bluuebunny/crossref_metadata_2025 huggingface dataset:
Ambient temperature and risk of cardiovascular and respiratory adverse health outcomes: a nationwide cross-sectional study from Spain
Authors: Achebak Hicham , Rey Grégoire , Lloyd Simon J , Quijal-Zamorano Marcos , Méndez-Turrubiates Raúl Fernando , Ballester Joan
Published: February 2024

Aims

We assessed the association of temperature and temperature variability with cause-specific emergency hospitalizations and mortality from cardiovascular and respiratory diseases in Spain, as well as the effect modification of this association by individual and contextual factors.

Methods and results

We collected data on health (hospital admissions and mortality), weather (temperature and relative humidity), and relevant contextual indicators for 48 Spanish provinces during 2004–2019. The statistical analysis was separately performed for the summer (June–September) and winter (December–March) seasons. We first applied a generalized linear regression model with quasi-Poisson distribution to estimate daily province-specific temperature-health associations, and then we fitted multilevel multivariate meta-regression models to the evaluate effect modification of the contextual characteristics on heat- and cold-related risks. High temperature increased the risk of mortality across all cardiovascular and respiratory diseases, with the strongest effect for hypertension (relative risk (RR) at 99th temperature percentile vs. optimum temperature: 1.510 [95% empirical confidence interval {eCI} 1.251 to 1.821]), heart failure (1.528 [1.353 to 1.725]), and pneumonia (2.224 [1.685 to 2.936]). Heat also had an impact on all respiratory hospitalization causes (except asthma), with similar risks between pneumonia (1.288 [1.240 to 1.339]), acute bronchitis and bronchiolitis (1.307 [1.219 to 1.402]), and chronic obstructive pulmonary disease (1.260 [1.158 to 1.372]). We generally found significant risks related to low temperature for all cardiovascular and respiratory causes, with heart failure (RR at 1st temperature percentile vs. optimum temperature: 1.537 [1.329 to 1.779]) and chronic obstructive pulmonary disease (1.885 [1.646 to 2.159]) exhibiting the greatest risk for hospitalization, and acute myocardial infarction (1.860 [1.546 to 2.238]) and pneumonia (1.734 [1.219 to 2.468]) for mortality. Women and the elderly were more vulnerable to heat, while people with secondary education were less susceptible to cold compared to those not achieving this educational stage. Results from meta-regression showed that increasing heating access to the highest current provincial value (i.e. 95.6%) could reduce deaths due to cold by 59.5% (57.2 to 63.5).

Conclusion

Exposure to low and high temperatures was associated with a greater risk of morbidity and mortality from multiple cardiovascular and respiratory conditions, and heating was the most effective societal adaptive measure to reduce cold-related mortality.
Digest: Habitat and competition drive diversification in Gondwanan fish
Authors: Dhanda Aavika , Hubbard Lillian , Goyal Naman
Published: February 2024

Why do some clades diversify more than others? And what are the roles of abiotic and biotic factors in driving such unequal diversification? To explore this, Burns et al. (2024) investigate variation in body morphology in a group of freshwater fish, Characiformes, across South America and Africa. They find that habitat features such as slope, elevation, and flow rates have played a major role in the diversification of morphological variation in the Characiformes. The Neotropical lineages residing in significantly more diverse slope and elevation habitats were found to display more body shape diversity than African lineages. The authors also report that competition might have limited the morphological variation in African Characiformes compared to the Neotropical lineages. This study highlights the importance of exploring both abiotic and biotic factors when examining diversification.
Increased Care Provision and Caregiver Wellbeing: Moderation by Changes in Social Network Care Provision
Authors: Kirkegaard Allison , Friedman Esther M , Edgington Sarah , Kennedy David
Published: February 2024

Objectives

Previous research links increased care provision to worse wellbeing among family and friend caregivers, both before and during the coronavirus disease 2019 (COVID-19) pandemic. We expand on this by incorporating data on caregivers’ social networks and exploring the relationships between own and network changes in care during the pandemic and caregiver wellbeing.

Methods

We use nationally representative data from 1,876 family and friend caregivers in the first wave of our Care Network Connections over Time study (fielded 12/17/2020–1/4/2021) who had provided care continuously since before the COVID-19 pandemic began. Caregivers were asked about the amount of care that they and each member of their social networks were providing at the time of the survey relative to before the pandemic. We use multivariate regression models to examine the associations between five caregiver wellbeing outcomes and changes in care, and explore the moderating role of networks’ changes in care.

Results

Among caregivers who had provided care since prior to the pandemic, most increased (42.0%) or maintained the same (40.8%) care. Their networks also typically increased (33.4%) or maintained (46.5%) care. Increasing one’s own care provision was associated with higher levels of anxiety, depression, loneliness, and emotional difficulty than maintaining stable care. Among those who increased care, these levels were highest when the network also increased or decreased care.

Discussion

Increased care provision was most strongly associated with poor caregiver wellbeing in contexts where caregivers’ social networks also changed care provisions. Supports for caregivers undertaking additional care tasks should take into account caregivers’ networks.
Sleep and Caregiver Burden Among Caregivers of Persons Living With Dementia: A Scoping Review
Authors: Mattos Meghan K , Bernacchi Veronica , Shaffer Kelly M , Gallagher Virginia , Seo Shinae , Jepson Laura , Manning Carol
Published: February 2024

Background and Objectives

Caregivers of persons with dementia report worse sleep when compared to the general population. The objective of this review was to synthesize evidence regarding the link between caregiver burden and dementia caregivers’ sleep.

