bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Multiple Cranial Neuropathies in Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report and Scoping Review of the Literature
Authors: Shahjouei Shima , Calmet Michelle , Grogan James , Mamarabadi Mansoureh
Published: August 2024

Objectives:

Cranial nerve (CN) involvement is not a common feature of typical chronic inflammatory demyelinating polyneuropathy (CIDP). Patients with acute presentation of CN palsy in CIDP may be misdiagnosed and treated as other pathologies.

Methods:

We report a patient with multiple cranial neuropathies at the onset of CIDP in detail. In addition, we reviewed a large cohort of patients with CN involvement in CIDP and summarized their characteristics and clinical findings.

Results:

We presented a 28-year-old woman who presented with progressive weakness and involvement of CN III, VII, X, XII in the subacute phase who was diagnosed as CIDP and was treated accordingly. A scoping review of the literature resulted in a total of 59 patients with available patient-level data [61.2% men, median age of 32 (Q1–Q3; 20–51.5) years]. CN impairment was present in the acute phase of the polyneuropathy in 10 out of 43 patients (23.3%), while it took a median of 7.7 [Q1–Q3; 3–13] years for other patients to present CN palsy. Sensitivity analysis did not reveal any difference among patients with acute-phase presentation of CN symptoms (N = 11) compared with those with delayed CN palsy (N = 33) in terms of demographics, patterns of CN involvement, associated diminished sensorimotor findings, or relapse. However, patients with acute presentation of CN palsy underwent plasmapheresis approximately 4 times more than those with delayed CN presentations (45.5% vs. 12.1%,P= 0.02).

Conclusion:

In this case presentation and review study, we observed that in one-fourth of patients with CIDP and CN neuropathy, CN involvement occurred in the acute phase. This finding indicates the necessity of considering CIDP among differential diagnoses of patients with CN involvement and polyneuropathies.
Community profiles in northeastern and central Pennsylvania characterized by distinct social, natural, food, and physical activity environments and their relation to type 2 diabetes
Authors: Moon Katherine A. , Poulsen Melissa N. , Bandeen-Roche Karen , Hirsch Annemarie G. , DeWalle Joseph , Pollak Jonathan , Schwartz Brian S.
Published: August 2024

Background:

Understanding geographic disparities in type 2 diabetes (T2D) requires approaches that account for communities’ multidimensional nature.

Methods:

In an electronic health record nested case–control study, we identified 15,884 cases of new-onset T2D from 2008 to 2016, defined using encounter diagnoses, medication orders, and laboratory test results, and frequency-matched controls without T2D (79,400; 65,069 unique persons). We used finite mixture models to construct community profiles from social, natural, physical activity, and food environment measures. We estimated T2D odds ratios (OR) with 95% confidence intervals (CI) using logistic generalized estimating equation models, adjusted for sociodemographic variables. We examined associations with the profiles alone and combined them with either community type based on administrative boundaries or Census-based urban/rural status.

Results:

We identified four profiles in 1069 communities in central and northeastern Pennsylvania along a rural-urban gradient: “sparse rural,” “developed rural,” “inner suburb,” and “deprived urban core.” Urban areas were densely populated with high physical activity resources and food outlets; however, they also had high socioeconomic deprivation and low greenness. Compared with “developed rural,” T2D onset odds were higher in “deprived urban core” (1.24, CI = 1.16–1.33) and “inner suburb” (1.10, CI = 1.04–1.17). These associations with model-based community profiles were weaker than when combined with administrative boundaries or urban/rural status.

Conclusions:

Our findings suggest that in urban areas, diabetogenic features overwhelm T2D-protective features. The community profiles support the construct validity of administrative-community type and urban/rural status, previously reported, to evaluate geographic disparities in T2D onset in this geography.
Computed tomography–based radial endobronchial ultrasound image simulation of peripheral pulmonary lesions using deep learning
Authors: Zhang Chunxi , Zhou Yongzheng , Sun Chuanqi , Zhang Jilei , Chen Junxiang , Zheng Xiaoxuan , Li Ying , Liu Xiaoyao , Liu Weiping , Sun Jiayuan
Published: August 2024

Background and Objectives

Radial endobronchial ultrasound (R-EBUS) plays an important role during transbronchial sampling of peripheral pulmonary lesions (PPLs). However, existing navigational bronchoscopy systems provide no guidance for R-EBUS. To guide intraoperative R-EBUS probe manipulation, we aimed to simulate R-EBUS images of PPLs from preoperative computed tomography (CT) data using deep learning.

Materials and Methods

Preoperative CT and intraoperative ultrasound data of PPLs in 250 patients who underwent R-EBUS–guided transbronchial lung biopsy were retrospectively collected. Two-dimensional CT sections perpendicular to the biopsy path were transformed into ultrasonic reflection and transmission images using an ultrasound propagation model to obtain the initial simulated R-EBUS images. A cycle generative adversarial network was trained to improve the realism of initial simulated images. Objective and subjective indicators were used to evaluate the similarity between real and simulated images.

Results

Wasserstein distances showed that utilizing the cycle generative adversarial network significantly improved the similarity between real and simulated R-EBUS images. There was no statistically significant difference in the long axis, short axis, and area between real and simulated lesions (all P > 0.05). Based on the experts’ evaluation, a median similarity score of ≥4 on a 5-point scale was obtained for lesion size, shape, margin, internal echoes, and overall similarity.

