bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute-on-Chronic Inflammation and Patients’ Risk for Renal Support in Critically Ill Patients
Authors: Graham Julie-Kathryn , Quillin-Mcewan Molly , Kelley Christina
Published: December 2024

Hypertension (HTN) and heart failure (HF) can chronically activate the renin-angiotensin-aldosterone system, a mechanism designed to maintain hemodynamic stability by reabsorption of water and electrolytes. Additionally, this system activates the sympathetic nervous system to increase vagal tone. When these patients face acute illness requiring hospitalization, the acute stressor or pathogen also activates the sympathetic nervous system. The combination of activation of both systems puts patients at increased risk of organ failure, specifically renal failure. With early recognition of renal insult, organ damage can be reversed. C-reactive protein (CRP) and D-dimer are commonly used to measure acute inflammation. These biomarkers can alert critical care nurses to excessive inflammation in patients with underlying HTN and HF, enabling nurses to make informed decisions to intervene at the earliest sign of renal failure. This retrospective study of adult SARS-CoV-2 patients in an intensive care unit setting sought to examine the relationship of CRP, D-dimer, and the need for eventual renal support in patients with HF and HTN. Of the sample (n + 189), mean age was 62 (SD = 14.0), and most (70.9%) were male. Thirty-nine patients (20.6%) required renal support. Of the cases requiring renal support, 21 (53.8%) had a history of prior renal disease (P < 0.001, r = 0.351). History of HTN was significantly correlated with requirement for renal support (P = 0.010, r = 0.187). D-dimer (P = 0.038, η = 1.0) and CRP (P = 0.018, η = 0.924) were also significant. Survival was significantly worse in the renal support group (P < 0.001, r = −0.310). D-dimer and CRP were correlated with more severe illness and need for renal support. Study findings have implications for future validation research of chronic inflammation and risk for renal support during acute severe illness.
Alpha-Gal Syndrome
Authors: Silbernagel Trevor J. , Bullard Zackery T.
Published: December 2024

Alpha-gal syndrome is a serious, potentially life-threatening allergic reaction to mammalian products that has been linked to the lone star tick. Early recognition and management of alpha-gal syndrome is key for desirable patient outcomes and informed nursing care can make all the difference. The purpose of this article is to provide background information regarding alpha-gal syndrome, review common sources of potential reaction triggers including food and medications, and discuss strategies to detect and avoid allergic reactions from occurring.
Adult Pancreatoblastoma Presenting with Obstructive Jaundice: A Case Report and Literature Review
Authors: Leong Yeu Chyi , Liu Hung-Wei , Chen Yaw-Sen
Published: December 2024

Pancreatoblastoma (PB), a rare malignancy originating from pancreatic exocrine cells, predominantly affects pediatric patients but is exceptionally rare in adults. We present a case of adult PB presenting with obstructive jaundice secondary to a pancreatic head mass. Despite nonspecific clinical and radiological manifestations, pathological evaluations confirmed the diagnosis. Treatment involved Roux-en-Y cholecytojejunostomy biliary bypass followed by systemic chemotherapy and local radiotherapy due to advanced disease stage with liver metastases. This case highlights the diagnostic challenges and aggressive nature of PB in adults, necessitating interdisciplinary collaboration for optimal management.
Gender-affirming Chest Surgery: A Prospective Series of 155 Consecutive Cases of Double Incision Mastectomy
Authors: Vico Pierre G. , Salmon Salomé
Published: December 2024

Background:

Mastectomy is the first single surgery that transgender men and nonbinary people frequently undergo. We present a prospective series of 155 cases of double incision mastectomy (DIM) with nipple-areolar complex (NAC) graft.

Methods:

From January 2019 to December 2022, 165 outpatients were operated on, and 155 are included in the study. We analyzed age, resection weight, blood loss, duration of the procedure, complications, and follow-up. The Student t test combined with the nonparametric Mann-Whitney U test was used for statistical analysis. If the P value was less than 0.05, the test was considered significant.

Results:

A total of 111 (72.6%) patients experienced no complications. Complications (27.4%) were minor: 4 seromas, 8 hematomas, 10 partial necrosis of the NAC, and 8 depigmentation of the NAC. Thirteen patients presented axillary dog ears requiring secondary excision. Two patients had hypertrophic scars. No case of infection was observed. We find a statistically significant correlation between hematoma and perioperative blood loss (P < 0.05), and between dog ears requiring secondary procedure and body mass index (P < 0.001), weight of resection (P < 0.01), and blood loss (P < 0.001).

Conclusions:

DIM with NAC graft is a safe, reliable, top surgery procedure. Complications are minor, and postoperative morbidity is low. This study shows a correlation between blood loss during surgery and postoperative hematoma, and between dog ears requiring a surgery and body mass index, weight of resection, and blood loss. This surgery gives nice aesthetic results enhancing patients’ quality of life by improving body image.
Exploring the Evolution of the Term “Presence” in Nursing
Authors: Monge Moreno Jesús Tomás
Published: December 2024

This article explores the evolution of the concept of presence as a therapeutic and care measure in nursing from 1962 to the present. The findings are derived from an extensive bibliographic search conducted through documentary sources such as PubMed and Google Scholar, utilizing and interlinking descriptors including “nursing,” “presence,” “care,” “intentionality,” “humanization,” and “concept.” The results reveal a progressive refinement and enrichment of the concept of presence, culminating in recent developments that emphasize an intentional perspective, which seeks to enhance the human, integral, and ethical dimensions of health relationships. Intentional Presence represents a novel approach to accompaniment and care, which has become fundamental in holistic nursing, fostering a deeper and more human connection between nurse and patient, leading to more comprehensive and meaningful care.
Staff and work environment factors associated with workplace violence in hospitals: Comparison of units with high versus low rates of violence
Authors: Derscheid Della J. , Arnetz Judith E.
Published: December 2024

Objective

This study examined healthcare worker perceptions of physical environment and safety climate contributors to workplace violence.