Research Design and Methods

We conducted a scoping review using a systematic search for pertinent literature in PubMed, CINAHL, and Web of Science through March 2022. Keywords included content areas of dementia, caregiver burden, and sleep. Inclusion criteria were informal caregivers of persons living with dementia, a measured relationship between informal dementia caregiver sleep and subjective caregiver burden variables, and original research. Non-English studies were excluded. Extracted data were organized in tables, compared, and synthesized.

Results

The search yielded 540 nonduplicate articles screened by title and abstract; 118 full-text articles were reviewed; 24 were included. Most studies were cross-sectional, with variable sample sizes. Dementia caregivers had significantly poorer overall perceived sleep than noncaregivers across 4 studies that examined self-reported sleep measures. Eighteen studies investigated the association between caregiver burden and self-reported sleep quality, with 14 reporting a significant positive association between caregiver burden and self-reported sleep quality, and 4 finding null results. Only 2 of the 4 studies reporting the association between caregiver burden and objective sleep parameters (ie, actigraphy and polysomnography) reported a significant positive association for at least one sleep subdomain.

Discussion and Implications

Although subjective sleep quality is commonly affected by dementia caregiving burden, there is a lack of corresponding evidence on the relationship between burden and objective sleep metrics. Healthcare providers should consider the dementia caregiver burden’s impact on sleep and regularly assess caregivers’ sleep difficulties. Future studies should focus on consistently measuring caregiver burden and sleep to promote dementia caregiver health and well-being.
A95 INCIDENCE OF LUMINAL GASTROINTESTINAL CANCERS IN PATIENTS WITH CIRRHOSIS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Authors: Jogendran M , Zhu K , Jogendran R , Sabrie N , Chahal D
Published: February 2024

Background

The global incidence of cirrhosis is increasing, as is the incidence of luminal gastrointestinal cancers. It is unknown, however, if cirrhosis itself is a predisposing factor for luminal gastrointestinal cancer. Such an association would have significant clinical implications, particularly for cancer screening prior to liver transplantation.

Aims

To investigate the incidence of luminal gastrointestinal cancers in patients with underlying cirrhosis.

Methods

An electronic search was conducted to study the incidence of luminal gastrointestinal cancers in patients with cirrhosis. Study-specific standardized incidence ratios (SIR) along with their corresponding 95% confidence intervals for both overall cancer incidence and luminal cancer incidence were analyzed using a random-effects model. Statistical heterogeneity was assessed using the Cochran’s Q test and I2 statistic. Subgroup analysis was performed based on cirrhosis etiology and location of luminal malignancy.

Results

We identified 5054 articles; 4 studies were selected for data extraction. The overall incidence of all cancers was significantly higher in patients with cirrhosis, with a SIR of 2.79 (95% CI 2.18–3.57). When stratified by cirrhosis etiology, the incidence of all cancers remained significantly elevated for alcohol (SIR 3.13, 95% CI 2.24–4.39), PBC (SIR 1.40, 95% CI 1.10–1.79), and unspecified cirrhosis (SIR 3.52, 95% CI 1.87–6.65). Unspecified cirrhosis had the greatest overall cancer risk followed by alcohol, and PBC cirrhosis (p ampersand:003C 0.01). Alcohol related cirrhosis was significantly associated with an increased incidence of luminal cancers (SIR 4.39, 95% CI 2.84–6.78). Specifically, the highest incidence was observed for oral cavity and pharyngeal cancer (SIR 10.44, 95% CI 8.90–12.24), followed by esophageal cancer (SIR 7.85, 95% CI 4.98–12.36), and colorectal cancer (SIR 2.43, 95% CI 1.62–3.66) (p ampersand:003C 0.01). PBC cirrhosis was significantly associated with an increased incidence of luminal cancers (SIR 2.11, 95% CI 1.10–4.04). However, subgroup analysis did not reveal a significant association with the incidence of any subgroups. Unspecified cirrhosis was significantly associated with an increased incidence of luminal cancers (SIR 2.60, 95% CI 1.65–4.09). Risk of oral cavity and pharynx cancers (SIR 4.75, 95% CI 2.18–10.33) were greatest, followed by esophageal (SIR 4.52, 95% CI 1.57–12.99), stomach (SIR 2.12, 95% CI 1.31–3.42), and colorectal cancer (SIR 1.57, 95% CI 1.14–2.16) (p = 0.03).

Conclusions

The incidence of luminal gastrointestinal cancer is increased amongst patients with cirrhosis. Oral cavity, pharyngeal and esophageal cancer had increased incidence across all cirrhosis etiologies compared to gastric and colorectal cancer. Therefore, increased screening of luminal cancers should be considered in this population.

Funding Agencies

None
A169 A RARE MANIFESTATION OF ENTERITIS DUE TO IMMUNE CHECKPOINT INHIBITOR: CASE REPORT OF PYLORIC STRICTURE
Authors: Cintosun A , Bollegala N
Published: February 2024

Background

Immune checkpoint inhibitors (ICI) are immunomodulatory antibodies used to enhance the immune response against tumor cells that have revolutionized the treatment of various malignancies. ICIs pose a risk of immune-related adverse events in various organs including the gastrointestinal tract, with diarrhea and colitis being most common. ICIs can rarely cause involvement of the upper gastrointestinal tract, with case reports of gastritis, duodenitis, and esophagitis. There are very rare reports of strictures caused by ICIs, more frequently in the lower gastrointestinal tract, and only a few reports in the esophagus or duodenum.

