bluuebunny/crossref_metadata_2025 huggingface dataset:
Chronic kidney disease and its association with cerebral small vessel disease in the general older hypertensive population
Authors: Månsson Tomas , Rosso Aldana , Ellström Katarina , Abul-Kasim Kasim , Elmståhl Sölve
Published: March 2024

Background

Cerebral small vessel disease can be identified using magnetic resonance imaging, and includes white matter hyperintensities, lacunar infarcts, cerebral microbleeds, and brain atrophy. Cerebral small vessel disease and chronic kidney disease share many risk factors, including hypertension. This study aims to explore an association between chronic kidney disease and cerebral small vessel disease, and also to explore the role of hypertension in this relationship.

Methods

With a cross sectional study design, data from 390 older adults was retrieved from the general population study Good Aging in Skåne. Chronic kidney disease was defined as glomerular filtration rate < 60 ml/min/1,73m2. Associations between chronic kidney disease and magnetic resonance imaging markers of cerebral small vessel disease were explored using logistic regression models adjusted for age and sex. In a secondary analysis, the same calculations were performed with the study sample stratified based on hypertension status.

Results

In the whole group, adjusted for age and sex, chronic kidney disease was not associated with any markers of cerebral small vessel disease. After stratification by hypertension status and adjusted for age and sex, we observed that chronic kidney disease was associated with cerebral microbleeds (OR 1.93, CI 1.04–3.59, p-value 0.037), as well as with cortical atrophy (OR 2.45, CI 1.34–4.48, p-value 0.004) only in the hypertensive group. In the non-hypertensive group, no associations were observed.

Conclusions

In this exploratory cross-sectional study, we observed that chronic kidney disease was associated with markers of cerebral small vessel disease only in the hypertensive subgroup of a general population of older adults. This might indicate that hypertension is an important link between chronic kidney disease and cerebral small vessel disease. Further studies investigating the relationship between CKD, CSVD, and hypertension are warranted.
Anaphylaxis-induced premature uterine contractions: a case report and literature review
Authors: Warintaksa Puntabut , Lertrat Waranyu , Romero Roberto , Vivithanaporn Pornpun , Mongkolsuk Paninee , Kamlungkuea Threebhorn , Settacomkul Rapeewan , Pongchaikul Pisut , Chaemsaithong Piya
Published: March 2024

Background

Preterm labor is caused by multiple etiologies, including intra-amniotic infection and/or intra-amniotic inflammation, vascular disorders, cervical disease, decidual senescence, and breakdown of maternal–fetal tolerance. Accumulating evidence in vivo and in vitro has shown that an allergic reaction, including anaphylaxis, can induce preterm uterine contractions. This report describes a case of a pregnant woman who developed anaphylaxis and regular uterine contractions after the ingestion of a strawberry-coated biscuit. We also review the mechanism of allergic reaction (hypersensitivity)-induced preterm labor.

Case presentation

A 31-year-old woman (gravida 1, para 0) at 30+2 weeks of gestation was admitted to the labor and delivery unit with regular uterine contractions and anaphylactic symptoms after she ingested a strawberry-coated biscuit as a snack. The uterine contractions resolved after the treatment of anaphylaxis by administering antihistamines and epinephrine. The patient subsequently delivered at 39+3 weeks of gestation. The amniotic fluid profile showed no infection or inflammation. A postpartum skin-prick test confirmed a positive type 1 hypersensitivity reaction to the strawberry-coated biscuit.

Conclusions

We report a case of anaphylaxis-induced uterine contractility in which uterine contractions subsided after the treatment of anaphylaxis. The absence of intra-amniotic infection and/or intra-amniotic inflammation and the cause of the anaphylaxis were confirmed. Our findings indicate that maternal allergic reactions may be one of the mechanisms of preterm labor.
Use of antimicrobials in pediatric wards of five Brazilian hospitals
Authors: de Barros Fernandes Thais , Ramos Sheila Feitosa , Leitzke Luísa Rodrigues Furtado , Júnior Ronaldo Gomes Alexandre , de Araújo Janaína Morais , de Souza Júnior Alcidésio Sales , da Silva Alice Ramos Oliveira , Heineck Isabela , de França Fonteles Marta Maria , Bracken Louise E. , Peak Matthew , de Lyra Junior Divaldo Pereira , Osorio-de-Castro Claudia G S , Lima Elisangela Costa
Published: March 2024