Methods

Inpatient hospital employee (2015) convenience sample survey (N = 327) comparisons were via Mann Whitney, Wilcoxon Rank Sum, or Chi-square to determine response differences by workplace violence experience (yes/no), and hospital units (higher/lower) violence rates.

Results

Employees with workplace violence experience and units with higher violence rates identified a higher number of contributing physical environment factors. Safety climate ratings were higher among employees without workplace violence experience but did not differ between hospital units with higher versus lower violence rates.

Conclusions

Prioritization of staff perceived climate safety and physical environment contributors can support organizational efforts to mitigate specific workplace violence hazards on hospital units.
Patterns of Mental Health and Resilience among Nurses and Physicians throughout the COVID-19 Pandemic: A Three-Year Longitudinal Study
Authors: Vala Katelyn C. , Fishbein Joanna S. , Bellehsen Mayer H. , Parashar Nidhi , Yacht Andrew C. , Young John Q. , Schwartz Rebecca M.
Published: December 2024

Objective

The COVID-19 pandemic is associated with increased difficulties in emotional wellbeing among healthcare workers. The current investigation assesses how changes in depression and anxiety symptoms fluctuate relative to resilience across three time points: baseline, one-year, and two-year follow up among a cohort of physicians and nurses (N = 728).

Methods

Generalized linear mixed modeling for repeated measures was used to assess the association between resilience and mental health symptoms using validated measures for all variables.

Results

The odds of probable anxiety were reduced by 81% for each one-unit increase in resilience (OR = 0.19, 95% CI [0.14, 0.26]). The odds of probable depression were reduced by 88% for each one-unit increase in BRS (OR = 0.12, 95% CI [0.07, 0.2]).

Conclusions

Results highlight the importance of developing and implementing interventions that foster resilience among healthcare workers.
Mental Health Support for First Responders Provided Outside of California’s Workers’ Compensation System
Authors: Quigley Denise D. , Qureshi Nabeel , Dworsky Michael , Meredith Lisa S.
Published: December 2024

Objective

Concern about psychiatric injuries for first responders has grown. We examine alternatives to workers’ compensation (WC).

Method

We conducted 15 interviews across 5 California departments contracted with non-WC mental health (MH) providers. We performed content analysis.

Results

MH support outside of WC most often was a dedicated contract with outside MH providers for assessment, diagnosis, and treatment. Departments had formal financing mechanisms with union and city support designating funding for MH care. Frustration and past WC experiences drove the desire for WC alternatives. First responders reported high levels of stigma associated with MH care. Compared to WC, these alternatives allowed more comprehensive services to injured workers along with ease of accessing care, expediting the healing process.

Conclusion

Contracting culturally competent MH providers outside of WC for first responders has potential and needs formal evaluation.
Cost-effectiveness of a Low-cost Educational Messaging and Prescription-fill Reminder Intervention to Improve Medication Adherence Among Individuals With Intellectual and Developmental Disability and Hypertension
Authors: Chen Brian , McDermott Suzanne , Salzberg Deborah , Zhang Wanfang , Hardin James W.
Published: December 2024

Background:

Adults with intellectual and developmental disabilities (IDDs) have a similar prevalence of hypertension as the general population, but a higher rate of medication nonadherence at 50% compared with the average of 30%.

Objectives:

To assess the cost-effectiveness of educational messaging and prescription-fill reminders to adults with IDD and hypertension and their helpers among Medicaid members in a randomized control trial.

Research Design:

The authors calculated net cost savings by subtracting per-participant intervention costs from differences in spending between preintervention/postintervention cases versus controls. Using bootstrap samples, they assessed the probability of positive cost savings. They used quantile and logistic regression to examine which members contributed to the cost savings and to identify future high-cost members at baseline.

Subjects:

Four hundred twelve members with IDD and their helpers were recruited from the South Carolina Medicaid agency in 2018.

Measures:

Intervention costs were determined using labor and communication costs. Health expenditures were obtained from South Carolina’s all-payer claims database, using actual Medicaid expenditures and total all-payer expenditures estimated with cost-to-charge ratios.

Results:

The intervention, which cost $26.10 per member, saved $1008.02 in all-payer spending and $1126.42 in Medicaid payments per member, respectively, with 78% and 91% confidence. Cost savings occurred among members above the 85th percentile of spending, and those using the emergency department or inpatient services at least twice at baseline were predicted to be future high-cost members.