Aims

We report a rare case of an upper gastrointestinal stricture due to ICI at the pylorus.

Methods

Case report.

Results

A 38-year-old woman with breast cancer on ICI pembrolizumab presented with several weeks of nausea and early satiety. She had started pembrolizumab 8 months prior, underwent neoadjuvant chemotherapy and mastectomy months ago, and completed radiation 6 weeks earlier. She also described nocturnal reflux and heartburn, but no vomiting, weight loss, or other gastrointestinal symptoms. Her examination was normal and recent bloodwork only showed a mild normocytic anemia.

EGD (esophagogastroduodenoscopy) showed friable circumferential ulceration of the distal antrum with surrounding erythema and luminal narrowing from the pyloric channel to duodenum. 1-centimetre gastroscope was not passable but 4.9-millimetre pediatric gastroscope passed into the duodenum where there were no abnormalities past the duodenal bulb. Pathology showed granulation tissue, fibrinopurulent exudate, and antral mucosa with chronic active inflammation negative for Helicobacter pylori and malignancy. Oncology felt that radiation was too far from the pylorus to be responsible for the findings.

High-dose proton pump inhibitor (PPI) and soft diet were recommended with minimal symptomatic improvement. 2 months later, she developed weight loss and repeat EGD showed minimal endoscopic improvement (Figure 1).

ICI-related enteritis was suspected and she was started on prednisone 50 mg daily. Her appetite and nausea significantly improved. Steroid taper was planned for 8 weeks.

At 3 months, symptoms recurred with prednisone taper. EGD showed only mild improvement of the duodenal stricture. Prednisone dose was increased. On repeat EGD at 7 months, the pylorus was patent with only granular inflammation predominantly in the apex of the duodenal bulb. She tolerated a slower prednisone taper thereafter.

Conclusions

ICI-related inflammation is common in the lower gastrointestinal tract and can less commonly affect the upper gastrointestinal tract. This is a rare report of upper gastrointestinal stricture and the first report known to us of pyloric stricture caused by ICI. Treatment may be challenging, but was achieved with PPI and high-dose steroids with slow taper.

Funding Agencies

None
A265 BARRIERS TO DIETARY MODIFICATION IN INFLAMMATORY BOWEL DISEASE (IBD): A MIXED-METHODS ASSESSMENT OF PATIENT PERCEPTIONS
Authors: Szeto J , Noejovich C V , Verma R , Miranda P , Pinto-Sanchez M , Verdu E , Armstrong D
Published: February 2024

Background

Many patients living with IBD identify diet as a key factor in managing their disease, symptoms and general health, and many report implementing dietary restrictions in response to disease activity and symptoms. Despite increasing data on the role of diet, IBD patients face a variety of challenges that can compromise adherence to dietary recommendations in clinical practice.

Aims

To identify IBD patients’ perceptions regarding barriers to dietary modification and to understand their experiences and expectations of dietary advice from gastroenterologists (GI) or dietitians (RD).

Methods

A mixed-method qualitative data collection strategy with semi-structured focus group and individual one-on-one interviews moderated by a clinical psychologist over a web-based, video communication platform (Zoom). Adult IBD patients (between 18 to 75 years old) attending the McMaster University Medical Centre IBD Clinic were invited to join a focus group consisting of 2-6 individuals or a one-on-one interview. All participants were asked to complete a demographics survey (REDCap) before the session. Recorded audio files for all sessions were transcribed, de-identified and reviewed for accuracy by 2 reviewers with an independent adjudicator to resolve discrepancies followed by thematic analysis (NVIVO).

Results

Between May to December 2022 and May 2023, 38 of 90 invitees took part in 11 focus groups and 9 chose individual interviews. Most participants (mean age 42 years; 60% female) were Caucasian (87%); 42% had a self-reported history of mental health disorders. Mean IBD duration was 16 years (min-max: 0.5–44 years); 73% were in remission and 68% had Crohn’s disease. Thematic analysis identified 5 primary and 11 secondary barriers to dietary adoption (Table).

Participants reported positive and negative experiences with dietary advice from GIs and RDs; expectations included GI referral to a specialist RD and integration of an RD into the health care team.

Conclusions

IBD patients report multiple, varied barriers to dietary adoption and identify a need for improved access to dietary advice and other resources, including integration of RDs into primary and IBD Clinic care teams. The identification of multiple, varied patient-reported barriers offers an opportunity to develop personalized dietary advice for IBD patients to enhance health, well-being and quality of life.

Thematic map of barriers experienced by patients when adopting dietary modifications

Funding Agencies

Farncombe Family Digestive Health Research Institute; Douglas Family
A306 A CASE OF SCLEROSING CHOLANGITIS AS A COMPLICATION OF CAR-T THERAPY
Authors: Zhao B , Kim H , Huang A , Jain A , Chahal D , Yoshida E
Published: February 2024

Background

Chimeric antigen receptor T-cell (CAR-T) therapy is a novel immunotherapy for treating hematological malignancies. CAR-T therapy starts with the collection of T-cells from patients. Then, receptors on the T-cell membrane are re-engineered to become chimeric antigen receptors that specifically target antigens on the surface of malignant cells. These engineered cells are grown ex vivo and infused back into the patient, leading to a targeted immune response against cancer. While CAR-T therapy has shown promising results in treating malignancies refractory to conventional treatment, there have also been reports of complications from unwanted off-target effects with CAR-T therapy.