The use of antimicrobials (AMs) in pediatric infections is common practice and use may be inappropriate leading to antimicrobial resistance. Off-label AM use is also common in this group and can result in drug-related problems. There is lack of DUR data in Brazil and in Latin America, specially for AM pediatric use. The aim of this study was to describe the utilization of AMs in hospitalized children in five hospitals in Brazil. We conducted an observational study of the utilization of AMs in pediatric wards in hospitals in the states of Ceará (CE), Sergipe (SE), Rio de Janeiro (RJ), Rio Grande do Sul (RS) and the Federal District (DF). Data derived from patient medical records and prescriptions were collected over a six-month period in each hospital. The number of AMs used by each patient was recorded, and AM use was assessed using Days of therapy (DOT) and Length of therapy (LOT) per 1000 patient days according to different patient characteristics. Off-label (OL) use was described according to age. The study analyzed data from 1020 patients. The sex and age distributions were similar across the five hospitals. However, differences were found for comorbidities, history of ICU admission and length of hospital stay. The most common diseases were respiratory tract infections. There were wide variations in DOT/1000PD (278–517) and LOT/1000PD (265–390). AM utilization was highest in the hospital in SE. The consumption of second-generation penicillins and cephalosporins was high. The prevalence of OL use of AMs was higher for patients in the RJ hospital, in infants, in patients who underwent prolonged hospital stays, and in patients who used multiple AMs. The AM that showed the highest prevalence of OL use was azithromycin, in both oral and parenteral formulations. Overall AM use was high and showed differences in each setting, possibly influenced by local characteristics and by prescribing standards adopted by pediatricians.
Validation of the inventory: lockdown and its impact on the university Community
Authors: González-Alonso María Yolanda , Ortiz-González Andrea Liliana , Escolar-Llamazares María Camino , Serrano-Gómez Diego , Serrano-Pintado Isabel , Martínez-Martín María Ángeles
Published: March 2024

Background

Significant consequences of COVID-19 within academic/professional life are, at the psychological level, related to worry, tension, stress; coping strategies and lifestyle changes. This study describes the process of design and validation of an inventory (QPIC), which aims to assess the psychological impact that a situation of confinement can produce among university students and teachers.

Methods

Design of the instrument and psychometric tests. A sample of 862 students and 229 professors affiliated to Spanish and Colombian universities was used. Data were collected in April 2020 with the request of the favourable Bioethics Committee IR/2020.

Results

Six experts carried out the content validation. A confirmatory factor analysis of the theoretical dimensions proposed for the scales was performed and the internal consistency of each of the three initial scales was confirmed (0.866, 0.813 and 0.834).

Conclusion

A rigorous and reliable instrument is achieved, consisting of two final scales: (a) Worry, tension and stress scale (b) Coping scale, which helps to measure individual psychological effects in housebound situations. It is an instrument designed, constructed ad hoc to assess the impact of confinement and subjected to validation. The factor structure and reliability of the instrument are examined and good psychometric properties are obtained. The application of this inventory will make it possible to assess the impact on people’s mental health during a period of confinement.
Satisfaction with local healthcare services and medical need among hypertensive patients: a nationwide study
Authors: Kim Woorim , Ju Yeong Jun , Lee Soon Young
Published: March 2024

Background

Investigating the factors associated with unmet medical needs is important since it can reflect access to healthcare. This study examined the relationship between the unmet medical needs of patients with hypertension and their satisfaction with the healthcare services available in their neighborhoods.

Methods

Data were from the 2021 Korean Community Health Survey. The sample included individuals aged 19 years who were diagnosed with hypertension. The main outcome measure was unmet medical need. The relationship between the outcome measure and independent variables were analyzed using multivariate logistic regressions, along with a subgroup analysis based on whether patients were currently receiving treatment for hypertension.

Results

Unmet medical needs were found in 4.3% of the study participants. A higher likelihood of unmet medical needs was found in individuals not satisfied with the healthcare services at proximity (adjusted OR = 1.69, 95% CI: 1.49–1.92) compared to those satisfied with services nearby. Similar tendencies were found regardless of whether individuals were currently receiving treatment for hypertension, although larger differences were found between groups in participants who were currently not receiving treatment.

Conclusions

The findings infer the need to consider patient satisfaction with nearby healthcare services in implementing public health policies that address unmet medical need in patients with hypertension.
Extending the diabetic retinopathy screening intervals in Singapore: methodology and preliminary findings of a cohort study
Authors: Aravindhan Amudha , Fenwick Eva K. , Chan Aurora Wing Dan , Man Ryan Eyn Kidd , Tan Ngiap Chuan , Wong Wei Teen , Soo Wern Fern , Lim Shin Wei , Wee Sabrina Yi-Mei , Sabanayagam Charumathi , Finkelstein Eric , Tan Gavin , Hamzah Haslina , Chakraborty Bibhas , Acharyya Sanchalika , Shyong Tai E. , Scanlon Peter , Wong Tien Yin , Lamoureux Ecosse L.
Published: March 2024

Background

The Diabetic Retinopathy Extended Screening Study (DRESS) aims to develop and validate a new DR/diabetic macular edema (DME) risk stratification model in patients with Type 2 diabetes (DM) to identify low-risk groups who can be safely assigned to biennial or triennial screening intervals. We describe the study methodology, participants’ baseline characteristics, and preliminary DR progression rates at the first annual follow-up.

Methods

DRESS is a 3-year ongoing longitudinal study of patients with T2DM and no or mild non-proliferative DR (NPDR, non-referable) who underwent teleophthalmic screening under the Singapore integrated Diabetic Retinopathy Programme (SiDRP) at four SingHealth Polyclinics. Patients with referable DR/DME (> mild NPDR) or ungradable fundus images were excluded. Sociodemographic, lifestyle, medical and clinical information was obtained from medical records and interviewer-administered questionnaires at baseline. These data are extracted from medical records at 12, 24 and 36 months post-enrollment. Baseline descriptive characteristics stratified by DR severity at baseline and rates of progression to referable DR at 12-month follow-up were calculated.