Conclusions:

The intervention is cost-saving, and insurers can prospectively identify and target members who will likely benefit.
Innovation in Medical Education on Intellectual/Developmental Disabilities
Authors: Chandan Priya , Noonan Emily J. , Brody Kayla Diggs , Feller Claire , Lauer Emily
Published: December 2024

The lack of physician training in serving patients with intellectual and developmental disabilities (IDDs) has been highlighted as a key modifiable root cause of health disparities experienced by this high-priority public health population. To address gaps in medical education regarding the lack of IDD curriculum, lack of evaluation/assessment, and lack of coordination across institutions, the American Academy of Developmental Medicine and Dentistry created the National Inclusive Curriculum for Health Education–Medical (NICHE-MED) Initiative in 2016. The aims of NICHE-MED are to: (1) impact medical students’ attitudes and/or knowledge to address underlying ableism and address how future physicians think about disability; (2) apply a lens of health equity and intersectionality, centering people with IDD, but fostering conversation and learning about issues faced by other disability and minoritized populations; and (3) support community-engaged scholarship within medical education. As of 2024, the NICHE-MED initiative consists of close to 40 Medical School Partners, each with their own community-engaged disability curriculum intervention paired with a rigorous evaluation that ties centrally to coordinated program evaluation. The NICHE-MED initiative demonstrates implementation success at scale and is a successful community-engaged curriculum change model that may be replicated regarding disability more broadly and regarding necessary medical education efforts that center other marginalized populations.
Safety observations in neuroblastoma patients undergoing 18F-mFBG PET
Authors: Pandit-Taskar Neeta , Basu Ellen , Balquin Eloisa , Mozley P. David , Jacobson Arnold F. , Modak Shakeel
Published: December 2024

Objective

Limited safety data have been published on fluorine-18 (18F) meta-fluorobenzylguanidine (mFBG), a new PET radiopharmaceutical for imaging neural crest and neuroendocrine tumors. As part of a prospective clinical trial, safety data in patients with neuroblastoma were collected and analyzed.

Methods

Between April 2015 and January 2022, 27 patients with neuroblastoma underwent 18F-mFBG PET imaging as part of an ongoing single-center phase 1/2 trial (NCT 02348749). Pre- and postinjection safety assessments were performed, including vital sign measurement and observation for occurrence of adverse events (AEs).

Results

mFBG administration resulted in no significant changes in measured vital signs. Two subjects had transient, grade 1 facial flushing shortly after the administration, which resolved within a few minutes. Neither subject had a clinically significant change in pulse or blood pressure on postadministration measurements.

Conclusion

In this investigation of the potential clinical utility of mFBG PET imaging, no significant adverse safety signals were noted. Two mild, self-limited AEs were observed, without associated changes in vital signs. No grade 2 or higher AEs were noted. The findings are consistent with a favorable safety profile for mFBG in the target population of patients with neuroblastoma.
The evolution and hotspots of radioactive iodine therapy in hyperthyroidism: a bibliometric analysis
Authors: Chen Shi-qi , Gou Rui-qin , Zhang Qing
Published: December 2024

Objective

Hyperthyroidism, a prevalent endocrine disorder, disrupts metabolic balance and cardiovascular health, affecting millions globally. Radioactive iodine (RAI), a treatment for hyperthyroidism, employs high-energy beta particles to reduce thyroid tissue, lowering volume and hormone levels. This study utilizes bibliometric analysis to outline RAI’s evolution and identify hotspots in hyperthyroidism treatment.

Methods

A total of 2904 articles and reviews published between 1981 and 2023 were retrieved from the Web of Science Core Collection using the research strategy. Bibliometric analyses, employing VOSviewer and CiteSpace, were performed to visualize the cooperation network, evolution, and hot topics.

Results

Annual publications rose in waves, 2904 papers from 2564 institutions, and 84 countries. The USA led, contributing the largest share, with the journal Thyroid dominating publication. The University of Pisa contributed the most articles. Co-occurrence analysis classified keywords into five clusters: treatment mechanism, safety, effectiveness assessment, individualized radioactive dosage, and management. The development of RAI therapy for hyperthyroidism can be divided into three stages: safety and efficacy assessment, personalized treatment plans, and treatment of drug-resistant and surgery-resistant hyperthyroidism.

Conclusion

Attention to RAI in hyperthyroidism should be significantly increased. It is necessary to establish collaborations between authors, countries, and institutions to promote the development of this field. Recent research has focused on personalized radioactive dosage formulation and follow-up. Future studies are likely to concentrate on drug-resistant and surgery-resistant hyperthyroidism, which is also worthy of investigation. These findings provide a new perspective on the study of RAI in hyperthyroidism, potentially contributing to the improvement of the quality of life for patients with hyperthyroidism.
The potential of circulating nonesterified fatty acids and sphingolipids in the biological understanding of cognitive decline and dementia
Authors: Moseholm Kristine F. , Meineche Josefine T. , Jensen Majken K.
Published: December 2024

Purpose of review

Cognitive decline and late-onset dementia pose significant challenges in aging societies, and many dementia cases could be prevented or delayed through modification of associated risk factors, many of which are tied to cardiovascular and metabolic dysfunction. As individuals age, the blood-brain barrier becomes more permeable, easing the exchange of molecules between the bloodstream and the brain. Consequently, blood-based biological markers (so-called biomarkers) provide a minimally invasive and accessible means of accessing molecular changes associated with aging and neurodegeneration.