Aims

We report a case of sclerosing cholangitis secondary to CAR-T therapy for the treatment of mantle cell lymphoma.

Methods

Case report.

Results

A 67-year-old male with refractory stage IVB mantle cell lymphoma underwent CAR-T therapy. His lymphoma was first diagnosed in 2011 and previous treatment included R-CHOP followed by autologous stem cell transplant. He had disease progression despite rituximab maintenance therapy and was switched to ibrutinib therapy with good response until 2023.

In 2023, he was noted to have progression of his lymphoma. He subsequently underwent CAR-T therapy. His treatment was complicated by grade 2 cytokine release syndrome requiring two doses of tocilizumab. Other complications included immune effector cell-associated neurotoxicity syndrome leading to status epilepticus. He was intubated and required monitoring in the ICU however he was not in shock, nor did he require vasopressors.

Post-CAR-T therapy he developed an increase of his liver enzymes in a cholestatic pattern. Magnetic resonance cholangiopancreatography (MRCP) showed irregular biliary dilation with beading suggestive of sclerosing cholangiopathy. He subsequently underwent multiple endoscopic retrograde cholangiopancreatography (ERCP) with stent insertions but there were no improvements in his liver enzymes and jaundice. A liver biopsy was performed which showed large bile duct obstruction with extensive cholestasis and some evidence of non-caseating granulomatous inflammation. Given the timing of new sclerosing cholangiopathy post-CAR-T therapy along with multiple other complications related to CAR-T therapy, it was thought this patient developed sclerosing cholangitis secondary to CAR-T therapy. Due to worsening clinical status along with progression of mantle cell lymphoma, he was transitioned to comfort care.

Conclusions

CAR-T therapy is a novel immunotherapy for the treatment of refractory hematological malignancies. However, complications from the off-target effects of CAR-T therapy can occur. This case highlighted a rare side effect associated with CAR-T therapy. In the future, more research will be needed to further characterize the risks associated with CAR-T therapy.

Cholangiogram showing no visible filling defects or obstructive lesion.

Funding Agencies

None
Spontaneous pneumoperitoneum presenting as an acute abdomen
Authors: Bedard Megan , McInnis Madison , Banton Kaysie
Published: February 2024

Most cases of pneumoperitoneum with associated peritonitis are due to perforation of a hollow viscus. In cases where hollow viscus perforation is not the cause, the pneumoperitoneum is classified as spontaneous and typically can be further subcategorized into thoracic, abdominal, gynecologic, and idiopathic categories. Spontaneous pneumoperitoneum is classically seen in asymptomatic patients, however in a small number of cases patients can present with a concomitant peritonitis. This case report presents a patient that had signs of sepsis and peritonitis with moderate pneumoperitoneum on computed tomography (CT) imaging but was found to have no perforated hollow viscus after an extensive operative and non-operative work up.
An unusual hernia postkidney transplantation led to intermittent ureteric obstruction
Authors: Shaheen Mohammed F , Almalki Faisal J , Altheaby Abdulrahman , Alsaikhan Bader
Published: February 2024

A 53-year-old man underwent a living donor kidney transplantation in the right iliac fossa 25 years prior to presentation. He had been noting an inguinal bugle that became more prominent as the day progressed, and it regressed at night. Upon further investigations, an ultrasound of the allograft revealed moderate-to-severe hydronephrosis. A computed tomography scan revealed herniation of the bladder and part of the transplanted ureter within the supravesical/direct inguinal space. Lichtenstein-like fashion of repair was performed, and the patient continues to enjoy satisfactory graft function with no recurrence. The case illustrates a rare hernia as a late complication of the kidney transplant incision leading to ureteric obstruction and a successful attempt at operative repair.
Axillary artery pseudoaneurysm with concurrent distal thrombosis: a case report
Authors: Wei Runze , Chen Zhaolei
Published: February 2024

This report details a case of axillary artery pseudoaneurysm with concurrent distal thrombosis, manifesting as acute upper extremity ischemia. The condition was successfully treated with a hybrid surgical approach, employing a covered stent graft and Fogarty balloon thrombectomy. We review the relevant literature on the management of this rare but critical vascular condition.
Silver nitrate: a novel therapeutic approach for refractory Seroma following body malodor surgery
Authors: Ho Wen-Tsao
Published: February 2024

Seroma, a fluid collection that can develop after surgery, can be a challenging complication to manage. Conventional treatment options, such as quilting suture and drainage tubes, may not be effective in resolving refractory seromas. This article presents two cases of refractory seroma after axillary osmidrosis surgery that were successfully treated with silver nitrate. Silver nitrate, a topical agent with antiseptic, anti-inflammatory, and wound-healing properties, has been shown to be effective in treating perianal fistulas and persistent tracheocutaneous fistulas. In both cases presented here, silver nitrate resulted in complete seroma resolution within 7 and 14 days, respectively. This study suggests that silver nitrate may be a promising treatment option for refractory seroma after axillary osmidrosis surgery. Further research is warranted to validate these findings and establish optimal dosage and treatment protocols.
Exploratory analysis of glial fibrillary acidic protein and ubiquitin C-terminal hydrolase L1 in management of patients with mild neurological symptoms undergoing head computed tomography scan at the emergency department: a pilot study from a Croatian tertiary hospital
Authors: Lapić Ivana , Rogić Dunja , Lončar Vrančić Ana , Gornik Ivan
Published: February 2024

Background

Diagnostic accuracy of glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) in identification of intracranial abnormalities detected by computed tomography (CT) in mild traumatic brain injury (mTBI), and in patients with mild neurological symptoms not caused by head trauma but suspected with a neurological disorder, was examined.