Conclusions

Simulated R-EBUS images of PPLs generated by our method can closely mimic the corresponding real images, demonstrating the potential of our method to provide guidance for intraoperative R-EBUS probe manipulation.
Fatal Neonatal Influenza A Myocarditis
Authors: Ralser Elisabeth , Edwards Christina , Höck Michaela , Sprung Susanne , Kiechl-Kohlendorfer Ursula , Griesmaier Elke
Published: August 2024

A term baby underwent unexpected, fatal resuscitation in the delivery room. The mother suffered from a common cold during her last trimester of pregnancy. All other examinations throughout gestation were normal. Despite immediate, extended and effective resuscitation, heart rate did not exceed 15-20 beats/minute. In the autopsy, fetal myocarditis due to influenza A infection was detected.
Circular RNA LDLRAD3 promotes gastric cancer progression by upregulating COL4A5 through sponging miR-h37
Authors: Li Chenghui , Xing Xiao , Huang Sinian , Zhu Ting , Yan Bin
Published: August 2024

Background:

Circular RNAs play an important role in the development of gastric cancer (GC). circ-low-density lipoprotein receptor class A domain containing 3 (LDLRAD3) has been confirmed to be related to GC progression. miR-137 is also a suppressor in GC. However, the impact of the interaction between circ-LDLRAD3 and miR-137 on the progression of GC remains unclear at present.

Methods:

The study identified expression level differences of circ-LDLRAD3, miR-137, and COL4A5 in GC pathological specimens compared to normal tissue samples. Furthermore, through in vitro experiments, including flow cytometry, cell counting kit-8 (CCK-8) assays, wound healing, Western blotting, and colony formation assays, we further explored the molecular regulatory mechanisms by which these factors promote the progression of GC.

Results:

In this study, circ-LDLRAD3 was confirmed to have higher expression, and miR-137 had lower expression in GC tissues and cell lines. circ-LDLRAD3 knockdown and miR-137 overexpression promoted apoptosis and inhibited proliferation, migration, and invasion in GC cell lines. Further experiments validated that COL4A5 had a positive relationship with GC and that circ-LDLRAD3 promoted the expression of COL4A5. circ-LDLRAD3 could be sponged and inhibited by miR-137 in GC cells. As a result, the promotional effect of circ-LDLRAD3 on COL4A5 was counteracted by miR-137.

Conclusion:

Our study showed that the knockdown of circ-LDLRAD3 suppressed the development of GC by regulating the miR-137/COL4A5 axis.
Supportive Workplace Wellness Cultures and Mattering Are Associated With Less Burnout and Mental Health Issues in Nurse Managers
Authors: Melnyk Bernadette Mazurek , Chenot Teri , Hsieh Andreanna Pavan , Messinger Jeffrey
Published: August 2024

OBJECTIVE

The aims of this study were to describe burnout, mental health, and healthy lifestyle behaviors of nurses in a managerial role and assess associations among workplace culture factors (perceived culture, mattering, support, and staff shortages) with burnout, mental health outcomes, and healthy lifestyle behaviors.

BACKGROUND

Nurse managers foster unit-based wellness cultures, yet burnout and mental health problems adversely impact the culture and well-being of staff.

METHODS

A cross-sectional, descriptive correlational design was used. The Florida Organization for Nursing Leadership enabled distribution of a wellness survey to nurse managers.

RESULTS

There were 125 participants. Healthy lifestyle behaviors were infrequently practiced. Analysis revealed significant correlations among workplace culture factors, burnout, and mental health outcomes. When compared with nurse managers with staff shortages, those without staff shortages were 6.11 times more likely to not screen positive for burnout.

CONCLUSIONS

Health systems should address workplace culture factors and staff shortages to reduce burnout, improve mental health, and enhance healthy behaviors in nurse managers.
Trajectory of Infant Problematic Feeding Symptoms: Study Protocol
Authors: Thoyre Suzanne M. , Park Jinhee , Crandell Jamie , Estrem Hayley , Knafl Kathleen , Wimmer John
Published: August 2024

Background

Infants with developmental risk factors are more likely to have feeding problems and develop chronic feeding disorders. Early detection and understanding of the progression of problematic feeding and its relationship with a child’s biological functioning and the family feeding environment will enhance effective symptom management and development of interventions to prevent pediatric feeding disorders.

Objectives

The New Through Two (NewThru2) feeding study protocol is described. Study aims are to (a) characterize symptoms of problematic feeding and trajectories of symptoms from pre-discharge from neonatal intensive care through age 24 months; (b) determine the relationship of child biological function at discharge with symptom characteristics and trajectories; (c) describe the child’s feeding environment and its relationship to symptoms from discharge through 24 months; and (d) determine the relationship between problematic feeding symptoms and growth and developmental outcomes.

Methods

NewThru2 is a prospective, longitudinal, mixed method study following over 200 infants who received care in a neonatal intensive care unit and were identified as at risk for compromised development. The study follows enrolled infants through 24 months of age. Symptoms of problematic feeding are measured pre-discharge by clinical observation and medical record review and post-discharge by parent report. Biological function is measured by medical history and cardiorespiratory and autonomic nervous system function during feeding prior to discharge. Child feeding environment is measured by strategies parents use to manage feeding, the effect of feeding on the parent and family, and the use of feeding services. A subset of parents is interviewed to achieve a contextual understanding of the family feeding environment. Child outcome measures include parent-reported feeding skills and clinician-reported growth and neurodevelopment.

