bluuebunny/crossref_metadata_2025 huggingface dataset:
Low-density lipoprotein apheresis for refractory lupus nephritis: A case demonstrating marked improvement in proteinuria, haematuria, and kidney function
Authors: Iwamura Narumichi , Matsukuma Yuta , Tsutsumi Kanako , Higashi Narumi , Shomura Seiya , Uesugi Noriko , Hamashoji Takafumi , Arita Yui , Deguchi Takashi , Nakano Toshiaki
Published: February 2025

Systemic lupus erythematosus (SLE) predominantly involves the kidneys, causing lupus nephritis (LN). Patients with diffuse proliferative LN frequently experience poor outcomes despite advances in immunosuppressive therapies. Low-density lipoprotein apheresis (LDL-A) has been a potential therapeutic option for steroid-resistant nephrotic syndromes (NSs), but its efficacy in LN remains unknown. Here, we report the case of a 26-year-old female patient with SLE and LN classified as IV + V (G) A/C according to the renal pathology society, who developed refractory NS, severe haematuria, and declining renal function. The initial induction therapy, which included hydroxychloroquine, glucocorticoids, mycophenolate mofetil, and belimumab, proved to be ineffective. Consequently, LDL-A significantly improved proteinuria, haematuria, and kidney function. The urinary protein-to-creatinine ratio decreased from 7.15 to 0.61 g/gCr, and haematuria dropped from >100 to 10–19 erythrocytes per high-power field. Additionally, complement levels were improved and anti-double-stranded DNA antibody titres were reduced. Ascribing these improvements solely to LDL-A remains challenging, but the rapid proteinuria and haematuria reduction within 48 h indicates a substantial contribution of LDL-A to the clinical response. The effluent from LDL-A contained not only LDL cholesterol but also measurable amounts of immunoglobulin G and M, which may have contributed to the reduction in LN activity. This case represents the first report of a marked haematuria reduction following LDL-A in LN. LDL-A is a valuable adjunctive treatment in patients with refractory NS or highly active LN unresponsive to standard induction therapies.
Adverse Neurologic Events of Immune Checkpoint Inhibitor Monotherapy vs. Combination Therapy for Melanoma
Authors: Das Nikita , Dhamija Ravi , Kaelber David C , Kelly Michael , Xie Peter , Reddy Deven
Published: February 2025

Background

Over the past decade, novel immune checkpoint inhibitors have revolutionized melanoma treatment. These new therapies are associated with complex immune-related adverse events. This study examines whether combination anti-PD-1/CTLA-4 immunotherapy for melanoma is associated with increased incidence of neurologic irAEs (n-irAEs) compared to anti-PD-1 monotherapy.

Methods

A retrospective, multicenter study using TriNetX identified adult melanoma patients receiving anti-PD-1 monotherapy (pembrolizumab or nivolumab) [Cohort 1: n=10,586] and patients receiving anti-PD-1/CTLA-4 combination therapy (nivolumab + ipilimumab) [Cohort 2: n=5,705]. Propensity score matching generated final cohorts (n=5,185) using covariates: gender, race, age at diagnosis, TNM staging, nervous system metastasis, and history of neurologic disease. Odds ratios (OR) for n-irAE subtypes at 3- and 5- years post-therapy initiation were calculated, and Kaplan-Meier analyses assessed overall survival by aggregate n-irAE status in each cohort.

Results

At 3 years, patients receiving combination immunotherapy exhibited increased risk of immune-related meningitis [OR: 2.6, 95% CI: (1.7, 4.1)] and encephalitis [OR: 3.0 , 95% CI: (1.9, 4.9)], peripheral neuropathy [OR: 1.3, 95% CI (1.1, 1.5)], and myopathy [OR: 1.5, 95% CI: (1.1, 2.1)], but no significantly increased risk of demyelinating syndromes [OR: 1.5, 95% CI: (0.82, 2.6)], vasculitis [OR: 0.88, 95% CI: (0.43, 1.8)], or neuromuscular junction disorders [OR: 1.3, 95% CI: (0.87, 2.0)]. At 5 years, these trends for risk of neurologic irAEs persisted. There was no significant difference in overall survival by n-irAE presence at 3 or 5 years in either cohort.