Methods

GFAP and UCH-L1 were determined using the chemiluminescence immunoassays on the Alinity i analyzer (Abbott Laboratories).

Results

Significantly higher GFAP (median 53.8 vs 25.7 ng/L, P < .001) and UCH-L1 (median 350.9 vs 153.9 ng/L, P < .001) were found in mTBI compared to non-head trauma patients. In mTBI diagnostic sensitivity (Se) and specificity (Sp) for the combination of GFAP and UCH-L1 were 100% and 30.9%, respectively, with area under the curve (AUC) 0.655. GFAP alone yielded Se 85.7%, Sp 41.8%, and AUC 0.638, while UCH-L1 yielded Se 57.1%, Sp 56.4%, and AUC 0.568. In non-head trauma patients, the combination of GFAP and UCH-L1 showed Se 100%, Sp 87.9%, and AUC 0.939, while GFAP alone demonstrated Se 100%, Sp 90.9%, and AUC 0.955.

Conclusions

If these results are reproduced on a larger sample, GFAP and UCH-L1 may reduce CT use in patients with mild neurological symptoms after systemic causes exclusion and neurologist’s evaluation.
Validation of rapid detection methods for Salmonella enterica in green chile
Authors: Kailany Raghda , Presmont Yatziri , Zapata Ruben , Owusu-Kwarteng James , Fedio Willis
Published: February 2024

The objective of this study is to validate the US Food and Drug Administration (FDA) rea-time polymerase chain reaction (qPCR) assay, the Neogen Amplified Nucleic Single Temperature Reaction (ANSR) assay, and the Vitek ImmunoDiagnostic Assay System (VIDAS) SLM procedure against the FDA cultural procedure for Salmonella detection in green chile pepper. Green chile was artificially contaminated with Salmonella according to the FDA guidelines (FDA. Guidelines for the Validation of Microbiological Methods for the FDA Foods Program, 3rd Edition. 2019. www.fda.gov/media/83812/download?attachment (17 March 2024, date last accessed)) at a fractional recovery level (where 50%–25% tests positive and at a level +1 log greater for each organism tested). Enriched samples were tested directly by the ANSR Salmonella test and by qPCR, and were subcultured into Rappaport-Vassiliadis and tetrathionate brilliant green broth for cultural detection and qPCR. For the VIDAS-SLM assay, the selective enrichments were further cultured in M broth before testing. Presumptive salmonellae were confirmed with biochemical tests, serology, and qPCR. All three rapid assays were compared favorably with the FDA-BAM (Bacteriological Analytical Manual) method. No significant differences at P < .05 were found between the procedures using McNemar’s χ2 test. The three procedures were found to be rapid and reliable alternatives to cultural detection of Salmonella enterica in green chile.
Surface heterojunction based on n-type low-dimensional perovskite film for highly efficient perovskite tandem solar cells
Authors: Jiang Xianyuan , Zhou Qilin , Lu Yue , Liang Hao , Li Wenzhuo , Wei Qi , Pan Mengling , Wen Xin , Wang Xingzhi , Zhou Wei , Yu Danni , Wang Hao , Yin Ni , Chen Hao , Li Hansheng , Pan Ting , Ma Mingyu , Liu Gaoqi , Zhou Wenjia , Su Zhenhuang , Chen Qi , Fan Fengjia , Zheng Fan , Gao Xingyu , Ji Qingqing , Ning Zhijun
Published: February 2024

Enhancing the quality of junctions is crucial for optimizing carrier extraction and suppressing recombination in semiconductor devices. In recent years, metal halide perovskite has emerged as the most promising next-generation material for optoelectronic devices. However, the construction of high-quality perovskite junctions, as well as characterization and understanding of their carrier polarity and density, remains a challenge. In this study, using combined electrical and spectroscopic characterization techniques, we investigate the doping characteristics of perovskite films by remote molecules, which is corroborated by our theoretical simulations indicating Schottky defects consisting of double ions as effective charge dopants. Through a post-treatment process involving a combination of biammonium and monoammonium molecules, we create a surface layer of n-type low-dimensional perovskite. This surface layer forms a heterojunction with the underlying 3D perovskite film, resulting in a favorable doping profile that enhances carrier extraction. The fabricated device exhibits an outstanding open-circuit voltage (VOC) up to 1.34 V and achieves a certified efficiency of 19.31% for single-junction wide-bandgap (1.77 eV) perovskite solar cells, together with significantly enhanced operational stability, thanks to the improved separation of carriers. Furthermore, we demonstrate the potential of this wide-bandgap device by achieving a certified efficiency of 27.04% and a VOC of 2.12 V in a perovskite/perovskite tandem solar cell configuration.
Breeding birds of high-elevation mixed-conifer forests have declined in national parks of the southwestern U.S. while lower-elevation species have increased, with responses to drought varying by habitat
Authors: Jones Harrison H , Ray Chris , Johnson Matthew , Siegel Rodney
Published: February 2024