Discussion

The results of this study will improve understanding of pediatric feeding disorders during a time of development sensitive to adequate nutrition and with infants at risk for developmental delays or impairments.
Excessive Daytime Sleepiness, Inflammation, and Platelet Energy Metabolism in Chronic Stroke Survivors
Authors: Hoch Christine R. , Klinedinst N. Jennifer
Published: August 2024

Background

Excessive daytime sleepiness is a prevalent and sustained symptom that contributes to untoward physiological and psychological outcomes among stroke survivors. Mechanisms of excessive daytime sleepiness poststroke are not fully understood. Chronic systemic inflammation may contribute to impaired mitochondrial functioning and thereby reduce cellular energy metabolism, which may contribute to symptoms of excessive daytime sleepiness in stroke survivors.

Objectives

This pilot study aimed to assess the relationship between systemic inflammation and cellular energy metabolism to poststroke excessive daytime sleepiness.

Methods

This descriptive pilot study explored the relationship between excessive daytime sleepiness, systemic inflammation, and aerobic energy metabolism of platelets in 22 chronic stroke survivors. The Epworth Sleepiness Scale was used to measure excessive daytime sleepiness. Systemic inflammation was measured by assessing pro-inflammatory cytokines interleukin-6, interleukin-1β, and tumor necrosis factor-alpha and the inflammatory marker C-reactive protein. Aerobic energy metabolism was measured by assessing oxygen consumption rates of platelets. Simple linear regression was used to test the influence of oxygen consumption rates and inflammation on excessive daytime sleepiness. Correlations were analyzed using Spearman rho correlation coefficients.

Results

Excessive daytime sleepiness was recognized in 27.3% of the sample. Systemic inflammation was associated with excessive daytime sleepiness in women but not men. We found no significant relationship between excessive daytime sleepiness and energy metabolism of platelets. However, all oxygen consumption rates were numerically higher in persons with excessive daytime sleepiness.

Discussion

Systemic inflammation may be related to excessive daytime sleepiness symptoms with a notable effect among women. Future larger studies are needed to further explore the sexually dimorphic relationship of poststroke excessive daytime sleepiness to systemic inflammation. Numerically higher platelet oxygen consumption rates may indicate higher energy demands for stroke survivors with excessive daytime sleepiness.
Risk of pedestrian collision for persons with peripheral field loss: A computational analysis
Authors: Kurukuti Nish Mohith , Manda Sailaja , Peli Eli
Published: August 2024

SIGNIFICANCE

People with peripheral field loss report colliding with other pedestrians on their blind side(s). We show that, in dyadic collision scenarios between persons, one with field loss, such as homonymous hemianopia, and the other normally sighted pedestrian, collisions occur only if the persons with homonymous hemianopia are overtaking the pedestrians, and the collision risk is concentrated at farther bearing angles than previously suggested.

PURPOSE

Prior work computed the risk of collision while simulating both pedestrians as points and did not consider the ability of the other pedestrian's normal vision to avoid the collision. We extended the model to better characterize the open space collision risk posed for persons with homonymous hemianopia by normally sighted pedestrians where both have volume.

METHODS

We computed the risk of collision with approaching pedestrians using a model that simulates approaching pedestrians as volumetric entities without vision, volumetric entities with vision, and as points for comparison with the prior work. Collision risk of approaching pedestrians is characterized for all three conditions through spatial collision risk maps and collision risk densities as a function of bearing and radial distances.

RESULTS

The collision risk for volumetric pedestrians is slightly different from that of point pedestrians. For volumetric pedestrians simulated with normal vision, the risk of collision was reduced substantially, as the other pedestrians could detect and avoid most impending collisions. The remaining collision risk is from pedestrians approaching at higher bearing angles (>50°) and from shorter radial distances (<2 m). Thus, collisions occurred when the pedestrians started in front of the person with homonymous hemianopia that was overtaking the pedestrian.

CONCLUSIONS

The probability of collisions between pedestrians and the person with peripheral field loss is low and occurs only when the person with peripheral field loss is walking from behind the pedestrian at faster speed, thereby overtaking them. Such collisions occur with pedestrians at higher bearing angles, which should be monitored by assistive aids to avoid collisions. The same collision risk applies not only in homonymous hemianopia but also in other peripheral field loss such as monocular vision loss or concentric field loss, as common in retinitis pigmentosa and glaucoma.
MiR-450b-5p enhances the radiosensitivity of HR+ and HER2− breast cancer by targeting CDK6
Authors: Wu Ruxing , Zhang Hanwang , Huang Xiaoyuan , Zhuang Liang
Published: August 2024

Background

The sensitivity of breast cancer cells to radiation is a key cause of locoregional recurrence after postoperative radiotherapy. Several studies have reported that microRNAs (miRNAs) are involved in the radiosensitivity of human breast cancer cells. One miRNA microarray study showed that miR-450b-5p was overexpressed 13.3-fold in patients with estrogen receptor–positive (ER+) and human epidermal growth factor receptor 2–negative (HER2−) breast cancer and no local relapse compared with local relapse patients. However, its underlying mechanism of action remains unknown.