Conclusions

Melanoma patients receiving combination anti-PD-1/CTLA-4 immunotherapy have greater long-term risk of n-irAEs than patients receiving anti-PD-1 monotherapy.
Predictive model for daily risk alerts in sepsis patients in the ICU: visualization and clinical analysis of risk indicators
Authors: Yang Hao , Li Jiaxi , Zhang Chi , Sierra Alejandro Pazos , Shen Bairong
Published: February 2025

Objective

This study aims to develop a Transformer-based time-series modeling approach to predict patient outcomes in the Intensive Care Unit (ICU). The primary goal is to improve the identification of patients at elevated risk, thereby optimizing therapeutic interventions and prognostic assessments.

Methods

We developed two-stage transformer models that account for the duration of patients' ICU stays, integrating features from prior days using the eICU dataset. The Transformer-based model was designed to capture the evolving health dynamics of patients, enabling a more nuanced understanding of changes in their medical condition. We systematically increased the volume of integrated data to assess its direct impact on model performance.

Results

The model exhibited a strong alignment with patients' actual conditions, achieving an initial Area Under the Curve (AUC) of 0.87 (±0.021) on the first day, which improved to 0.92 (±0.009) by the fifth day. External validation on a Chinese ICU sepsis dataset showed an accuracy of approximately 81.8%, with an AUC of 0.73. Further validation using the MIMIC-IV-3.1 dataset resulted in an accuracy of 76.56% and an AUC of 0.84, highlighting the model's robust performance across different data sources. Using the SHAP visualization algorithm, we generated activation heatmaps of life features associated with mortality as the time sequence progressed, providing valuable insights into the model's predictive capabilities.

Conclusion

Our findings indicate that the proposed Transformer-based time-series modeling approach has significant potential for enhancing the accuracy and timeliness of patient outcome predictions in ICU settings. The observed relationship between the volume of integrated data and model performance highlights the approach's capacity to offer valuable insights and reliable predictions for patient prognosis and treatment.
Trends in mental health care and telehealth use across area deprivation: An analysis of electronic health records from 2016 to 2024
Authors: Ettman Catherine K , Ringlein Grace V , Dohlman Priya , Straub Jason , Brantner Carly Lupton , Chin Elizabeth T , Sthapit Sazal , Badillo Goicoechea Elena , Mojtabai Ramin , Albert Michael , Spivak Stanislav , Iwashyna Theodore J , Goes Fernando S , Stuart Elizabeth A , Zandi Peter P
Published: February 2025

While telehealth may improve access to healthcare for some, it may also widen gaps in access across different economic groups. Using electronic health records for outpatient mental health care of patients with depression in a large US academic health system, we assessed changes in mental health care utilization from 2016 to 2024 (primary care: n = 42,640 patients, 270,754 visits; psychiatry: n = 12,846 patients, 336,918 visits) and odds of using telehealth relative to in-person care from 2020 to 2024, across national area deprivation index (ADI) percentiles. We found that over 3 years prepandemic (July 2016–June 2019), the volume of mental health care delivered to patients from low-deprivation areas (1st–25th national ADI percentile) was increasing at a steeper rate than for high-deprivation areas (76th–100th national ADI percentile). Visit volume changed rapidly at the onset of the COVID-19 pandemic, and by July 2021 it was increased relative to prepandemic levels. From July 2021 to June 2024, volume of care declined for all deprivation groups, but at a more rapid rate for the high-deprivation group than the low-deprivation group. Further, on average from July 2020 to June 2024, the odds of receiving telehealth relative to in-person care were significantly higher for patients living in low deprivation rather than high-deprivation areas in both primary care and psychiatry. We did not find evidence of telehealth improving access to care for patients in high-deprivation areas. Differences in telehealth use may contribute to sustained disparities in access to mental health care across economic groups.
Rotating DMI Fungicides within Spray Programs to Manage Cercospora Leaf Spot in Sugar Beet in Northwest Minnesota, 2024
Authors: Deleon James Allen , Lien Austin Kyle , Chanda Ashok Kumar
Published: February 2025