Climate change is considered a major driver of recent avian population declines, particularly in the drought-stricken southwestern United States. Predicting how bird populations will respond requires understanding the climatic drivers influencing population density across the region’s diverse habitats. We modelled breeding-season densities of 50 bird species in relation to spring and summer drought and the timing of North American monsoon rainfall over a 12-year period (2007–2018) and across 4 habitats comprising an approximately 1,500 m elevational gradient. We estimated annual breeding-season population density in relation to climate in the previous year by fitting a Bayesian hierarchical N-mixture model to point-count data from each of 6 national parks on the Colorado Plateau. Specifically, we asked whether (1) population trends were stable, increasing, or decreasing in the focal parks; (2) breeding densities were affected by drought or the timing of monsoon rains; and (3) climatic effects differed across habitat types and among species that molt on the breeding grounds, the nonbreeding grounds, or stopover to molt in the monsoon region of northwestern Mexico (molt migrants). Population trends varied with habitat. Species of high-elevation mixed-conifer forest declined over the study period, matching regional Breeding Bird Survey trends, likely in response to climate-related habitat loss and disturbance. By contrast, lower-elevation pinyon-juniper and grassland-shrubland species density generally increased. Effects of drought varied by habitat with elevation: mixed-conifer species responded positively to drought in the previous year, likely due to earlier snowmelt and breeding phenology, whereas pinyon-juniper species were unaffected, and grassland-shrubland species responded negatively, perhaps due to reduced nest survival. Later arrival of monsoon rains, a common prediction of climate models, had a positive effect on grassland bird densities, but a negative effect on molt-migrant densities. Late monsoon rains may result in a phenological mismatch between migration timing and the pulse of resources required to molt.
A multiparametric risk table for loss of clinical remission status in patients with rheumatoid arthritis: a STARTER study post-hoc analysis
Authors: Perniola Simone , Alivernini Stefano , Gremese Elisa , Landolfi Gianpiero , Carrara Greta , Iagnocco Annamaria , Scirè Carlo Alberto
Published: February 2024

Objective

This post-hoc analysis was carried out on data acquired in the longitudinal Sonographic Tenosynovitis Assessment in RheumaToid arthritis patiEnts in Remission (STARTER) study. Our primary aim was to determine the predictive clinical and musculoskeletal ultrasonographic (MSUS) features associated with disease flare in RA patients in clinical remission, while our secondary aim was to evaluate the probability of disease flare based on clinical and MSUS features.

Methods

We analysed data for a total of 389 RA patients in DAS28-defined remission. All patients underwent a MSUS examination according to the OMERACT guidelines. Logistic regression and results, presented as odds ratio and 95% CI, were used for the evaluation of the association between selected variables and disease flare. Significant clinical and MSUS features were incorporated into a risk table for predicting disease flare within at least 12 months of follow-up in patients with RA remission.

Results

Within 12 months, 137 (35%) RA patients experienced a disease flare. RA patients who experienced a flare disease differed from those with persistent remission in terms of ACPA positivity (75.9% vs 62.3%, respectively; P = 0.007), percentage of sustained clinical remission at baseline (44.1% vs 68.5%, respectively; P = 0.001) and synovium power Doppler signal presence (58.4% vs 33.3%, respectively; P < 0.001). Based on these results, these three features were considered in a predictive model of disease flare with an adjusted odds ratio of 3.064 (95% CI 1.728–5.432). Finally, a risk table was constructed including the three significant predictive factors of disease flare occurring within 12 months from the enrolment.

Conclusion

An adaptive flare-prediction model tool, based on data available in outpatient settings, was developed as a multiparametric risk table. If confirmed by external validation, this tool might support the defining of therapeutic strategies in RA patients in DAS28-defined remission status.
Sleepless behind bars: the connection between mental health, environment, and sleep among women in jail
Authors: Tussey Emma J , Perez Gabriela R , Lynch Shannon M
Published: February 2024

Study Objectives

Given the barriers to good sleep in corrections facilities and the lack of research in this area, the current study aimed to characterize sleep quality and insomnia incidence in women in jail. Furthermore, we aimed to investigate the relation of sleep to depression, posttraumatic stress disorder (PTSD), and trauma exposure in incarcerated women. Lastly, we examined self-reports of environmental and individual factors that impaired sleeping in this population.

Methods

Participants included 176 women incarcerated in two jails in southeast Idaho. Participants were randomly selected to complete several self-report questionnaires, including the Pittsburgh Sleep Quality Index and the Insomnia Severity Index, verbally administered by interviewers.

Results

A majority of participants endorsed poor sleep quality (76%) and subthreshold or higher levels of insomnia (70%). Multiple regression analyses found that depressive symptoms and PTSD symptoms were both significantly related to insomnia and poor sleep quality. Excessive noise, poor bedding, and mental health were commonly cited factors that disrupted sleep.