Recent findings

Circulating free fatty acids, also called nonesterified fatty acids (NEFAs), and sphingolipids are associated with cardiovascular disease, insulin resistance, and diabetes; thus, could be promising candidates as biomarkers for cognitive decline and dementia.

The opportunity to study such minimally invasive biomarkers further opens up potential new avenues for improved understanding of the underlying biology of diseases of the brain
Interpretation of p16 and p53 in the Classification of Squamous Cell Carcinoma of the Vulva—An Interobserver Agreement Study
Authors: Jeffus Susanne K. , Wooldridge Jacob T. , Hoang Lynn , Parra-Herran Carlos , Hamza Mugahed , Lindsey Miki , Verret Meredith , Zoumberos Nicholas , Fogel Bradley , Wyeth Autumn , Gama João , Quick Charles M.
Published: December 2024

Squamous cell carcinoma of the vulva (vSCC) is currently categorized either as human papillomavirus (HPV) associated or independent. Immunohistochemical stains, p16INK4a (p16) and p53 are helpful biomarkers to support the designation of vSCC into 1 of the 3 tumor pathways: (1) HPV-associated, (2) HPV-independent, TP53 mutant, or (3) HPV-independent, TP53 wild type. Recently, a framework of p53 expression patterns in vSCC was proposed. In this international and multi-institutional study, we evaluated the interrater agreement for p53 and p16 and tumor pathway classification in a cohort of 50 invasive vSCC across a variety of practice settings (private practice, academic medicine) and levels of expertise (trainees, gynecologic pathologists, dermatopathologists, private practice pathologists). Our study shows that the overall interrater agreement for the interpretation of p16 in vSCC is strong to near perfect, while the agreement for p53 and tumor pathway assignment is overall moderate. Interrater agreement for p53 and tumor pathway is higher (strong) in the academic practice setting. Pathologists without gynecologic subspecialty expertise benefited the most from a brief educational module, which fostered a better understanding and improved comfort level with the p16/p53 stain interpretation and tumor pathway designation in the diagnosis of vSCC. Some interpretative challenges remain, particularly in regard to select p53 patterns and high-risk HPV-in situ hybridization utilization, warranting additional research.
When a Horseshoe Is Not a Lucky Find
Authors: Yim Wesley , Subramaniam Sathyaseelan
Published: December 2024

Identification of a neonatal horseshoe kidney in the emergency department is uncommon but has implications for future healthcare planning for patients. We present a case of a neonate with bloody diapers who was evaluated with renal point-of-care ultrasound (POCUS) that identified a horseshoe kidney. The ultrasound was remarkable for its clear visualization of the isthmus of the horseshoe kidney in the midline abdomen. Midline interrogation is not part of the routine technique for ultrasound imaging of the kidney but should be considered when the limits of the lower pole of bilateral kidneys are difficult to visualize. This case highlights the importance of understanding normal anatomical landmarks when performing renal POCUS to identify renal anomalies.
“Room of Horrors”
Authors: Capua Tali , Arnon Maya , Rozenberg Moriya , Perets Efrat , Samuel Nir , Levy Dana Adatto , Elmaliach Nadav , Padova Hagit , Rimon Ayelet
Published: December 2024

Objective:

This pilot study aimed to assess the effectiveness of a “room of horrors” (RoH) simulation in identifying patient safety threats in a pediatric emergency department (PED) and to evaluate health care workers’ (HCWs’) perceptions of the experience.

Methods:

We developed an RoH simulation featuring 25 potential safety hazards derived from actual PED incidents and “never events.” The teams of physicians and nurses who participated in the simulation identified as many hazards as they could within a 10-minute window followed by a debriefing session during which errors were corrected and missed hazards were pointed out. The participants’ perceptions were measured on a 5-point Likert scale of a questionnaire.

Results:

Twenty sessions that included a total of 45 participants were conducted. The teams identified an average of 23 of 25 safety threats, yielding a mean detection rate of 86% for electronic medical record errors, 95% for physical space errors, and 97% for communication errors. The simulation received high ratings for overall positive experience (4.88/5) and impact on daily activities (4.68/5).

Conclusion:

The RoH simulation experience was effective in evaluating the level of retention of earlier training and the ability of multidisciplinary teams to correctly identify major safety threats in a PED setting. The participants found the experience valuable and engaging. Future research should focus on other means by which the retention of learned skills can be reinforced and new safety threats can be identified with a high level of alertness.
Proviral HIV DNA sequencing to inform suitability for long-acting injectable cabotegravir/rilpivirine
Authors: Alagaratnam Jasmini , Kelly Niall , Dustan Simon , Naous Nadia , Nwanbila Modest , Byrne Ruth , Girometti Nicolo , Asboe David , Taylor Graham P. , Boffito Marta
Published: December 2024

Increasingly, people attending HIV services are requesting long-acting injectable (LAI) antiretroviral treatment (ART). However, without HIV RNA resistance-associated mutation results, individuals are considered unsuitable for LAI ART. We present our experience of sequencing proviral HIV DNA in 30 individuals to inform suitability for LAI ART, of whom 23 were considered suitable. In conclusion, optimization of diagnostic tools such as proviral HIV DNA sequencing to confirm suitability for LAI ART would be a welcome addition.
Malignant Phyllodes Tumor With Sphenoid Bone Metastasis Detected on 99mTc-MDP SPECT/CT and 18F-FDG PET/CT
Authors: Wakankar Ritwik , Dharmashaktu Yamini , Venugopal Akhil , Kumar Rakesh
Published: December 2024