Cercospora leaf spot (CLS), caused by Cercospora beticola, is among the most devastating foliar diseases of sugar beet worldwide. Symptoms include small, circular, tan to brown spots that coalesce into large necrotic lesions when infection is severe which leads to reduced plant vigor and sucrose accumulation in the roots. In this study, we evaluated the efficacy of fungicide spray programs with emphasis on the rotation of systemic fungicides for management of CLS. The trial was conducted in 2024 in Crookston, MN on a moderately susceptible sugar beet variety (Beta vulgaris ‘Crystal 912RR’). Results from this trial will help sugar beet growers in developing effective fungicide spray programs for managing this disease.
Periacetabular Osteotomy Multimodal Pain Control Using Erector Spinae Plane vs Epidural Catheter: A Retrospective Cohort Analysis
Authors: Fiedler Anna K , Siahaan Jacob J , Aboulafia Alexis H , Ham Angel A , Mansour Alfred A
Published: February 2025

Background:

Periacetabular osteotomy (PAO) is an established treatment for symptomatic developmental hip dysplasia. Epidural analgesia is traditionally used for perioperative pain management but may have negative secondary effects, including distal motor and sensory deficits, and hypotension which delays rehabilitation and prolongs discharge. One alternative is Erector Spinae Plane Block (ESPB), an ultrasound-guided injection or catheter insertion remote to the spinal canal. Despite high success with minimal complications, ESPB use during PAO has not been studied. This study's purpose was to retrospectively evaluate the efficacy and side effect profile of ESPB compared to epidural analgesia for PAO pain control.

Methods:

Patients at a single site received preoperative epidural (n=73) or ESPB (n=73) for PAO pain management. Data including pain scores, morphine equivalents, complications, and discharge details was retrospectively reviewed. Welch’s t test, Glass’ Delta, and Fisher exact tests were utilized, with an alpha level of 0.05 to indicate statistical significance.

Results:

There were no significant differences in patient populations, catheter use duration, or length of stay between groups (p>0.05). Patients reported slightly more pain with ESPB on postoperative day 0 (4.5 [CI: 4.0,4.9]) compared to epidural (3.5 [CI: 2.9,4.0]), p=0.008. Patients who received ESPB required fewer morphine equivalents than epidural patients on postoperative day 0, postoperative day 1, and postoperative day 2 (p<0.001). The epidural cohort had more weakness (16.44%), numbness (39.73%), and symptomatic hypotension (10.96%) compared to the ESPB cohort (4.11%, 9.59%, 1.37% respectively, p=0.03, p<0.001, p=0.03). Epidural patients were more likely to report adverse events (17.81% vs 43.16%, p<0.001).

Conclusion:

ESPB provides an effective method of pain control for PAO patients. Compared to lumbar epidurals, patients required less systemic opioids and reported fewer side effects, particularly numbness, symptomatic hypotension, and weakness. ESPB is an attractive option in multimodal pain protocol for PAO.
Relationships Between Neighborhood Disadvantage, Race/Ethnicity, and Neurobehavioral Symptoms Among Veterans With Mild Traumatic Brain Injury
Authors: Kinney Adam R. , Bahraini Nazanin H. , Schneider Alexandra L. , Yan Xiang-Dong , Forster Jeri E. , Holliday Ryan , Brenner Lisa A.
Published: February 2025

Objective:

To examine the relationship between neighborhood disadvantage and severity of vestibular, sensory, mood-behavioral, and cognitive neurobehavioral symptoms among Veterans with a mild traumatic brain injury (mTBI); and whether Veterans in underrepresented racial/ethnic groups with high neighborhood disadvantage experience the most severe symptoms.

Setting:

Outpatient Veterans Health Administration (VHA).

Participants:

Veterans with the following data available in the electronic health record (2014-2020): (1) clinician-confirmed mTBI and complete neurobehavioral symptom inventory (NSI) as part of their comprehensive traumatic brain injury evaluation (CTBIE) and (2) area deprivation index (ADI) scores assessing neighborhood disadvantage from the same quarter as their CTBIE.