Results

Of 5,840 eligible patients, 78.3% (n = 4,570, median [interquartile range [IQR] age 61.0 [55–67] years; 54.7% male; 68.0% Chinese) completed the baseline assessment. At baseline, 97.4% and 2.6% had none and mild NPDR (worse eye), respectively. Most participants had hypertension (79.2%) and dyslipidemia (92.8%); and almost half were obese (43.4%, BMI ≥ 27.5 kg/m2). Participants without DR (vs mild DR) reported shorter DM duration, and had lower haemoglobin A1c, triglycerides and urine albumin/creatinine ratio (all p < 0.05). To date, we have extracted 41.8% (n = 1909) of the 12-month follow-up data. Of these, 99.7% (n = 1,904) did not progress to referable DR. Those who progressed to referable DR status (0.3%) had no DR at baseline.

Conclusions

In our prospective study of patients with T2DM and non-referable DR attending polyclinics, we found extremely low annual DR progression rates. These preliminary results suggest that extending screening intervals beyond 12 months may be viable and safe for most participants, although our 3-year follow up data are needed to substantiate this claim and develop the risk stratification model to identify low-risk patients with T2DM who can be assigned biennial or triennial screening intervals.
Predictive effect of the systemic inflammation response index (SIRI) on the efficacy and prognosis of neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer
Authors: Ding Yuanyi , Liu Zining , Li Jing , Niu Wenbo , Li Chenhui , Yu Bin
Published: March 2024

Background

Inflammation is a part of tumours, and inflammatory cells can affect the proliferation, invasion, and development of tumour cells. An increasing number of peripheral blood inflammatory markers have been found to play very important roles in the treatment and prognosis of cancer patients. The systemic inflammatory response index (SIRI) is a newer inflammatory marker, and its role in colorectal cancer, especially in locally advanced rectal cancer, is still unclear.

Methods

From 2015 to 2020, 198 patients with locally advanced rectal cancer (LARC) who underwent surgery following neoadjuvant chemoradiotherapy (Neo-CRT) were analysed. Patients were categorized into good- and poor- response groups according to their pathological results, and clinical characteristics and baseline parameters were compared between the two groups. The optimal cutoff values for inflammatory indicators were determined using receiver operating characteristic (ROC) analysis. Univariate and multivariate analyses were performed using the Cox proportional hazard model. Survival analysis was performed via the Kaplan‒Meier method.

Results

After patients were grouped into good and poor response groups, indicator differences were found in CEA, neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), and SIRI. According to the ROC analysis, the NLR (P = 0.015), SII (P = 0.001), and SIRI (P = 0.029) were significant prognostic factors. After univariate and multivariate analyses of the Cox proportional hazards regression model, only the SIRI was found to be an independent prognostic factor for overall survival (OS) and disease-free survival (DFS). Finally, Kaplan‒Meier survival curves also confirmed the ability of the SIRI to predict survival.

Conclusion

The preoperative SIRI can be used to predict the response to Neo-CRT in LARC patients and is an independent predictor of OS and DFS in postoperative patients. A high SIRI was associated with poor radiotherapy response and predicted poor OS and DFS.
The role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma
Authors: Wei Mengchao , Yang Wenjie , Xu Weifeng , Liu Guanghua , Xie Yi , Dong Jie , Ji Zhigang
Published: March 2024

Background

To investigate the role of antimicrobial prophylaxis in laparoscopic nephrectomy for renal cell carcinoma.

Methods

We retrospectively enrolled 1000 patients who underwent laparoscopic nephrectomy from August 2019 to November 2021 in the Peking Union Medical College Hospital. Patients were divided into group without antimicrobial prophylaxis (n = 444) and group with antimicrobial prophylaxis (n = 556). Outcomes including 30-day postoperative infection rate, the increase rate of pre- and post-operative white blood cell counts and hospital stay were analyzed.

Results

The overall infection rate was 5.0% (28/556) in the group with antimicrobial prophylaxis, which was similar to 4.1% (18/444) in the group without antimicrobial prophylaxis (P = 0.461). The increase rate of pre- and post-operative white blood cell counts was significantly lower (85.5% versus 97.0%) in the group with antimicrobial prophylaxis (P = 0.004). The postoperative hospital stay was 5 (4, 6) days in both groups (P = 0.483). Logistic regression analyses identified the use of antimicrobial prophylaxis had no influence on the occurrence of infection events (odds ratio = 0.797; 95% confidence interval, 0.435–1.460;P = 0.462). Hemoglobin (odds ratio = 0.430; 95% confidence interval, 0.257–0.719;P = 0.001) and partial nephrectomy (odds ratio = 2.292; 95% confidence interval, 1.724–3.046;P < 0.001) influenced the use of antimicrobial prophylaxis independently.

Conclusions

The use of antimicrobial prophylaxis had no impact on postoperative infection in patients receiving laparoscopic nephrectomy for renal cell carcinoma.
Self-reported preparedness of final year undergraduate dental students and interns in Saudi Arabia: a multi-institutional study
Authors: Javed Muhammad Qasim , Abulhamael Ayman Moaz , Ahmad Zaina , Muhammad Muhammad , Faridi Muhammad Ali , Khan Kiran Imtiaz , Habib Syed Rashid , Ali Kamran
Published: March 2024

Background

Contemporary undergraduate dental education aims to equip the dental students with clinical competence, empathy, and professionalism to enable them to deliver safe and effective dental care to the communities. The purpose of this study was to assess the self-reported preparedness of final year dental students and interns at three Saudi dental institutions, using the pre-validated Dental Undergraduates Preparedness Assessment Scale (DU-PAS).