Methods

The predicted target mRNAs of miR-450b-5p were screened using the TargetScan, miRDB, and miRWalk databases. Western blotting, quantitative polymerase chain reaction, and dual-luciferase reporter assays explored the association between cyclin-dependent kinase 6 (CDK6) and miR-450b-5p. The cell counting kit-8 assay and flow cytometry detected the proliferation of transfected MCF7 cells. Colony formation and xenograft tumors detected the radiosensitivity of the transfected MCF7 cells.

Results

Bioinformatics analysis, Western blotting, quantitative polymerase chain reaction, and dual-luciferase reporter assays demonstrated that CDK6 was the target gene of miR-450b-5p. Furthermore, in vitro and in vivo experiments showed that miR-450b-5p inhibited MCF7 cell proliferation and cell cycle progression, increased the sensitizer enhancement ratio, and decreased the volume of xenograft tumors after irradiation by regulating CDK6.

Conclusions

This study demonstrates that miR-450b-5p enhances the radiosensitivity of hormone receptor–positive (HR+) and HER2− breast cancer cells and elucidates its mechanism. miR-450b-5p may be considered a therapeutic target in HR+ and HER2− breast cancer treated with radiotherapy.
Advances in the therapeutic study of oncolytic virus in colorectal cancer
Authors: Chen Junjie , Chen Kailang , Yuan Xianglin
Published: August 2024

Colorectal cancer (CRC) represents a considerable global health challenge, ranking third in incidence and second in mortality worldwide. However, existing therapies for diseases with advanced stages often fail, thereby necessitating the search for more comprehensive treatments. Oncolytic virus, a novel anticancer approach, exhibits promising capabilities in selectively targeting and destroying tumor cells while augmenting their efficacy through genetic engineering modifications. Anticipated as a new therapeutic paradigm for CRC, this study aimed to assess the performance of oncolytic virus in clinical trials and explore their potential synergies with other therapeutic modalities, offering insights into the future direction of CRC treatment.
Pharmacokinetic Factors Associated With Early Meropenem Target Attainment in Pediatric Severe Sepsis*
Authors: Paice Kelli , Tang Girdwood Sonya , Mizuno Tomoyuki , Pavia Kathryn , Punt Nieko , Tang Peter , Dong Min , Curry Calise , Jones Rhonda , Gibson Abigayle , Vinks Alexander A. , Kaplan Jennifer
Published: August 2024

OBJECTIVES:

To determine the frequency of early meropenem concentration target attainment (TA) in critically ill children with severe sepsis; to explore clinical, therapeutic, and pharmacokinetic factors associated with TA; and to assess how fluid resuscitation and volume status relate to early TA.

DESIGN:

Retrospective analysis of prospective observational cohort study.

SETTING:

PICU in a single academic quaternary care children’s hospital.

PATIENTS:

Twenty-nine patients starting meropenem for severe sepsis (characterized as need for positive pressure ventilation, vasopressors, or ≥ 40 mL/kg bolused fluid), of which 17 were newly escalated to PICU level care.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Concentration-time profiles were analyzed using modeling software employing opportunistic sampling, Bayesian estimation, and a population pharmacokinetic model. Time above four times minimum inhibitory concentration (T > 4×MIC), using the susceptibility breakpoint of 1 µg/mL, was determined for each patient over the first 24 hours of meropenem therapy, as well as individual clearance and volume of distribution (Vd) estimates. Twenty-one of 29 patients met a target of 40%T > MIC 4 μg/mL. Reaching TA, vs. not, was associated with lower meropenem clearance. We failed to identify a difference in Vd or an association between the TA group and age, weight, creatinine-based estimated glomerular filtration rate (eGFR), or the amount of fluid administered. eGFR was, however, negatively correlated with overall T > MIC.

CONCLUSIONS:

Eight of 29 pediatric patients with early severe sepsis did not meet the selected TA threshold within the first 24 hours of meropenem therapy. Higher clearance was associated with failure to meet targets. Identifying patients likely to have higher meropenem clearance could help with dosing regimens.
Quantification of Coronary Artery Stenosis in Very-High-Risk Patients Using Ultra-High Resolution Spectral Photon-Counting CT
Authors: Fahrni Guillaume , Boccalini Sara , Mahmoudi Allal , Lacombe Hugo , Houmeau Angèle , Elbaz Meyer , Rotzinger David , Villien Marjorie , Bochaton Thomas , Douek Philippe , Si-Mohamed Salim A.
Published: August 2024

Objective

Development of spectral photon-counting computed tomography (SPCCT) for ultra-high-resolution coronary CT angiography (CCTA) has the potential to accurately evaluate the coronary arteries of very-high-risk patients. The aim of this study was to compare the diagnostic performances of SPCCT against conventional CT for quantifying coronary stenosis in very-high-risk patients, with invasive coronary angiography (ICA) as the reference method.

Materials and Methods

In this prospective institutional review board–approved study, very-high-risk patients addressed for ICA following an acute coronary syndrome were consecutively included. CCTA was performed for each patient with both SPCCT and conventional CT before ICA within 3 days. Stenoses were assessed using the minimal diameter over proximal and distal diameters method for CCTA and the quantitative coronary angiography method for ICA. Intraclass correlation coefficients and mean errors were assessed. Sensitivity and specificity were calculated for a >50% diameter stenosis threshold. Reclassification rates for conventional CT and SPCCT were assessed according to CAD-RADS 2.0, using ICA as the gold standard.