Design:

Retrospective cohort study. Latent variable regression was used to examine unique and interactive relationships between neighborhood disadvantage, race/ethnicity, and neurobehavioral symptoms.

Main Measures:

NSI and ADI national percentile rank.

Results:

The study included 58 698 eligible Veterans. Relative to Veterans in the first quintile of ADI national percentile rank, representing those with the least neighborhood disadvantage, Veterans in the ADI quintiles indicating greater neighborhood disadvantage reported more severe vestibular, sensory, mood-behavioral, and cognitive symptoms. The strongest associations between neighborhood disadvantage and neurobehavioral symptoms were observed within the sensory (β = 0.07-0.16) and mood-behavioral domains (β = 0.06-0.15). Statistical interactions indicated that the association between underrepresented racial/ethnic group status (vs. identifying as white, non-Hispanic) and the severity of neurobehavioral symptoms did not differ among those with severe neighborhood disadvantage versus those without.

Conclusion:

Veterans with mTBI living in more disadvantaged neighborhoods reported more severe neurobehavioral symptoms relative to those in the most advantaged neighborhoods, with the strongest relationships detected within the sensory and mood-behavioral domains. While neighborhood disadvantage and underrepresented race/ethnicity were both independently associated with symptoms, these factors did not interact to produce more severe symptoms. Findings suggest that addressing factors driving socioeconomic disadvantage may assist in mitigating symptoms in this population.
Predictive Value of Quantitative CRP Levels as a Marker of Nosocomial Neonatal Sepsis
Authors: Mir Nasir Ahmad , Ganie Jabish , Shah Idrees A. , Qazi Iqbal A. , Charoo Bashir A.
Published: February 2025

Background:

Nosocomial infection (NI) is a serious health concern primarily for premature neonates and for term babies with illnesses requiring continued hospitalisation. Early diagnosis of NI using biomarkers is central to decreased neonatal mortality and morbidity. We aimed to evaluate the predictive value of C-reactive protein (CRP) as a marker of NI.

Methods:

Sixty-four neonates, suspected of sepsis, admitted to the Department of Paediatrics and Neonatology with a negative workup for sepsis on their first day of admission were investigated for various haematological parameters, blood culture positivity, and CRP levels. The patients were then stratified into culture-positive and culture-negative groups. All the parameters analysed were compared between these 2 groups, and ROC curve analysis was performed to determine the value of CRP in predicting positive blood culture in NI.

Results:

NI was seen in a total of 70.31% (n = 45) neonates based on blood culture-positive status. Compared to females, a greater number of male neonates were culture-positive (60% vs 40%). The mean birth-weight of the culture-positive group was significantly lower than the negative group (P = 0.03). The mean CRP levels were elevated in the positive group (98.5 ± 47.8) when compared to the negative group (32.2 ± 24.1; P < .001). Using the ROC curve,a cut-off value (45.05 mg/L) of CRP had sensitivity and specificity of 80.0% and 73.7% respectively in predicting blood culture-positive NI.

Conclusion:

Serum CRP is a sensitive marker to diagnose NI in admitted neonates.

Implication for practice and research:

CRP levels can aid in the diagnosis of clinical deterioration, and a treating physician can modify the regimen based on elevated CRP levels.
Peroral Endoscopic Myotomy for Achalasia Among the Elderly Population
Authors: Hayat Umar , Kamal Faisal , Memon Adil , Sadiq Syeda Madeeha , Rana Usman Iqbal , Gangwani Manesh K. , Ali Hassam , Gopalakrishnan Keerthy , Obuch Joshua C. , Adler Doulas G.
Published: February 2025

Objective:

Achalasia is an esophageal motility disorder associated with halting symptoms. There is conflicting evidence about the feasibility of peroral endoscopic myotomy (POEM) for achalasia among the elderly. In this meta-analysis, we sought to evaluate POEM’s therapeutic safety and efficacy among elderly patients with achalasia.

Methods:

Major databases were searched to find articles that compared the feasibility and safety of POEM for Achalasia between 4 age groups in 2 separate comparisons: ≥75 and <75 years, and ≥65 and <65 years. Our primary outcomes of interest were to compare POEM’s technical and clinical success rates. The secondary outcome was the adverse events of the procedure. A random effect model calculated pooled odds ratios with 95% CIs.