Phyllodes tumors (PTs) are rare fibroepithelial tumors accounting for less than 1% of all breast neoplasms. They are malignant in 20% of cases. Only a few cases of malignant PT metastatic to bone have been reported. We report a case of metastatic malignant PT of the breast involving the greater wing of the sphenoid bone and discuss the radiological findings of 99mTc-methylene diphosphonate skeletal scintigraphy, SPECT/CT, and 18F-FDG PET/CT. To our knowledge, this is the first time such a case has been reported in literature.
Arachnoid Cyst Associated With Traumatic Chronic Subdural Hemorrhage in Children
Authors: Xu Tianqi , Chen Jiwu , Xi Bin , Xie Zhiping
Published: December 2024

Introduction:

It was reported that most arachnoid cyst (AC)-associated chronic subdural hematoma (CSDH) was spontaneous. However, AC with CSDH caused by trauma was extremely scarcely reported. In this paper, the authors reported a successful surgical treatment of a case of AC associated with CSDH after trauma.

Case Presentation:

A 15-year-old girl was admitted with headache and vomiting persisting for 3 days following a head injury received 1 month previously. Head magnetic resonance imaging (MRI) showed a left temporal AC and ipsilateral CSDH. Digital subtraction angiography (DSA) of the brain showed no vascular abnormalities. The patient underwent a left burr hole irrigation and drainage (BHID). The patient recovered well after surgery and was discharged 4 days later.

Clinical Discussion:

This event’s pathogenesis is thought to be caused by vascular rupture around AC. It can not only occur spontaneously but also be caused by varying degrees of head trauma. Surgery is the most common and effective treatment, including BHID, partial/subtotal membrane resection, endoscopic fenestration, and so on.

Conclusion:

Arachnoid cyst (AC) with traumatic CSDH is an extremely scarce condition. Surgery is the most common and effective treatment. Moreover, it is necessary to perform DSA before surgery to rule out cerebral vascular malformations in children and adolescents.
ED Regional Anesthesia Practice and the Basics on Local Anesthesia Toxicity
Authors: Olsen BJ
Published: December 2024

In the United States and the United Kingdom, where the author resides, many Emergency Departments utilize nerve blocks for fractures waiting to be seen by orthopedic surgery. As emergency nurses, be it advance practice nurse or staff nurse, it is our professional responsibility to be aware of emergencies that can result from these nerve blocks, namely local anesthetic toxicity (LAT). In the United Kingdom, there are protocols and guidelines for the treatment of this adverse event, which are shared in this article as a knowledge base for identifying and treating LAT. This paper also discusses the similarities in symptoms of LAT and anaphylaxis.
Prospective comparative clinical trials of novel non-invasive intracranial pressure pulse wave monitoring technologies: preliminary clinical data
Authors: Putnynaite Vilma , Chaleckas Edvinas , Deimantavicius Mantas , Bartusis Laimonas , Hamarat Yasin , Petkus Vytautas , Karaliunas Andrius , Ragauskas Arminas
Published: December 2024

Intracranial pressure (ICP) monitoring is crucial in the management of traumatic brain injury (TBI) and other neurological conditions. Elevated ICP or too low intracranial compliance (ICC) can compromise brain perfusion. Simultaneous monitoring of ICP and ICC is needed to optimize patient-specific brain perfusion in pathological conditions. Surrogate ICC changes can be extracted by analysis of ICP pulse wave morphology. Non-invasive, fully passive sensor and ICC changes monitoring are needed. This study introduces Archimedes, a novel, fully passive, non-invasive ICP wave monitor that utilizes mechanical pulsatile movement of the eyeball to assess ICP pulse waveforms. Preliminary findings indicate a high correlation
r
= [0.919; 0.96] between non-invasive and invasive ICP pulse wave morphologies, demonstrating the device’s potential for accurate ICP pulse waveform monitoring. Additionally, the monitor can discern ICC changes, providing valuable insights for TBI and normal tension glaucoma patients according to the shape of non-invasive measured ICP pulse wave. The k-nearest neighbours algorithm used in preliminary glaucoma studies yielded promising diagnostic performance, with an accuracy of 0.89, sensitivity of 0.82, specificity of 1.0 and area under curve 0.91. Ethical approvals for ongoing studies have been secured. Initial results indicate that Archimedes real-time ICC non-invasive monitor is safe, cost-effective alternative to conventional monitoring techniques.
A brief history of the development of transcranial tissue Doppler ultrasound
Authors: Nicholls Jennifer K. , Lecchini-Visintini Andrea , Ince Jonathan , Pallett Edward , Minhas Jatinder S. , Oura Mitsuhiro , Chung Emma M. L.
Published: December 2024