Results

Twenty-six coronary stenoses were identified in 26 patients (4 women [15%]; age 64 ± 8 years) with 19 (73%) above 50% and 9 (35%) equal or above 70%. The median stenosis value was 64% (interquartile range, 48%–73%). SPCCT showed a lower mean error (6% [5%, 8%]) than conventional CT (12% [9%, 16%]). SPCCT demonstrated greater sensitivity (100%) and specificity (90%) than conventional CT (75% and 50%, respectively). Ten (38%) stenoses were reclassified with SPCCT and one (4%) with conventional CT.

Conclusions

In very-high-risk patients, ultra-high-resolution SPCCT coronary angiography showed greater accuracy, sensitivity, and specificity, and led to more stenosis reclassifications than conventional CT.
THE PROTECTIVE EFFECT OF FASCIOTOMY COMBINED WITH HYPERTONIC SALINE FLUSHING FOR CRUSH SYNDROME IN RATS
Authors: Wen Yaqian , Wang Xiaoge , Zhang Jie , Rong Lei , Ren Wenjie , Tian Linqiang , Liu Liangming
Published: August 2024

In natural disasters such as earthquakes and landslides, the main problem that wounded survivors are confronted with is crush syndrome (CS). The aim of this study was to explore more convenient and effective early treatment measures for it. In the present study, we investigated the protective effect of fasciotomy combined with different concentration of hypertonic saline flushing with CS rats. CS model was prepared by compressing the buttocks and both lowering limbs of rats with 7.5 kg dumbbell for 4 h. The rats were divided into 10 groups, which were normal control group, model group, incision without flushing group, 0.45%, 0.9%, 3%, 5%, 7% saline group, 3%–0.45% and 7%–0.45% saline alternating flushing group, respectively. Six hours after the treatment, the blood was sampled for measurement of the potassium, calcium, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, creatinine, urea, myoglobin, and lactic acid content. The blood flow of the compressed tissue and kidneys, the pathological changes of the kidneys, and the survival rate of 3%–0.45% saline alternating flushing group were also observed. The experimental results showed that fasciotomy alone for treatment cannot improve the presentation of CS of rats. Instead, hypertonic saline flushing significantly improved the glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, creatinine, urea indices, blood flow of muscles, and kidneys. It also enormously decreased the blood K+, myoglobin, lactic acid concentration, and slight increased the blood Ca2+. Among them, alternating flushing with 3%–0.45% saline had the best therapeutic effect on CS. Finally, it can be found that 3%–0.45% saline treatment regimen dramatically raised the survival rate of CS rats. All in all, this study suggests that fasciotomy combined with hypertonic saline flushing is a good therapeutic approach for CS.
ACUTE KIDNEY INJURY FOLLOWING ACUTE CHOLANGITIS: A RISK MULTIPLIER FOR ADVERSE OUTCOMES AND HEALTHCARE UTILIZATION
Authors: Tang Lili , Wan Weiwei , Zhang Jie , Zhang Hongtao , Wang Yuhao , Li Xiaoyue
Published: August 2024

Background: Acute kidney injury (AKI) is a common, fatal complication of acute cholangitis (AC). The link between AC and AKI is poorly understood. Aims: To delineate the incidence trends, clinical outcomes and healthcare utilization of inpatients with AKI following AC and to explore the risk factors for AKI following AC. Methods: This population-based retrospective study used the National Inpatient Sample database from 2010 to 2018 to compare the demographics, complications, in-hospital mortality and healthcare utilization between AC patients with and without AKI. Predictors of AKI and the prognostic impact of AKI on in-hospital outcomes were defined using multivariate logistic regression. Results: The overall incidence of AKI was 24.06% among AC patients. Its trend generally increased annually. AKI was associated with more complications, greater invasive therapy requirements, longer hospital stays, costlier total hospital charges, and higher in-hospital mortality. The risk factors for AKI following AC were advanced age, Black race, multiple comorbidities, large hospitals, teaching hospitals, urban hospitals, hospitals in the southern and western United States, choledocholithiasis/cholelithiasis, surgery, percutaneous transhepatic biliary drainage, deficiency anemia, congestive heart failure, coagulopathy, diabetes, hypertension, chronic liver disease, obesity, chronic kidney disease excluding end-stage renal disease, weight loss, acute pancreatitis, and severe sepsis. Female sex, private insurance, elective admission, and endoscopic retrograde cholangiopancreatography were protective factors against AKI in AC patients. Conclusion: AKI often follows AC and is strongly associated with poor prognosis and increased healthcare utilization. Healthcare professionals should make more efforts to identify patients with AC at risk of AKI and start management promptly to limit adverse outcomes.
Searching for the earliest archaeological record: insights from chimpanzee material landscapes
Authors: Reeves Jonathan S. , Proffitt Tomos , Pacome Soiret Serge , Luncz Lydia V.
Published: August 2024