Methods

A cross-sectional study design was employed to assess the self-reported preparedness of the participants using the DU-PAS. Following ethics approval, a probability sampling technique was used to recruit undergraduate dental students and interns from three dental institutions in Saudi Arabia. The data was collected online on Google Forms and all participants provided their consent to participate in the study prior to providing their responses to DU-PAS.

Results

Responses were received from 397 participants including 171 males and 226 females yielding a response rate of 60.3%. The total mean score of the participants was 81.85 ± 13.11. Although higher scores were reported in males, the interaction between gender and DU-PAS scores were not significant. Interaction between DU-PAS scores and stage of education showed significant effect of the stage of education with interns reporting higher overall scores. The participants reported that they were able to perform most clinical procedures independently. However, low confidence was reported in performing multi-rooted endodontics, fabrication of removable dentures and orthodontic assessment. The participants also expressed their confidence in a wide range of behavioural attributes related to communication, teamworking and professionalism. However, lack of experience was noted in referral for oral cancer, interpreting research, and evaluation of new dental products using an evidence-based approach.

Conclusion

The study provides useful insights into the self-reported preparedness of undergraduate dental students and interns in three dental institutions. While the overall preparedness of the participants was comparable to their international peers, the findings underscore the need for further enhancements to the teaching and training of undergraduate students particularly in multirooted endodontics, removable prosthodontics and orthodontics.
Deep learning of movement behavior profiles and their association with markers of cardiometabolic health
Authors: Farrahi Vahid , Collings Paul J , Oussalah Mourad
Published: March 2024

Background

Traditionally, existing studies assessing the health associations of accelerometer-measured movement behaviors have been performed with few averaged values, mainly representing the duration of physical activities and sedentary behaviors. Such averaged values cannot naturally capture the complex interplay between the duration, timing, and patterns of accumulation of movement behaviors, that altogether may be codependently related to health outcomes in adults. In this study, we introduce a novel approach to visually represent recorded movement behaviors as images using original accelerometer outputs. Subsequently, we utilize these images for cluster analysis employing deep convolutional autoencoders.

Methods

Our method involves converting minute-by-minute accelerometer outputs (activity counts) into a 2D image format, capturing the entire spectrum of movement behaviors performed by each participant. By utilizing convolutional autoencoders, we enable the learning of these image-based representations. Subsequently, we apply the K-means algorithm to cluster these learned representations. We used data from 1812 adult (20–65 years) participants in the National Health and Nutrition Examination Survey (NHANES, 2003–2006 cycles) study who worn a hip-worn accelerometer for 7 seven consecutive days and provided valid accelerometer data.

Results

Deep convolutional autoencoders were able to learn the image representation, encompassing the entire spectrum of movement behaviors. The images were encoded into 32 latent variables, and cluster analysis based on these learned representations for the movement behavior images resulted in the identification of four distinct movement behavior profiles characterized by varying levels, timing, and patterns of accumulation of movement behaviors. After adjusting for potential covariates, the movement behavior profile characterized as “Early-morning movers” and the profile characterized as “Highest activity” both had lower levels of insulin (P < 0.01 for both), triglycerides (P < 0.05 and P < 0.01, respectively), HOMA-IR (P < 0.01 for both), and plasma glucose (P < 0.05 and P < 0.1, respectively) compared to the “Lowest activity” profile. No significant differences were observed for the “Least sedentary movers” profile compared to the “Lowest activity” profile.

Conclusions

Deep learning of movement behavior profiles revealed that, in addition to duration and patterns of movement behaviors, the timing of physical activity may also be crucial for gaining additional health benefits.
The optimal antithrombotic strategy for post-stroke patients with atrial fibrillation and extracranial artery stenosis—a nationwide cohort study
Authors: Tsai Chuan-Tsai , Chan Yi-Hsin , Liao Jo-Nan , Chen Tzeng-Ji , Lip Gregory Y. H. , Chen Shih-Ann , Chao Tze-Fan
Published: March 2024

Background

In post-stroke atrial fibrillation (AF) patients who have indications for both oral anticoagulant (OAC) and antiplatelet agent (AP), e.g., those with carotid artery stenosis, there is debate over the best antithrombotic strategy. We aimed to compare the risks of ischemic stroke, composite of ischemic stroke/major bleeding and composite of ischemic stroke/intracranial hemorrhage (ICH) between different antithrombotic strategies.

Methods

This study included post-stroke AF patients with and without extracranial artery stenosis (ECAS) (n = 6390 and 28,093, respectively) identified from the Taiwan National Health Insurance Research Database. Risks of clinical outcomes and net clinical benefit (NCB) with different antithrombotic strategies were compared to AP alone.