This article documents the early development of the first transcranial Doppler (TCD)-based ultrasound system for continuous monitoring of brain tissue pulsations (BTPs). Transcranial tissue Doppler (TCTD) uses a lightweight, wearable single-element ultrasound probe to track tissue motion perpendicular to the skin’s surface, providing tissue displacement estimates along a single beam line. Feasibility tests using an adapted TCD system confirmed that brain tissue motion data can be obtained from existing TCD hardware. Brain Tissue Velocimetry (Brain TV), a TCTD data acquisition system, was then developed to provide a lightweight and portable means of continuously recording TCTD data in real-time. Brain TV measurements are synchronized to a 3-lead electrocardiogram and can be recorded alongside other physiological measurements, such as blood pressure, heart rate and end-tidal carbon dioxide. We have shown that Brain TV is able to record BTPs from sample depths ranging from 22 to 80 mm below the probe’s surface and from multiple positions on the head. Studies in healthy volunteers, stroke patients and ultrasound phantom brain models demonstrate how TCTD might provide insights into the relationships between physiological measurements and brain tissue motion and show promise for rapid clinical assessment and continuous monitoring of BTPs.
Digital genetic counselling services for cascade cardiogenetic testing: a focus group study on proband, relative, and provider perspectives
Authors: van Lingen Marlies N. , van Till Sietske A. L. , Giesbertz Noor A.A. , Beinema Tessa C. , Ausems Margreet G.E.M. , Klaassen Randy , Cornel Martina C. , van den Heuvel Lieke M. , van Tintelen J.Peter
Published: December 2024

Digital interventions are potentially promising to improve accessibility and efficiency of genetic counselling services. However, current literature on stakeholder perspectives towards digital tools for cascade testing is limited. Therefore, this focus group study aimed to gain insights into the attitude and perspectives of probands, at-risk relatives (ARR), and genetic healthcare professionals (HCP) towards digital innovations for assistance with both pre-test and post-test counselling and cascade genetic testing in cardiogenetics. We conducted seven online focus groups, which where transcribed and thematically analysed. In total, 37 individuals participated (10 probands, 11 ARR and 16 HCP). Thematic analysis of focus group transcripts showed a first theme of (1) acceptability of digital tools. Other identified themes were defined as ‘domains’ where digital tools impact traditional, in-person clinical genetic care, being: (2) family communication, (3) decision-making, (4) care relations, and (5) the genetic care system. Stakeholders expressed a predominantly positive attitude towards digitisation of (parts of) the predictive genetic counselling in cardiogenetics, under the condition that access to human contact is preserved. In the clinical setting of predictive counselling, efforts should be made to ensure access to genetic services for all ARR and to protect in-person involvement of HCP.
The membrane-associated ubiquitin ligase MARCHF8 promotes cancer immune evasion by degrading MHC class I proteins
Authors: Khalil Mohamed I. , Wang Jie , Yang Canchai , Vu Lexi , Yin Congcong , Chadha Smriti , Nabors Harrison , Vocelle Daniel , May Danielle G. , Chrisopolus Rachel J. , Zhou Li , Roux Kyle J. , Bernard Matthew P. , Mi Qing-Sheng , Pyeon Dohun
Published: December 2024

The loss of major histocompatibility complex class I (MHC-I) molecules has been proposed as a mechanism by which cancer cells evade tumor-specific T cells in immune checkpoint inhibitor (ICI)-refractory patients. Nevertheless, the mechanism by which cancer cells downregulate MHC-I is poorly understood. We report here that membrane-associated RING-CH-type finger 8 (MARCHF8), upregulated by human papillomavirus (HPV), ubiquitinates and degrades MHC-I proteins in HPV-positive head and neck cancer (HPV+ HNC). MARCHF8 knockdown restores MHC-I levels on HPV+ HNC cells. We further reveal thatMarchf8knockout significantly suppresses tumor growth and increases the infiltration of natural killer (NK) and T cells in the tumor microenvironment (TME). Furthermore,Marchf8knockout markedly increases crosstalk between the cytotoxic NK cells and CD8+T cells with macrophages and enhances the tumor cell-killing activity of CD8+T cells. CD8+T cell depletion in mice abrogatesMarchf8knockout-driven tumor suppression and T cell infiltration. Interestingly,Marchf8knockout, in combination with anti-PD-1 treatment, synergistically suppresses tumor growth in mice bearing ICI-refractory tumors. Taken together, our finding suggests that MARCHF8 could be a promising target for novel immunotherapy for HPV+ HNC patients.

One Sentence Summary

Targeting MARCHF8 restores MHC-I proteins, induces antitumor CD8+T cell activity, and suppresses the growth of ICI-refractory tumors.
Cardiovascular autonomic dysfunction is linked with arterial stiffness across glucose metabolism: The Maastricht Study
Authors: Schaarup Jonas R. , Bjerg Lasse , Hansen Christian S. , Andersen Signe T. , van Greevenbroek Marleen , Schram Miranda T. , de Galan Bastiaan E. , Stehouwer Coen , Witte Daniel R.
Published: December 2024

Objective

To ascertain the cross-sectional association between cardiovascular autonomic function and arterial stiffness across glucose metabolism status.

Methods

We performed a cross-sectional analysis of participants of The Maastricht Study without prior CVD. Cardiovascular autonomic function was based on heart rate variability (HRV) indices from 24-hour electrocardiogram recordings and summarized in Z-scores for time and frequency domains. Aortic and carotid stiffness were assessed by carotid-femoral pulse wave velocity (PWV) and carotid artery distensibility (CD), respectively. We used multiple linear regression to study the associations and adjusted for demographic and lifestyle factors and a range of cardiovascular risk factors. We tested the modification of the associations by glucose metabolism status.