The origin of tool use is a central question in human evolutionary studies. Plio-Pleistocene core and flake technologies represent the earliest evidence of tool use in the human lineage. Some suggest this form of tool use is probably pre-dated by a phase of percussive tool use. However, there is currently no evidence for such a record. The archaeological signature of solely percussive behaviours is not as well understood as that associated with cores and flakes. The durable nature of primate percussive stone tools and their by-products provide an opportunity to investigate what such a record looks like. Here, we present a landscape-scale study of the chimpanzee (
Pan troglodytes verus
) material culture from the Djouroutou Chimpanzee Project, Taï Forest, Cote d’Ivoire. This study explores the interplay between behavioural and environmental factors in shaping the stone record of nut cracking. Through a survey of nut-cracking sites, the available nut species, and raw materials, we show how resource availability influences the resulting material signature of nut cracking. These results also reveal the diversity of material signatures associated with a purely percussive material record. We gain insight into the range of signatures that may be associated with a pre-core and flake archaeological record, providing new expectations for an earlier record of tool use.
Modeling the genomic architecture of adiposity and anthropometrics across the lifespan
Authors: Arehart Christopher H. , Lin Meng , Gibson Raine A. , Raghavan Sridharan , Gignoux Christopher R. , Stanislawski Maggie A. , Grotzinger Andrew D. , Evans Luke M.
Published: August 2024

Obesity-related conditions are among the leading causes of preventable death and are increasing in prevalence worldwide. Body size and composition are complex traits that are challenging to characterize due to environmental and genetic influences, longitudinal variation, heterogeneity between sexes, and differing health risks based on adipose distribution. We constructed a 4-factor genomic structural equation model using 18 measures and unveiled shared and distinct genetic architectures underlying birth size, abdominal size, adipose distribution, and adiposity. Multivariate genome-wide associations revealed the adiposity factor was enriched specifically in neural tissues and pathways, while adipose distribution was enriched across widespread physiological systems. In addition, polygenic scores for the adiposity factor predicted many adverse health outcomes, while body size and composition predicted a more limited subset. Finally, we characterized the factors’ genetic correlations with obesity-related traits and examined the druggable genome through constructing a bipartite drug-gene network to identify viable therapeutic targets.
Lipoprotein(a) and large artery atherosclerosis: Results from the BIOSIGNAL Study
Authors: Gross Felix , Schütz Valerie , Westphal Laura , Inauen Corinne , Pokorny Thomas , Wegener Susanne , Luft Andreas R. , Spanaus Katharina , von Eckardstein Arnold , Touboul Pierre-Jean , Arnold Markus , Katan Mira
Published: August 2024

Background

Lipoprotein(a) (Lp(a)) is a causal risk-factor for atherosclerotic cardiovascular disease including acute ischemic stroke (AIS). The underlying pathomechanisms mediating this risk are less well understood, especially in AIS caused by large artery atherosclerosis (LAA). In this observational cohort study we evaluated the association of Lp(a) with markers of LAA, namely carotid intima media thickness (cIMT) and the presence of extra- or intracranial vessel narrowing plaques.

Methods

Among participants of the BIOSIGNAL cohort study we determined Lp(a) levels within 24h after symptom onset in 1161 AIS patients from the single center of Zurich. cIMT was determined using a semi-automated computerized edge tracking software, internal carotid artery (ICA) stenosis was graded according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, intracranial ultrasound was performed by transcranial color-coded duplex (TCCD).

Results

In 1161 participants higher Lp(a) levels were not associated with an increased cIMT in univariable or multivariable regression models containing known cardiovascular risk-factors. Higher Lp(a) levels were not associated with the presence of neither extracranial high-grade ICA-stenosis nor significant intracranial stenosis assessed by neurovascular ultrasound.

Conclusion

In AIS patients higher Lp(a) levels were not associated with clinical markers of arteriosclerotic burden despite its association with LAA-stroke etiology and an increased risk for stroke recurrence.

Registration

Registration-URL:http://www.clinicaltrials.gov; Unique identifier: NCT-02274727
Cortical scaling of the neonatal brain in typical and altered development
Authors: Bonthrone Alexandra F. , Cromb Daniel , Chew Andrew , Gal-Er Barat , Kelly Christopher , Falconer Shona , Arichi Tomoki , Pushparajah Kuberan , Simpson John , Rutherford Mary A. , Hajnal Joseph V. , Nosarti Chiara , Edwards A. David , O’Muircheartaigh Jonathan , Counsell Serena J.
Published: August 2024

Theoretically derived scaling laws capture the non-linear relationships between rapidly expanding brain volume and cortical gyrification across mammalian species and in adult humans. However, the preservation of these laws has not been comprehensively assessed in typical or pathological brain development. Here we assessed the scaling laws governing cortical thickness, surface area and cortical folding in the neonatal brain. We also assessed multivariate morphological terms that capture brain size, shape and folding processes. The sample consisted of 375 typically developing infants, 73 preterm infants and 107 infants with congenital heart disease (CHD) who underwent brain magnetic resonance imaging (MRI). Our results show that typically developing neonates and those with CHD follow the cortical folding scaling law obtained from mammalian brains, children and adults which captures the relationship between exposed surface area, total surface area and cortical thickness. Cortical folding scaling was not affected by gestational age at birth, postmenstrual age at scan, sex or multiple birth in these populations. CHD was characterized by a unique reduction in the multivariate morphological term capturing size, suggesting CHD affects cortical growth overall but not cortical folding processes. In contrast, preterm birth was characterized by altered cortical folding scaling and altered shape, suggesting the developmentally programmed processes of cortical folding are disrupted in this population. The degree of altered shape was associated with cognitive abilities in early childhood in preterm infants.
Trajectories of disability and influence of contextual factors among adults aging with HIV: insights from a community-based longitudinal study in Toronto, Canada
Authors: Su Tai-Te , Bayoumi Ahmed M. , Avery Lisa , Chan Carusone Soo , Tang Ada , Solomon Patricia , Davis Aileen M. , O’Brien Kelly K.
Published: August 2024

Background

Individuals aging with HIV may experience disability that is multidimensional and evolving over time. Our aims were to characterize the longitudinal trajectories of disability and to investigate how intrinsic and extrinsic contextual factors influence dimensions of disability over an 8-month period among adults aging with HIV.