Results

The risk of recurrent ischemic stroke was higher for patients with ECAS than those without (12.72%/yr versus 10.60/yr; adjusted hazard ratio [aHR] 1.104, 95% confidence interval [CI] 1.052–1.158, p < 0.001). For patients with ECAS, when compared to AP only, non-vitamin K antagonist oral anticoagulant (NOAC) monotherapy was associated with lower risks for ischaemic stroke (aHR 0.551, 95% CI 0.454—0.669), the composite of ischaemic stroke/major bleeding (aHR 0.626, 95% CI 0.529—0.741) and the composite of ischaemic stroke/ICH (aHR 0.577, 95% CI 0.478—0.697), with non-significant difference for major bleeding and ICH. When compared to AP only, warfarin monotherapy was associated with higher risks of major bleeding (aHR 1.521, 95% CI 1.231—1.880), ICH (aHR 2.045, 95% CI 1.329—3.148), and the composite of ischaemic stroke and major bleeding. With combination of AP plus warfarin, there was an increase in ischaemic stroke, major bleeding, and the composite outcomes, when compared to AP only. NOAC monotherapy was the only approach associated with a positive NCB, while all other options (warfarin, combination of AP-OAC) were associated with negative NCB.

Conclusions

For post-stroke AF patients with ECAS, NOAC monotherapy was associated with lower risks of adverse outcomes and a positive NCB. Combination of AP with NOAC or warfarin did not offer any benefit, but more bleeding especially with AP-warfarin combination therapy.
Ce6-modified Fe ions-doped carbon dots as multifunctional nanoplatform for ferroptosis and photodynamic synergistic therapy of melanoma
Authors: Li Haiqiu , Dou Yichen , Yang Hang , Xing Hanlin , Zhu Cheng , Wang Tao , Xuan Zhaopeng , Yang Mingxi
Published: March 2024

Background

Despite the higher sensitivity of melanoma towards ferroptosis and photodynamic therapy (PDT), the lack of efficient ferroptosis inducers and the poor solubility of photosensitizers restrict their synergistic strategies. With unique advantages, carbon dots (CDs) are expected to serve as innovative building blocks for combination therapy of cancers.

Results

Herein, an ferroptosis/PDT integrated nanoplatform for melanoma therapy is constructed based on chlorin e6-modified Fe ions-doped carbon dots (Fe-CDs@Ce6). As a novel type of iron-carbon hybrid nanoparticles, the as-prepared Fe-CDs can selectively activate ferroptosis, prevent angiogenesis and inhibit the migration of mouse skin melanoma cells (B16), but have no toxicity to normal cells. The nano-conjugated structures facilitate not only the aqueous dispersibility of Ce6, but also the self-accumulation ability of Fe-CDs@Ce6 within melanoma area without requiring extra targets. Moreover, the therapeutic effects of Fe-CDs@Ce6 are synergistically enhanced due to the increased GSH depletion by PDT and the elevated singlet oxygen (1O2) production efficiency by Fe-CDs. When combined with laser irradiation, the tumor growth can be significantly suppressed by Fe-CDs@Ce6 through cyclic administration. The T2-weighted magnetic resonance imaging (MRI) capability of Fe-CDs@Ce6 also reveals their potentials for cancer diagnosis and navigation therapy.

Conclusions

Our findings indicate the multifunctionality of Fe-CDs@Ce6 in effectively combining ferroptosis/PDT therapy, tumor targeting and MRI imaging, which enables Fe-CDs@Ce6 to become promising biocompatible nanoplatform for the treatment of melanoma.

Graphic Abstract
Multicentric carpotarsal osteolysis syndrome with variants of MAFB gene: a case report and literature review
Authors: Gao Xianfei , Fang Xiang , Huang Danping , Zhang Song , Zeng Huasong
Published: March 2024

Background

Multicentric carpotarsal osteolysis (MCTO) is a rare genetic disorder characterized by the progressive loss of bone in the hands, feet, and other skeletal structures. It presents with symptoms that may resemble those of juvenile idiopathic arthritis, making diagnosis challenging for clinicians. The identification of MAF BZIP Transcription Factor B (MAFB) mutations as significant contributors to MCTO represents a major breakthrough in our understanding of the pathogenesis of this rare skeletal disorder.

Case presentation

Our objective was to present the phenotype, treatment, and outcome of a patient with a variant of MAFB-induced MCTO to broaden the range of clinical features associated with MCTO and share our clinical experience for improved diagnosis and treatment. In our case, early MRI examination of the bones and whole exome sequencing enabled an early and accurate MCTO diagnosis, and timely Denosumab administration resulted in no deterioration.

Conclusion

This suggests that MRI examination and whole exome sequencing should be considered when MCTO is suspected, and Denosumab might be an option in the treatment of MCTO.
Navigating the field of implementation science towards maturity: challenges and opportunities
Authors: Chambers David A. , Emmons Karen M.
Published: March 2024

Background

The field of implementation science has significantly expanded in size and scope over the past two decades, although work related to understanding implementation processes have of course long preceded the more systematic efforts to improve integration of evidence-based interventions into practice settings. While this growth has had significant benefits to research, practice, and policy, there are some clear challenges that this period of adolescence has uncovered.