Conclusions

These results are consistent with previous literature that has examined these outcomes in prison populations and incarcerated populations in other countries. Correctional facilities can consider altering environmental factors that impair sleep to not only promote better overall health but also as a way to address common manifestations of poor mental health in their inmate populations. Screening for and treating mental health problems, namely depression and PTSD, is another way these facilities can improve inmate health and promote better sleep.
Analysis of sexual dysfunction development among male and female living kidney donors
Authors: Johnson John C , Venna Rahul , Alzweri Laith
Published: February 2024

Introduction

Living kidney donations (LKDs) face a persistent demand for patients with end-stage renal disease, emphasizing the importance of LKDs’ growth and success. Although living kidney donors generally exhibit excellent survival rates, little research has explored the development of long-term sexual dysfunction following LKD.

Objectives

This study aimed to analyze differences in 5-year sexual dysfunction outcomes between male and female living kidney donors, utilizing the TriNetX database, a federated network of electronic medical records from multiple U.S. healthcare organizations.

Methods

A propensity score–matched cohort study compared 45-year sexual dysfunction outcomes in adult male and female living kidney donors from December 2013 to December 2022. Cohorts were matched on age; sex; race and ethnicity; diabetes, cardiovascular, genitourinary, and psychiatric comorbidities; lifestyle-related factors; and medications that may impact normal sexual functioning. Primary outcomes included hazard ratio (HR) for decreased libido, sexual dysfunction (composite of male erectile dysfunction, ejaculatory disorders, vaginismus/dyspareunia, infertility, orgasmic disorders, arousal/desire disorders), and sexually transmitted diseases. Secondary outcomes assessed sex counseling and interpersonal relationship issues with spouses or partners.

Results

The matched cohorts included 2315 patients each (male, female), and the mean age was 42.3 ± 12.5 years. At 5 years, male donors had a significantly higher HR for sexual dysfunction (HR, 3.768; 95% confidence interval, 1.929-7.358). Erectile dysfunction occurred in 1% of male patients, while vaginismus/dyspareunia affected <1% of female patients. Other sexual disorders, decreased libido, sexually transmitted diseases, and incidences of sexual and interspousal counseling were not significantly different.

Conclusion

Male living kidney donors faced a higher risk of developing sexual dysfunction 5 years after donation. While LKD remains a safe and viable alternative, clinicians and donors should be mindful of the potential association with sexual dysfunction postdonation. Further research may enhance support for the well-being of living kidney donors.
The detection of pomegranate (Punica granatum L.) peel apoptotic effects using AgNOR staining in MDA-MB-231
Authors: Ceyhan Rabia Nur , Nisari Mustafa , Nisari Mehtap , Uçar Sümeyye , Mehmet Koca Fatih , Kerek Gülderen , Özcanlı Tuğçe , İnanç Neriman
Published: February 2024

In present study, it was purposed to determine the in vitro effect of the extract obtained from the pomegranate (Punica granatum L.) peel on the breast cancer cell line. MDA-MB-231 cells were exposed to pomegranate peel extract (PoPx) at 37 °C and 5% CO2 for varying durations (24 and 48 h) and doses (25 and 50 μg/mL). At the end of the incubation periods, argyrophilic nucleolus organizer regions (AgNOR) protein status, cell viability/apoptosis and cell cycle of MDA-MB-231 cells were examined in the Muse Cell Analyzer device. Cell viability was observed to be decreased when the groups treated with PoPx were compared with the control group. The group in which apoptosis was observed with the highest value was 50 μg/mL PoPx group (p < 0.05). In the cell cycle test, the number of cells in the G0/G1 stage was found to be significantly higher in the 25 μg/mL PoPx group compared to the control and 50 μg/mL PoPx groups at the end of the 24-h incubation period (p < 0.05) The results also supported cell cycle and apoptosis, and at the end of 24 h, Total AgNOR area(TAA)/Total nuclear area (NA) ratio and AgNOR numbered decreased on the 50 μg/mL PoPx group and were found to be statistically significant compared to the control group (p < 0.05). Consequently, it was determined that PoPx increased apoptosis on breast cancer cells by various mechanisms and inhibited cell viability/cell growth. This study showed that the widespread consumption of PoPx may be effective in preventing cancer formation and slowing its progression.
Failed spinal anesthesia for cesarean delivery: prevention, identification and management
Authors: Girard Thierry , Savoldelli Georges L.
Published: February 2024

Purpose of review

There is an increasing awareness of the significance of intraoperative pain during cesarean delivery. Failure of spinal anesthesia for cesarean delivery can occur preoperatively or intraoperatively. Testing of the neuraxial block can identify preoperative failure. Recognition of the risk of high neuraxial block in repeat spinal in case of preoperative failure is important.

Recent finding

Knowledge of risk factors for block failure facilitates prevention by selecting the most appropriate neuraxial procedure, adequate intrathecal doses and choice of technique. Intraoperative pain is not uncommon, and neither obstetricians nor anesthesiologists can adequately identify intraoperative pain. Early intraoperative pain should be treated differently from pain towards the end of surgery.

Block testing is crucial to identify preoperative failure of spinal anesthesia. Repeat neuraxial is possible but care must be taken with dosing. In this situation, switching to a combined spinal epidural or an epidural technique can be useful. Intraoperative pain must be acknowledged and adequately treated, including offering general anesthesia. Preoperative informed consent should include block failure and its management.
Are There Still Any Benefits to Drainage for Anterior Cervical Arthrodesis/Arthroplasty by Cervicotomy?
Authors: Aggad Mourad , Terrier Louis-Marie , Nidal Salah Chakib , Zemmoura Ilyess , Planty-Bonjour Alexia , Francois Patrick , Amelot Aymeric
Published: February 2024

Study Design.