Methods

We analyzed longitudinal observational data from a community-based study in Toronto, Canada, where adults aging with HIV completed self-reported questionnaires over 8 months (5 time points). We measured disability using the Short-Form HIV Disability Questionnaire (SF-HDQ), which included six dimensions: physical, cognitive, mental-emotional health challenges, uncertainty, difficulties with day-to-day activities, and challenges to social inclusion. Higher SF-HDQ scores (range: 0-100) indicate greater severity of disability. We assessed intrinsic (age, gender, education, living status, number of comorbidities, mastery) and extrinsic (stigma, social support) contextual factors using baseline self-reported questionnaires. Latent class growth analysis was performed to identify distinct disability trajectories within each of the six dimensions. Multinomial logistic regression models were used to assess the influence of contextual factors on the disability trajectories.

Results

Of 108 participants, 89% identified as men with a mean age of 50.6 years (standard deviation ±10.9). We identified three disability trajectories: low, medium, and high disability severity in the physical, mental-emotional, and day-to-day activities dimensions. Four trajectories: low, medium-low, medium-high, and high (or high-declining) disability severity were in the cognitive, uncertainty, and social inclusion dimensions. Factors such as higher self-mastery and social support were associated with lower disability trajectories, whereas greater number of comorbidities and stigma were associated with more severe disability trajectories over time.

Conclusion

Disability experiences among adults aging with HIV included three or four distinct trajectories with considerable heterogeneity over time. Information on contextual factors may be helpful for informing interventions and supports that mitigate disability among adults aging with HIV.
Phytochemical Analysis and Cytotoxic Effects of Phyllanthus polygonoides Leaf Extracts on Hepatocellular Carcinoma: A Combined In-Vitro and In-Silico Approach
Authors: Ali Hasnain , Khalid Ammara , Akram Aqsa , Afzal Amina , Khalid Muhammad Noman , Masroor Ashir , Hameed Awais
Published: August 2024

The authors have withdrawn their manuscript owing to the Paper was mistakenly uploaded by the students and the paper was having a lots of mistake and fake data. Therefore, the authors do not wish this work to be cited as reference for the project. If you have any questions, please contact the corresponding author.
Evaluation of automated pediatric sleep stage classification using U-Sleep - a convolutional neural network
Authors: Kevat Ajay , Steinkey Rylan , Suresh Sadasivam , Ruehland Warren R , Chawla Jasneek , Terrill Philip I , Collaro Andrew , Iyer Kartik
Published: August 2024

Study Objectives

U-Sleep is a publicly-available automated sleep stager, but has not been independently validated using pediatric data. We aimed to a) test the hypothesis that U-Sleep performance is equivalent to trained humans, using a concordance dataset of 50 pediatric polysomnogram excerpts scored by multiple trained scorers, and b) identify clinical and demographic characteristics that impact U-Sleep accuracy, using a clinical dataset of 3114 polysomnograms from a tertiary center.

Methods

Agreement between U-Sleep and ‘gold’ 30-second epoch sleep staging was determined across both datasets. Utilizing the concordance dataset, the hypothesis of equivalence between human scorers and U-Sleep was tested using a Wilcoxon two one-sided test (TOST). Multivariable regression and generalized additive modelling were used on the clinical dataset to estimate the effects of age, comorbidities and polysomnographic findings on U-Sleep performance.

Results

The median (interquartile range) Cohen’s kappa agreement of U-Sleep and individual trained humans relative to “gold” scoring for 5-stage sleep staging in the concordance dataset were similar, kappa=0.79(0.19) vs 0.78(0.13) respectively, and satisfied statistical equivalence (TOST p<0.01). Median (interquartile range) kappa agreement between U-Sleep 2.0 and clinical sleep-staging was kappa=0.69(0.22). Modelling indicated lower performance for children <2 years, those with medical comorbidities possibly altering sleep electroencephalography (kappa reduction=0.07-0.15) and those with decreased sleep efficiency or sleep-disordered breathing (kappa reduction=0.1).

Conclusion

While U-Sleep algorithms showed statistically equivalent performance to trained scorers, accuracy was lower in children <2 years and those with sleep-disordered breathing or comorbidities affecting electroencephalography. U-Sleep is suitable for pediatric clinical utilization provided automated staging is followed by expert clinician review.
Primary care clinicians working in or near hospital emergency departments in the UK: A mixed methods systematic review
Authors: Wilsher Stephanie Howard , Brainard Julii , Hanson Sarah , Peacock Duncan , Everden Paul
Published: August 2024

Objectives

To synthesise evidence about primary care clinicians treating patients in or adjacent to hospital emergency departments in the UK.