Main body

This invited commentary reflects on the development of implementation science, its rapid growth, and milestones in its establishment as a viable component of the biomedical research enterprise. The authors reflect on progress in research and training, and then unpack some of the consequences of rapid growth, as the field has grappled with the competing challenges of legitimacy among the research community set against the necessary integration and engagement with practice and policy partners. The article then enumerates a set of principles for the field's next developmental stage and espouses the aspirational goal of a “big tent” to support the next generation of impactful science.

Conclusion

For implementation science to expand its relevance and impact to practice and policy, researchers must not lose sight of the original purpose of the field—to support improvements in health and health care at scale, the importance of building a community of research and practice among key partners, and the balance of rigor, relevance, and societal benefit.
Exercise-induced bronchoconstriction, allergy and sports in children
Authors: Klain Angela , Giovannini Mattia , Pecoraro Luca , Barni Simona , Mori Francesca , Liotti Lucia , Mastrorilli Carla , Saretta Francesca , Castagnoli Riccardo , Arasi Stefania , Caminiti Lucia , Gelsomino Mariannita , Indolfi Cristiana , del Giudice Michele Miraglia , Novembre Elio
Published: March 2024

Exercise-induced bronchoconstriction (EIB) is characterized by the narrowing of airways during or after physical activity, leading to symptoms such as wheezing, coughing, and shortness of breath. Distinguishing between EIB and exercise-induced asthma (EIA) is essential, given their divergent therapeutic and prognostic considerations. EIB has been increasingly recognized as a significant concern in pediatric athletes. Moreover, studies indicate a noteworthy prevalence of EIB in children with atopic predispositions, unveiling a potential link between allergic sensitivities and exercise-induced respiratory symptoms, underpinned by an inflammatory reaction caused by mechanical, environmental, and genetic factors. Holistic management of EIB in children necessitates a correct diagnosis and a combination of pharmacological and non-pharmacological interventions. This review delves into the latest evidence concerning EIB in the pediatric population, exploring its associations with atopy and sports, and emphasizing the appropriate diagnostic and therapeutic approaches by highlighting various clinical scenarios.
Expanding the swimmer’s itch pool of the Benelux: a first record of the neurotropic Trichobilharzia regenti and potential link to human infection
Authors: Schols Ruben , Smitz Nathalie , Vanderheyden Ann , Huyse Tine
Published: March 2024

Background

Swimmer's itch, an allergic contact dermatitis caused by avian and mammalian blood flukes, is a parasitic infection affecting people worldwide. In particular, avian blood flukes of the genus Trichobilharzia are infamous for their role in swimmer’s itch cases. These parasites infect waterfowl as a final host, but incidental infections by cercariae in humans are frequently reported. Upon accidental infections of humans, parasite larvae will be recognized by the immune system and destroyed, leading to painful itchy skin lesions. However, one species, Trichobilharzia regenti, can escape this response in experimental animals and reach the spinal cord, causing neuroinflammation. In the last few decades, there has been an increase in case reports across Europe, making it an emerging zoonosis.

Methods

Following a reported case of swimmer’s itch in Kampenhout in 2022 (Belgium), the transmission site consisting of a private pond and an adjacent creek was investigated through a malacological and parasitological survey.

Results

Six snail species were collected, including the widespread Ampullaceana balthica, a well-known intermediate host for Trichobilharzia parasites. Shedding experiments followed by DNA barcoding revealed a single snail specimen to be infected with T. regenti, a new species record for Belgium and by extension the Benelux. Moreover, it is the most compelling case to date of the link between this neurotropic parasite and cercarial dermatitis. Additionally, an Echinostomatidae sp. and Notocotylus sp. were isolated from two other specimens of A. balthica. However, the lack of reference DNA sequences for these groups in the online repositories prevented genus- and species-level identification, respectively.

Conclusions

The presence of T. regenti in Belgium might have severe clinical implications and its finding highlights the need for increased vigilance and diagnostic awareness among medical professionals. The lack of species-level identification of the other two parasite species showcases the barcoding void for trematodes. Overall, these findings demonstrate the need for a Belgian framework to rapidly detect and monitor zoonotic outbreaks of trematode parasites within the One Health context.

Graphical Abstract
Nephrotic syndrome with rectus sheath hematoma: a case report
Authors: Fujii Ai , Matsuda Yuto , Yabe Tomohisa , Norifumi Hayashi , Fujimoto Keiji , Yamazaki Masahide , Yokoyama Hitoshi , Furuichi Kengo
Published: March 2024

Background

Rectus sheath hematoma is a rare presentation often associated with abdominal trauma and anticoagulant therapy. Here, we present a patient with severe rectus sheath hematoma accompanied by nephrotic syndrome who achieved significant clinical improvement without the need for invasive treatment.

Case presentation

A 72-year-old Japanese woman was referred to our hospital for the treatment of nephrotic syndrome. She was receiving steroid and anticoagulant therapy. Then she had abdominal pain and she was diagnosed with spontaneous rectus sheath hematoma by abdominal computed tomography. She received transfusion and was managed conservatively with bed rest, which led to improvement in abdominal pain.