A retrospective single-center study between January 2019 and January 2023.

Objective.

The role and contribution of drainage in the anterior approach to the cervical spine (cervicotomy) is much debated, motivated primarily by the prevention of retropharyngeal hematoma, so are there still any benefits to drainage?

Background.

The anterior approach to the cervical spine is a widespread and common procedure performed in almost all spine surgery departments for the replacement of cervical intervertebral discs and medullar or radicular decompression. The primary endpoint was the occurrence of symptomatic postoperative cervical hematoma.

Patients and Methods.

Four hundred thirty-one patients who had undergone cervical spine surgery by anterior cervicotomy for cervicarthrosis or cervical disc herniation (anterior cervical discectomy and fusion and anterior cervical disc replacement) were consecutively included. Patients were separated into 2 groups: (1) Group A, 140 patients (with postoperative drainage) and (2) Group B, 291 patients (without drainage).

Results.

The mean follow-up was 2.8 months. The 2 groups were comparable on all criteria, but there was a predominance of arthroplasty (P< 0.0001), use of anticoagulants/antiaggregants (P< 0.0001) and a greater number of stages (P< 0.0001) in group A. There were a total of 4/431 symptomatic postoperative hematomas (0.92%) in this study. Two hematomas occurred in group A (2/140, 1.4%) and 2 in group B (2/291, 0.68%; P< 0.0001). One patient in group A (0.71%) required surgical drainage for cavity hematoma revealed by marked dyspnea, swallowing, and neurological disorders. One case of hematoma diagnosed by dysphonia and neurological deficit was reported in group B (0.34%; P< 0.0001).

Conclusions.

The placement of a drain during anterior cervicotomy (anterior cervical discectomy and fusion/anterior cervical disc replacement) did not limit the occurrence of symptomatic postoperative hematoma.
Risk of Autoimmune Disease in Research-Identified Cases of Autism Spectrum Disorder: A Longitudinal, Population-Based Birth Cohort Study
Authors: Villarreal Veronica R. , Katusic Maja Z. , Myers Scott M. , Weaver Amy L. , Nocton James J. , Voigt Robert G.
Published: February 2024

Objective:

Determine the risk of autoimmune disease in research-identified cases of autism spectrum disorder (ASD) compared with referents using a longitudinal, population-based birth cohort.

Methods:

ASD incident cases were identified from a population-based birth cohort of 31,220 individuals. Inclusive ASD definition based on DSM-IV-TR autistic disorder, Asperger syndrome, and pervasive developmental disorder, not otherwise specified, was used to determine ASD cases. For each ASD case, 2 age- and sex-matched referents without ASD were identified. Diagnosis codes assigned between birth and December 2017 were electronically obtained. Individuals were classified as having an autoimmune disorder if they had at least 2 diagnosis codes more than 30 days apart. Cox proportional hazards models were fit to estimate the hazard ratio (HR) between ASD status and autoimmune disorder.

Results:

Of 1014 ASD cases, 747 (73.7%) were male. Fifty ASD cases and 59 of the 1:2 matched referents were diagnosed with first autoimmune disorder at the median age of 14 and 17.1 years, respectively. ASD cases had increased risk of autoimmune disease compared with matched referents (HR 1.74; 95% confidence interval [CI], 1.21–2.52). The increased risk was statistically significant among male patients (HR 2.01; 95% CI, 1.26–3.21) but not among the smaller number of female subjects (HR 1.38; 95% CI, 0.76–2.50).

Conclusion:

This study provides evidence from a longitudinal, population-based birth cohort for co-occurrence of ASD and autoimmune disorders. Thus, children with ASD should be monitored for symptoms of autoimmune disease and appropriate workup initiated.
Radioclinical Assessment of Posterior Tympanotomy Difficulties during Ordinary Cochlear Implantation: A Prospective Case-Series Study
Authors: Barbara Maurizio , Margani Valerio , Covelli Edoardo , Romano Andrea , Bozzao Alessandro , Lotfy Rasha , Mandour Mahmoud , Swaid Ali , Soltan Islam , Elzayat Saad , Elfarargy Haitham H.
Published: February 2024

Objectives

This study proposes a preoperative radiologic scoring system for predicting posterior tympanotomy (PT) and mastoidectomy-associated difficulties during cochlear implantation (CI).

Study design

It was a prospective case-series study.

Settings

The included CI surgeries were performed at tertiary referral institutions from October 2022 to April 2023.

Subjects

We included 73 CI candidates performed via the PT approach

Intervention

The proposed radiologic score, composed of 13 items, was fulfilled and evaluated before each CI surgery.

Main outcome measure

We correlated this score with the intraoperative difficulty and surgical duration.

Results

The operation was straightforward in 42 patients with a score of 3.87 ± 1.72 and challenging in 31 patients with a score of 10.66 ± 1.73. The radiologic score was strongly correlated with the surgical difficulty and duration (p< 0.0001).

Conclusions

Our proposed radiologic score was a valid, reliable, and precise tool to predict intraoperative difficulty during cochlear implantation. Chorda-facial angle was the strongest predictor, significantly affecting the difficulty, surgical duration, and preoperative radiologic score. A score equal to or more than 7.5 was expected to be associated with surgical difficulty.