIS effectively monitors fluid status in ADHF patients, particularly in HFrEF. However, its prognostic utility in predicting outcomes in CKD and HFpEF subgroups is limited, warranting further investigation.
Association between resting heart rate and all-cause mortality in patients with intracerebral hemorrhage in the intensive care unit: a retrospective study based on the MIMIC-IV database
Authors: Yao Xinwei , Yang Junyu , Zhang Tao , Pang Ying , Zhang Chunyu , Huang Dan , Ji Tongjie , Xu Siyi , Liu Min , Zhong Chunglong
Published: January 2025

Background

Intracerebral hemorrhage (ICH) is a leading cause of disability and mortality, accounting for 20-30% of acute cerebrovascular events. Resting heart rate (RHR) is an important vital sign linked to prognosis, particularly in cardiovascular diseases. This study investigates the association between RHR and all-cause mortality (ACM) in intensive care unit (ICU) patients with ICH.

Methods

Data were extracted from the MIMIC-IV database. Patients were divided into quartiles (Q1–Q4) based on RHR. ACM at 30 days, 90 days, and one year was assessed. Kaplan-Meier curves, multivariate Cox regression, and restricted cubic splines were used to analyze the relationship between RHR and ACM, with receiver operating characteristic curves evaluating the predictive value of RHR >90.3 beats per minute (bpm).

Results

A total of 1,918 patients were included. Survival curves showed significantly higher mortality in higher RHR quartiles (Q3 and Q4) compared to Q1 and Q2. Multivariate Cox regression confirmed that RHR above the second quartile (RHR=78.5 bpm) was linked to higher mortality. Restricted cubic splines revealed a nonlinear relationship between elevated RHR and increased mortality.

Conclusions

A resting heart rate below 90.3 bpm may serve as an independent protective factor against all-cause mortality in patients with intracerebral hemorrhage in the intensive care unit. In contrast, an elevated resting heart rate exceeding 90.3 bpm may be independently associated with an increased risk of all-cause mortality in this population.
AI Perspectives on the Present and Future of Antidepressant Pharmaceutical Treatment Based on Anti-inflammatory Strategies: A Scoping Review of Randomised Controlled Clinical Trials
Authors: Bo Yan , Chen Yifei , Liang Hsu Yi , Dai Haoran , Zhao Fengjiao , Wu Ming , Wang Youwei , Sha Ren
Published: January 2025

Background

Depression remains an unresolved issue on a global scale. Recently, a novel concept of ‘anti-inflammatory-based pharmacotherapy’ has been developed. Despite the role of inflammation in depression having been discussed in many reviews at various levels, the prevalence of this new concept in randomised controlled clinical studies and its implications remain elusive. The aim of this scoping review was precisely to explore in depth the current status of inflammation in randomised controlled clinical trial studies of depression.

Methods

PubMed was systematically searched from inception to December 11 2024. Studies that researches on the treatment of depression based on anti-inflammatory strategies were included. Study characteristics and outcomes were extracted and organized thematically.

Findings

11 reports of randomised controlled clinical trials were included, which accumulated 119 depressed patients. All studies found that there is a connection between the effects of anti-inflammatory drugs in treating depression and a large decrease in the levels of inflammatory markers in the blood of depressed patients compared to before treatment. Three inflammatory markers, CRP, IL-6 and TNF-alpha, were the most frequently mentioned. The current strategy of anti-inflammatory drug administration did not differ fundamentally from the previous strategy of traditional antidepressant drugs combined with psychotherapy.

Interpretation

At present, the use of anti-inflammatory strategies for the pharmacological treatment of depression has limited research value and poor feasibility. The future direction of the new concept of anti-inflammatory strategies for the treatment of depression, proposed in the context of the association between inflammation and depression, is that psychiatrists, researchers, and psychotherapists should shift their future focus from pharmacological treatments based on anti-inflammatory strategies to non-pharmacological treatments of anti-inflammatory strategies, such as positive thinking, exercise, and so on. The popularity of purely clinical randomised controlled studies in the depression population is extremely low when considering the financial investment in research and the benefits of translating the results. In the future, public interest studies, low research costs, and research protocols with mass generalisability will be more likely to stimulate the depression community’s interest in participating in research. The potential value and feasibility of future research lies in the application of an integrated AI platform to assist pharmacological treatment of depression based on anti-inflammatory strategies.