Conclusion

Despite the absence of trauma history, rectus sheath hematoma should be considered in patients at risk of vascular failure, including those receiving anticoagulant or steroid therapy, those who are elderly, and those with nephrotic syndrome.
Spontaneous knot formation complication of double J: two case reports
Authors: Kolu Ahmet Can , Akan Serkan
Published: March 2024

Background

Use of ureteral stents has become an integral part of urological practice. However, it also brought with it many complications. Double J (DJ) stent knotting is a rare stent complication, and only a few cases have been reported in the literature. Although the exact cause is unknown and, in the literature, it is generally thought that knots occur due to traction. In this case report we present for the first time that spontaneous knots can occur due to ureteral peristalsis or ureteral anomalies.

Case presentation

Two patients (67 and 35 aged-Caucasian person) with ureteral stones who presented to the emergency department with colicky pain and had no previous history of urological surgery. We observed knot formation in the routine urinary system radiographs taken before stent removal in two patients whose ureters were observed to be narrow during endoscopic ureteral stone treatment. The stents were successfully removed using gentle traction under general anesthesia.

Conclusions

We discussed the cause and solution of spontaneous knot formation. We emphasized the importance of the direct urinary system radiograph taken before DJ stent removal.
Familial primary calcific band-shaped keratopathy with late onset systemic disease: a case series and review of the literature
Authors: Abdi Parisa , Asadigandomani Hassan , Amirkhani Arman , Taghizadeh Sara , Nozarian Zohreh
Published: March 2024

Background

Familial calcific band-shaped keratopathy (BSK) is a very rare disease, with no underlying cause. There is no underlying disease in this form of the disease. This article introduces a family with seven children, three of whom were diagnosed with familial primary calcific BSK. One of them developed a systemic disease 38 years after ocular manifestation.

Case presentation

In this case report, three Iranian siblings from a family with familial calcific band-shaped keratopathy (BSK) are introduced. Systemic and ocular examinations performed on these patients indicated the occurrence of chronic kidney disease in the older child, a 41-year-old woman, 38 years after ocular manifestation. The examinations conducted on the other two siblings revealed no pathological findings. The 41-year-old sister and 37-year-old brother underwent unilateral deep anterior lamellar keratoplasty (DALK), while the 33-year-old sister underwent bilateral superficial keratectomy (SK).

Conclusion

Considering the late onset of systemic disease in one of the siblings diagnosed with familial calcific band-shaped keratopathy (BSK), it is crucial to emphasize the necessity of long-term follow-up for these patients and their families.
Bioactive compounds from Withania somnifera dun and their toxicity against some piercing sucking pests
Authors: Ragab Amany , Taher Mohamed A. , El-Rafey Helmy H. , El-Rokh Ahmed Ramadan
Published: March 2024

Piercing sucking pests are destructive to many strategic crops all over the world. Botanical pesticides can be used to control these pests. A new withanolide derivative 3 named sominone A ((20R,22R)-1α,3β,20,27-tetrahydroxywitha-5,24-dienolide) was isolated from the alkaloid fraction of the whole plant of Withania somnifera. In addition, there are three known compounds named withasomine 1, methyl isoferulate 2, and coagulin Q 4 were also isolated. The structures of isolated compounds were identified using different spectroscopic methods such as 1D, 2D NMR, and HRESIMS spectroscopy. The alkaloid fraction and the four isolated compounds were tested for their pesticidal activity against four piercing sucking pests (Aphis craccivora Koch, Bemisia tabaci Gennadius, Nezara viridula Linnaeus, and Tetranychus urticae Koch) that attack many strategic crops under laboratory conditions, along with azadirachtin (Okios 3.2% EC) as a positive control. The results showed that the alkaloid compound (withasomine 1) was the most toxic to A. craccivora, B. tabaci, N. viridula, and T. urticae, with LC50 values of 15.44, 36.61, 85.11, and 128.28 ppm, respectively, compared with the control. Withanolide compounds had moderate effects on all tested pests. Biochemical parameters of six enzymes; α-esterase, β-esterase, chitinase, acetylcholinesterase, glutathione-S-transferase, and peroxidase of A. craccivora were estimated at the LC50 value of the most potent compound, withasomine 1 and the values were 38.83, 72.86, 31.45, 506.4, 2.62, and 251.0, respectively. The results demonstrated that all enzymes activity levels were increased compared with the control except a remarkable inhibition in AChE enzyme level was observed compared with control. Therefore, the alkaloid fraction of W. somnifera is a promising extract that contains many active compounds that can be used as a natural pesticide against many harmful pests in agriculture crops.

Graphical Abstract
A review of the current status and progress in difficult airway assessment research
Authors: Chen Haoming , Zheng Yuqi , Fu Qiang , Li Peng
Published: March 2024

A difficult airway is a situation in which an anesthesiologist with more than 5 years of experience encounters difficulty with intubation or mask ventilation. According to the 2022 American Society of Anesthesiologists Practice Guidelines for the Management of Difficult Airway, difficult airways are subdivided into seven detailed categories. This condition can lead to serious adverse events and therefore must be diagnosed accurately and quickly. In this review, we comprehensively summarize and discuss the different methods used in clinical practice and research to assess difficult airways, including medical history, simple bedside assessment, comprehensive assessment of indicators, preoperative endoscopic airway examination, imaging, computer-assisted airway reconstruction, and 3D-printing techniques. We also discuss in detail the latest trends in difficult airway assessment through mathematical methods and artificial intelligence. With the continuous development of artificial intelligence and other technologies, in the near future, we will be able to predict whether a patient has a difficult airway simply by taking an image of the patient's face through a cell phone program. Artificial intelligence and other technologies will bring great changes to the development of airway assessment, and at the same time raise some new questions that we should think about.
Purification, structural characterization, and immunoregulatory activity of a polysaccharide from mulberry branch
Authors: Xiang Wei , Xu Li , Zheng Li , Zhang Qi-ao , Shi Xiaowen
Published: March 2024