Results

PWV and CD measures were available in 3671 and 1806 participants, respectively (median (25th; 75thpercentile) age: 60 years (53; 66), 51% women, 20 % type 2 diabetes by design. Participants with lower HRV had higher aortic stiffness, as reflected by 2.8% (CI: 2.1; 3.4) and 2.8% (2.1; 3.5) higher PWV per standard deviation (SD) lower composite HRV time-domain and frequency domain Z-score, respectively. Similar trends were observed for carotid stiffness, reflected by 3.2% (1.4; 5.0) and 3.1% (1.2; 5.0) lower CD per SD lower composite HRV time-domain and frequency domain Z-score, respectively. Associations were stronger among people with prediabetes and type 2 diabetes compared to normal glucose metabolism (p-value for interaction for prediabetes: <0.05; and for type 2 diabetes ranging between: <0.05 - <0.10).

Conclusion

Cardiovascular autonomic dysfunction is associated with higher aortic and carotid stiffness, especially in people with dysglycemia. Thus, autonomic dysfunction may contribute to cardiovascular risk by affecting vascular stiffness.

Short abstract

This study investigates the association between cardiovascular autonomic function and arterial stiffness in 3,671 participants of The Maastricht Study without prior CVD. Cardiovascular autonomic function was assessed using 24-hour heart rate variability (HRV). Aortic stiffness was measured by pulse wave velocity (PWV), and carotid stiffness by carotid artery distensibility (CD). Lower HRV was associated with 2.8–3.2% higher PWV and 3.1–3.2% lower CD per SD decrease in HRV Z-scores, with stronger associations observed in individuals with dysglycemia. These findings suggest that autonomic dysfunction may increase cardiovascular risk through effects on vascular stiffness, particularly in prediabetes and diabetes.
Unified Clinical Vocabulary Embeddings for Advancing Precision
Authors: Johnson Ruth , Gottlieb Uri , Shaham Galit , Eisen Lihi , Waxman Jacob , Devons-Sberro Stav , Ginder Curtis R. , Hong Peter , Sayeed Raheel , Reis Ben Y. , Balicer Ran D. , Dagan Noa , Zitnik Marinka
Published: December 2024

Integrating clinical knowledge into AI remains challenging despite numerous medical guidelines and vocabularies. Medical codes, central to healthcare systems, often reflect operational patterns shaped by geographic factors, national policies, insurance frameworks, and physician practices rather than the precise representation of clinical knowledge. This disconnect hampers AI in representing clinical relationships, raising concerns about bias, transparency, and generalizability. Here, we developed a resource of 67,124 clinical vocabulary embeddings derived from a clinical knowledge graph tailored to electronic health record vocabularies, spanning over 1.3 million edges. Using graph transformer neural networks, we generated clinical vocabulary embeddings that provide a new representation of clinical knowledge by unifying seven medical vocabularies. These embeddings were validated through a phenotype risk score analysis involving 4.57 million patients from Clalit Healthcare Services, effectively stratifying individuals based on survival outcomes. Inter-institutional panels of clinicians evaluated the embeddings for alignment with clinical knowledge across 90 diseases and 3,000 clinical codes, confirming their robustness and transferability. This resource addresses gaps in integrating clinical vocabularies into AI models and training datasets, paving the way for knowledge-grounded population and patient-level models.
Weighted analysis of symptom profile by vaccination status in positive SARS-CoV-2 cases: observational study in São Gonçalo, Brazil
Authors: Rangel das Chagas Raphael , Freitas Hércules Rezende , Cardozo Sergian Vianna
Published: December 2024

This study investigates symptom associations in SARS-CoV-2 positive individuals based on vaccination status. Unvaccinated individuals exhibited significantly higher odds of experiencing severe symptoms, including fever > 38.5□°C (logOR = 3.64, 95% CI: 1.52–5.77, p = 0.0008), rhinitis (logOR = 2.94, 95% CI: 0.82–5.05, p = 0.0065), headache (logOR = 2.17, 95% CI: 0.06–4.28, p = 0.0436), and myalgia (logOR = 3.25, 95% CI: 1.17–5.34, p = 0.0023). Conversely, unvaccinated individuals were less likely to report cough (logOR = -2.44, 95% CI: -4.53 to -0.34, p = 0.0226), potentially reflecting behavioral factors related to vaccine hesitancy. Among vaccinated participants, symptom profiles varied by vaccine type. Both Oxford-AstraZeneca and Pfizer-BNT162b2 vaccines were associated with increased odds of loss of smell (logOR = 0.81 and 1.47, respectively) and loss of taste (logOR = 0.75 for Oxford-AstraZeneca). Additionally, the Oxford-AstraZeneca vaccine was linked to dyspnea (logOR = 0.85, 95% CI: 0.02–1.69, p = 0.0449). These findings suggest that vaccination reduces the likelihood of severe systemic and respiratory symptoms while influencing specific symptom manifestations in breakthrough cases. Ongoing research is essential to understand vaccine-specific immune responses and their impact on clinical outcomes.
“I Been Taking Adderall Mixing it With Lean, Hope I Don’t Wake Up Out My Sleep”: Harnessing Twitter to Understand Nonmedical Prescription Stimulant Use among Black Women and Men Subscribers
Authors: Webster Joni-Leigh , Lakamana Sahithi , Ge Yao , Sarker Abeed
Published: December 2024