Registration DOI:https://doi.org/10.17605/OSF.IO/A64GC
GLUCOSE: A Distributional Reinforcement Learning Model for Optimal Glucose Control After Cardiac Surgery
Authors: Desman Jacob M. , Hong Zhang-Wei , Sabounchi Moein , Sawant Ashwin S. , Gill Jaskirat , Costa Ana C , Kumar Gagan , Sharma Rajeev , Gupta Arpeta , McCarthy Paul , Nandwani Veena , Powell Doug , Carideo Alexandra , Goodwin Donnie , Ahmed Sanam , Gidwani Umesh , Levin Matthew , Varghese Robin , Filsoufi Farzan , Freeman Robert , Shetreat-Klein Avniel , Charney Alexander W , Hofer Ira , Chan Lili , Reich David , Kovatch Patricia , Kohli-Seth Roopa , Kraft Monica , Agrawal Pulkit , Kellum John A. , Nadkarni Girish N. , Sakhuja Ankit
Published: January 2025

This study introduces Glucose Level Understanding and Control Optimized for Safety and Efficacy (GLUCOSE), a distributional offline reinforcement learning algorithm for optimizing insulin dosing after cardiac surgery. Trained on 5,228 patients, tested on 920, and externally validated on 649, GLUCOSE achieved a mean estimated reward of 0.0 [-0.07, 0.06] in internal testing and -0.63 [-0.74, -0.52] in external validation, outperforming clinician returns of -1.29 [-1.37, -1.20] and -1.02 [-1.16, -0.89]. In multi-phase human validation, GLUCOSE first showed a significantly lower mean absolute error (MAE) in insulin dosing, with 0.9 units MAE versus clinicians’ 1.97 units (p < 0.001) in internal testing and 1.90 versus 2.24 units (p = 0.003) in external validation. The second and third phases found GLUCOSE‘s performance as comparable to or exceeding that of senior clinicians in MAE, safety, effectiveness, and acceptability. These findings suggest GLUCOSE as a robust tool for improving postoperative glucose management.
Safety and immunogenicity of 23-valent pneumococcal polysaccharide vaccine (PPV23) in Chinese children, adults and elderly: a phase 4, randomized, double-blind, active-controlled clinical trial
Authors: Liu Xiaoyu , Shi Gang , Yang Wanqi , Dong Yuanyuan , Ye Xianying , Zhang Juxiang , Yang Xinyi , Song Dan , Ma Yuehong , Wang Zeng , Li Hong , Yu Dan , Hu Weijun
Published: January 2025

Objectives

A randomized, double-blind, active-controlled noninferiority phase 4 clinical trial was conducted to evaluate the immunogenicity and safety of a 23-valent pneumococcal polysaccharide vaccine (PPV23).

Methods

Pneumococcal vaccine-naïve participants aged ≥2 years were randomly assigned in a 2:1 ratio to receive a single dose of either the treatment vaccine (n=1199) or a comparator vaccine (n=600). We evaluated the immunogenicity before and 30 days post-vaccination, by measuring serum IgG serotype-specific pneumococcal antibodies to 23 serotypes contained in the vaccines via an enzyme-linked immunosorbent assay. The primary outcome was seroconversion (two-fold increase) of serum IgG serotype-specific antibodies at days 30 compared with baseline.

Results

One month after the administration of PPV23, seroconversion rates for each of the 23 serotypes ranged from 59.22% to 95.67% in the treatment group, and in the control group from 59.66% to 94.07%. The lower bound of the 95% confidence interval (95%CI) of the rate differences for the 23 serotypes were all larger than −10%. Moreover, 12 serotypes (6B, 23F, 1, 2, 4, 8, 9N, 9V, 11A, 15B, 17F and 18C) had a lower bound of 95%CI for rate difference larger than 0. In total, 236 (19.68%) participants in the treatment group and 118 (19.67%) in the control group reported adverse reactions within 30 days poste-vaccination. No significant differences in incidence of adverse reactions were found between the two comparison groups.