In view of the fact that mulberry branch has not been effectively utilized and polysaccharide is one of the main active components in mulberry branch, this study aims to reveal the structure and immunomodulatory activity of its polysaccharide. A type of neutral polysaccharides, named mulberry branch polysaccharide-2 (MBP-2), was separated from mulberry branch using DEAE-52 and Sephadex G-100. As analyzed, they were mainly composed of glucose with a molecular weight of approximately 21.7 kDa. Methylation analysis demonstrated that MBP-2 primary contained a → 4)-α-d-Glcp-(1 → , α-d-Glcp-(1 → and → 4, 6)-α-d-Glcp-(1 → structure, which was validated by nuclear magnetic resonance (NMR). In addition, cellular experiments indicated that MBP-2 significantly enhanced the production of NO, TNF-α and IL-6 in RAW264.7 cells, unraveling the potential immunoregulatory activity of MBP-2. Further analysis showed that MBP-2 exerted their immunoregulatory activity mainly via binding with TLR4 to activate the downstream TRIF-dependent signaling pathways.

Graphical Abstract
Case report: Glycaemic management and pregnancy outcomes in a woman with an insulin receptor mutation, p.Met1180Lys
Authors: Crowley Mairéad T. , Goulden Eirena , Sanchez-Lechuga Begona , Fleming Aileen , Kennelly Maria , McDonnell Ciara , Byrne Maria M.
Published: March 2024

Background

Heterozygous insulin receptor mutations (INSR) are associated with insulin resistance, hyperglycaemia and hyperinsulinaemic hypoglycaemia in addition to hyperandrogenism and oligomenorrhoea in women. Numerous autosomal dominant heterozygous mutations involving the INSR β-subunit tyrosine kinase domain resulting in type A insulin resistance have been previously described. We describe the phenotype, obstetric management and neonatal outcomes in a woman with type A insulin resistance caused by a mutation in the β-subunit of the INSR.

Case presentation

We describe a woman with a p.Met1180Lys mutation who presents with hirsutism, oligomenorrhoea and diabetes at age 20. She has autoimmune thyroid disease, Coeliac disease and positive GAD antibodies. She is overweight with no features of acanthosis nigricans and is treated with metformin. She had 11 pregnancies treated with insulin monotherapy (n = 2) or combined metformin and insulin therapy (n = 9). The maximum insulin dose requirement was 134 units/day or 1.68 units/kg/day late in the second pregnancy. Mean birthweight was on the 37th centile in INSR positive offspring (n = 3) and the 94th centile in INSR negative offspring (n = 1).

Conclusion

The p.Met1180Lys mutation results in a phenotype of diabetes, hirsutism and oligomenorrhoea. This woman had co-existent autoimmune disease. Her insulin dose requirements during pregnancy were similar to doses observed in women with type 2 diabetes. Metformin may be used to improve insulin sensitivity in women with this mutation. Offspring inheriting the mutation tended to be smaller for gestational age.
mTOR inhibitor reduces nontumour-related death in liver transplantation for hepatocellular carcinoma
Authors: Zhang Lincheng , Liu Peng , Zhuang Li , Ling Sunbin , Zhan Qifan , Zhou Wei , Su Renyi , Yin Lu , Que Qingyang , Hong Jiachen , Bao Jiaqi , Shao Chuxiao , Cai Jinzhen , Zheng Shusen , Xu Xiao
Published: March 2024

Sirolimus is a regularly applied immunosuppressant for patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). Sirolimus not only significantly inhibits HCC recurrence but also protects renal function. However, the improvement effect of sirolimus on nontumour-related death in patients is still unknown. The aim of our study was to investigate the therapeutic effect of sirolimus on nontumour-related deaths. In this study, we retrospectively enrolled 403 LT patients with HCC from January 1, 2015, to December 31, 2018. The median follow-up time was 47.1 months. The patients were divided into the sirolimus group (N = 184) and the sirolimus-free group (N = 219). There were no significant differences between the sirolimus group and the sirolimus-free group in survival (P = 0.054). In transplant patients who exceeded the Milan or Hangzhou criteria, the sirolimus group achieved higher survival than the sirolimus-free group (P = 0.005; P = 0.02). Moreover, multivariate analysis showed that sirolimus strongly reduced the hazard ratio (HR) for nontumour-related death in LT patients who exceeded the Milan (HR: 0.42; 95% CI: 0.18–1; P = 0.05) or Hangzhou criteria (HR: 0.26; 95% CI: 0.08–0.89; P = 0.032). HCC recurrence increased the risk of nontumour-related death. In conclusion, sirolimus-based immunosuppression can significantly reduce nontumour-related death in LT patients who exceed the criteria for transplantation. In addition, this finding will further promote the application of sirolimus after liver transplantation for hepatocellular carcinoma.