Study design

Mixed methods narrative systematic review.

Methods

Eligible studies were in English and described primary care services (general practitioners, GPs, or nurse practitioners) that treat patients within or adjacent to hospital Emergency Departments (ED). Searches were conducted on Medline, EMBASE, Cochrane Library and CINAHL databases. The search included extraction from an international review updated from 2020 to October 2022, and grey literature from inception to October 2022. The methods were informed by consultation with members of the public.

Results

From 4189 studies screened, 20 met inclusion criteria. Four studies assessed typology and streaming of services. Seven studies reported patient and public involvement. Ten studies reported differences in clinical outcomes between primary care and emergency services, but not definitive benefit for either. Likewise, results were equivocal for economic evaluations. Diverse delivery formats complicate evaluation and may explain why clinicians had mixed opinions about the utility of such services. Patients were generally satisfied with the service they received, in either primary care or emergency services.

Conclusion

Diversity of implementation complicate conclusions that can be drawn. Existing evaluations provide little evidence that primary care services in or near emergency departments offers any system advantages for clinical outcomes, or cost savings. Process evaluation in future evaluations is essential to understand what aspects of primary care at emergency departments are likely to improve system and patient care.

Implications for the profession and/or patient care

The systematic review assessed outcomes arising due to primary care clinicians providing treatment in or near Emergency Departments (ED) in the UK. There were no consistent benefits for having primary care clinicians in or near EDs. This research highlights the need for healthcare leaders and policy makers to provide more clarity in developing primary care services in or near EDs. It will have impact for leaders in healthcare to consider whether primary care clinicians in or near EDs are providing ‘best value’ healthcare, or whether other models could provide patients appropriate NHS resources according to their health need.

Patient and public involvement

Three focus groups (with 13 public advisors) were conducted to understand patients’ priorities and perspectives for attending EDs with relatively minor health conditions. This helped to guide study design, data extraction and analysis of this review.
Critical dynamics predict cognitive performance and are disrupted by epileptic spikes, antiseizure medication and slow-wave activity
Authors: Müller Paul Manuel , Miron Gadi , Holtkamp Martin , Meisel Christian
Published: August 2024

The brain criticality hypothesis postulates that brain dynamics are set at a phase transition where information processing is optimized. Long-range temporal correlations (TCs) characterizing the dissipation of information within a signal have been shown to be a hallmark of brain criticality. However, the experimental link between cognitive performance, criticality and thus TCs has remained elusive due to limitations in recording length, and spatial and temporal resolution. In this study, we investigate multi-day invasive EEG recordings of 104 persons with epilepsy together with an extensive cognitive test battery. We show that short TCs predict cognitive impairment. Further, we show that heterogeneous factors, including interictal epileptiform discharges (IEDs), antiseizure medications (ASMs) and intermittent periods with slow-wave activity (SWSs), all act directly to perturb critical dynamics and thus cognition. Our work suggests critical dynamics to be the setpoint to measure optimal network function, thereby providing a unifying framework for the heterogeneous mechanisms impacting cognition in conditions like epilepsy.
Rapid Whole Genome Characterization of High-Risk Pathogens Using Long-Read Sequencing to Identify Potential Healthcare Transmission
Authors: Wu Chin-Ting , Shropshire William C. , Bhatti Micah M , Cantu Sherry , Glover Israel K , Anand Selvalakshmi Selvaraj , Liu Xiaojun , Kalia Awdhesh , Treangen Todd J. , Chemaly Roy F , Spallone Amy , Shelburne Samuel
Published: August 2024

Objective

Routine use of whole genome sequencing (WGS) has been shown to help identify transmission of pathogens causing healthcare-associated infections (HAIs). However, the current gold standard of short-read, Illumina-based WGS is labor and time-intensive. In light of recent improvements in long-read Oxford Nanopore Technologies (ONT) sequencing, we sought to establish a low resource utilization approach capable of providing accurate WGS-based comparisons of HAI pathogens within a time frame allowing for infection prevention and control (IPC) interventions.

Methods

WGS was prospectively performed on antimicrobial-resistant pathogens at increased risk of potential healthcare transmission using the ONT MinION sequencer with R10.4.1 flow cells and Dorado basecalling algorithm. Potential transmission was assessed via Ridom SeqSphere+ for core genome multilocus sequence typing and MINTyper for reference-based core genome single nucleotide polymorphisms using previously published cut-off values. The accuracy of our ONT pipeline was determined relative to Illumina-based WGS data generated from the same genomic DNA sample.

Results

Over a six-month period, 242 bacterial isolates from 216 patients were sequenced by a single operator. Compared to the Illumina gold-standard data, our ONT pipeline achieved a Q score of 60 for assembled genomes, even with a coverage rate of as low as 40X. The mean time from initiating DNA extraction to complete genetic analysis was 2 days (IQR 2-3.25 days). We identified five potential transmission clusters comprising 21 isolates (8.7% of all sequenced strains). Combining ONT WGS data with epidemiological data, >70% (15/21) of the isolates originated from patients with potential healthcare transmission links.

Conclusions

Via a stand-alone ONT pipeline, we detected potentially transmitted HAI pathogens rapidly and accurately, aligning closely with epidemiological data. Our low-resource method has the potential to assist in the efficient detection and deployment of preventative measures against HAI transmission.