Conclusions

The PPV23 vaccine administered among individual aged ≥2 years was safe, well tolerated and immunogenic, eliciting immune response either comparable to or higher than control vaccine.
Deep Learning Chest X-Ray Age, Epigenetic Aging Clocks and Associations with Age-Related Subclinical Disease in the Project Baseline Health Study
Authors: Chandra Jay , Short Sarah , Rodriguez Fatima , Maron David J. , Pagidipati Neha , Hernandez Adrian F. , Mahaffey Kenneth W. , Shah Svati H. , Kiel Douglas P. , Lu Michael T. , Raghu Vineet K.
Published: January 2025

Chronological age is a cornerstone of medical decision-making but is limited because individuals age at different rates. We recently released an open-source deep learning model to assess biological age from chest radiograph images (CXR-Age), which predicts incident all-cause and cardiovascular mortality better than chronological age. Here, we compare CXR-Age to two established epigenetic aging clocks (First generation – Horvath Age; Second generation - DNAm PhenoAge), to test which is more strongly associated with measures of cardiopulmonary disease. Our cohort consisted of 2,097 participants from the Project Baseline Health Study (PBHS), a prospective cohort study of individuals from four US sites enriched for cardiovascular and cardiometabolic disease risk factors. We found that CXR-Age was most strongly associated with the presence of coronary calcium, cardiovascular risk factors, worsening pulmonary function, increased frailty, and abundance in plasma of two proteins implicated in neuroinflammation and aging. Associations with second generation epigenetic clocks were weaker for pulmonary function and for all outcomes in younger adults. No associations were found with first generation clocks. These results suggest that opportunistic screening using CXR-Age may help identify high risk individuals who could benefit from directed screening and prevention.
Association between peripartum cardiomyopathy and mood disorders in a large, national U.S. cohort
Authors: Neuburg Blake , Harris Melissa , Palatnik Anna , Harrison Rachel
Published: January 2025

Objective

To examine the association between mood disorders in pregnancy and postpartum and peripartum cardiomyopathy (PPCM).

Methods

Retrospective cohort study utilizing the National Inpatient Sample from the Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality of pregnant and postpartum patients from 2017-2019. Patients were separated into two groups based on ICD-10 coding for presence or absence of mood disorder (depression, bipolar depression, anxiety, or other mood diagnosis). The primary outcome was diagnosis of PPCM. Secondary outcomes included a composite of adverse cardiac events and maternal death. Groups were compared via t-tests, chi-squared analysis, and logistic regression that included all variables that differed between groups with p<0.05.

Results

Over 2.2 million subjects were analyzed and approximately 168,000 (7.4%) had an ICD-10 diagnosis of mood disorder. Those with mood disorders were more likely to be non-Hispanic white, obese, tobacco users, publicly insured, have comorbidities, and deliver at a large, private, non-profit hospital (all p<0.05). They were delivered at an earlier gestational age and were also more likely to undergo cesarean (37.0±4.6 vs 37.8±3.7 weeks and 35.8% vs 31.8%, respectively)., p<0.001). The primary outcome of PPCM was identified more than twice as often in those with mood disorder (0.12% vs 0.05%, p<0.001). Composite cardiac events, consisting of incidence of acute myocardial infarction, cardiac arrest, cardioversion, cardiac failure, and pulmonary edema were more frequent among patients with mood disorders (0.36% vs 0.14%, p<0.001). After controlling for confounders, PPCM remained independently associated with diagnosis of mood disorders (aOR 1.36, 95%CI 1.03-1.80) as did the composite of adverse cardiac events (aOR 1.57, 95% CI 1.37-1.81).

Conclusion

Mood disorders in pregnancy and postpartum are associated with increased rates of PPCM and other cardiac events.