Black women and men outpace other races for stimulant-involved overdose mortality despite lower lifetime use. Growth in mortality from prescription stimulant medications is increasing in tandem with prescribing patterns for these medications. We used Twitter to explore nonmedical prescription stimulant use (NMPSU) among Black women and men using emotion and sentiment analysis, and topic modeling. We applied the NRC Lexicon and VADER dictionary, and LDA topic modeling to examine feelings and themes in conversations about NMPSU by gender. We paid attention to the ability of natural language processing techniques to detect differences in emotion and sentiment among Black Twitter subscribers given increased mortality from stimulants. We found that, although emotion and sentiment outcomes match the directionality of emotions and sentiment observed (i.e., Black Twitter subscribers use more positive language in tweets), this belies limitations of NRC and VADER dictionaries to distinguish feelings for Black people. Even still, LDA topic models showcased the relevance of hip-hop, dependence on NMPSU, and recreational use as consequential to Black Twitter subscribers’ discussions. However, gender shaped the relevance of these topics for each group. Greater attention needs to be paid to how Black women and men use social media to discuss important topics like drug use. Natural language processing methods and social media research should include larger proportions of Black, Hispanic/Latinx, and American Indian populations in development of emotion and sentiment lexicons, otherwise outcomes regarding NMPSU will not be generalizable to populations writ large due to cultural differences in communication about drug use online.
NeoCLIP: A Self-Supervised Foundation Model for the Interpretation of Neonatal Radiographs
Authors: Huang Yixuan , Sharma Puneet , Palepu Anil , Greenbaum Nathaniel , Beam Andrew , Beam Kristyn
Published: December 2024

Importance

Artificial intelligence (AI) based on deep learning has shown promise in adult and pediatric populations in the interpretation of medical imaging to make important diagnostic and management recommendations. However, there has been little work developing new AI methods for neonatal populations.

Objective

To develop a novel, deep contrastive learning model to predict a comprehensive set of pathologies from radiographs relevant to neonatal intensive care.

Design, Setting, and Participants

We identified a retrospective cohort of infants who obtained a radiograph while admitted to a large neonatal intensive care unit in Boston, MA from January 2008 to December 2023. After collecting radiographs with corresponding reports and relevant demographics for all subjects, we randomized the cohort into three sets: training (80%), validation (10%), and test (10%).

Interventions

We developed a deep learning model, NeoCLIP, to identify 15 unique pathologies and 5 medical devices relevant to neonatal intensive care on plain film radiographs. The pathologies were automatically extracted from radiology reports using a custom pipeline based on large language models.

Main Outcomes and Measures

We compared the performance of our model, as defined by AUROC, against various baseline methods.

Results

We identified 4,629 infants which were randomized into the training (3,731 infants), validation (419 infants), and test (479 infants) sets. In total, we collected 20,154 radiographs with a corresponding 15,795 reports. The AUROC of our model was greater than all baseline methods for every radiographic finding other than portal venous gas. The addition of demographics improved the AUROC of our model for all findings, but the difference was not statistically significant.

Conclusions and Relevance

NeoCLIP successfully identified a broad set of pathologies and medical devices on neonatal radiographs, outperforming similar models developed for adult populations. This represents the first such application of advanced AI methodologies to interpret neonatal radiographs.
Learning Outcomes that Maximally Differentiate Psychiatric Treatments
Authors: Strobl Eric V. , Kim Semmie
Published: December 2024

Objective

Matching each patient to the most effective treatment option(s) remains a challenging problem in psychiatry. Clinical rating scales often fail to differentiate between treatments because most treatments improve the scores of all individual items at only slightly varying degrees. As a result, nearly all clinical trials in psychiatry fail to differentiate between active treatments.

Methods

We introduce a new statistical technique called Supervised Varimax (SV) that corrects this problem by accurately detecting large treatment differences directly from original clinical trial data. The algorithm combines the individual items of a clinical rating scale that onlyslightlydiffer between treatments into a few scores thatgreatlydiffer between treatments. We applied SV to multi-center, double-blind and randomized clinical trials called CATIE and STAR*D which were long thought to identify few to no differential treatment effects.

Results

SV identified optimal outcomes harboring large differential treatment effects in Phase I of CATIE (absolute sum = 1.279,p= 0.002). Post-hoc analyses revealed that olanzapine is more effective than quetiapine and ziprasidone for hostility in chronic schizophrenia (difference = −0.284,pFWER= 0.047; difference = −0.283,pFWER= 0.048), and perphenazine is more effective than ziprasidone for emotional dysregulation (difference = −0.313,pFWER= 0.020). SV also discovered that bupropion augmentation is more effective than buspirone augmentation for treatment-resistant depression with increased appetite from Level 2 of STAR*D (difference = −0.280,pFWER= 0.003).

Conclusions

SV represents a powerful methodology that enables precision psychiatry from clinical trials by optimizing the outcome measures to differentiate between treatments.