Results:

Six studies were included with 290 patients ≥75 years of age and 2290 <75, 177 ≥65, and 354 younger than 65. The pooled technical success rate was 98.66% and 97.81% for patients ≥75 years of age and younger than 75, respectively. Similarly, the pooled clinical success rate was 99.01% and 97.97% for ≥75 and younger than 75, respectively. The pooled technical success rate was 99.69% and 99.84% for ≥65 and younger than 65, respectively. Similarly, the pooled clinical success rate was 95.74% and 95.31% for ≥65 and younger than 65, respectively. There was no difference in the technical and clinical success rates in both comparison groups. Also, the 2 groups had no difference in the adverse events profile of the 2 comparison groups.

Conclusions:

Our study demonstrates the feasibility and safety of POEM for achalasia among older people despite their comorbidities.
MASLD-F Algorithm to the Rescue
Authors: Lin Joanne , Green Victoria , McGrath Morgan , Lloyd Aaron , Ma Pearl , Higa Kelvin , Roytman Marina
Published: February 2025

Objective:

The gold standard to stage hepatic fibrosis is with a liver biopsy. It is not without its drawbacks and is more challenging for patients with severe obesity. Noninvasive testing, including the fibrosis-4 (FIB-4) score and vibration-controlled transient elastography (VCTE), have begun to be increasingly used as initial screening methods.

The applicability and accuracy of these noninvasive methods remain uncertain in patients with severe obesity and metabolic dysfunction-associated steatotic liver disease. Our study explored combining VCTE with lower FIB-4 cutoffs to improve concordance with biopsy in staging hepatic fibrosis in patients with metabolic dysfunction-associated steatotic liver disease and severe obesity undergoing bariatric surgery.

Methods:

A total of 632 patients with severe obesity underwent preoperative VCTE and intraoperative liver biopsy during bariatric surgery from January 2020 to August 2021. Variables collected included patient demographics, laboratory values, abdominal ultrasound, VCTE, and liver biopsy results. Analysis of variance 1-way test, χ2 tests, and Fisher exact tests were used for quantitative and qualitative variables, respectively. The 95% CIs for the mean FIB-4 scores were used to generate surrogate cutoff values. The VCTE and FIB-4 scores were integrated using an algorithm that utilized a dynamic decision-making process at each stage to find the values that would yield the highest concordance with liver biopsy.

Results:

VCTE alone was in concordance with liver biopsy results in 59.7% of cases. Combining the proposed FIB-4 cutoff scores with VCTE led to an improved concordance with a liver biopsy of 88%.

Conclusion:

Our study demonstrated that accessible noninvasive testing has limitations alone but when combined, can improve staging of hepatic fibrosis.
Gastrointestinal pathologist consensus of revised high-grade dysplasia in inflammatory bowel disease impacts the advanced neoplasia rate: a multicenter study
Authors: te Groen Maarten , Derks Monica E.W. , Nagtegaal Iris D. , Peters Charlotte P. , de Vries Annemarie C. , Dijkstra Gerard , Romkens Tessa E.H. , Horjus Carmen S. , de Boer Nanne K. , de Jong Michiel E. , van Ruijven Britt , Hoentjen Frank , Vos Shoko , Derikx Lauranne A.A.P. ,   on behalf of the Dutch Initiative on Crohn’s and Colitis (ICC) and the Dutch Nationwide Pathology Databank (PALGA) group
Published: February 2025

Objective

The diagnosis of inflammatory bowel disease (IBD) associated with high-grade dysplasia (HGD) has a significant impact on clinical management, including colectomy. However, the prognosis of HGD remains unclear due to diagnostic uncertainty and low-quality data on subsequent synchronous and metachronous neoplasia. We aimed to evaluate a diagnostic strategy with dedicated gastrointestinal (GI) pathologist consensus of revised HGD and the impact on synchronous and metachronous neoplasia rates.

Methods

In this retrospective multicenter cohort study, we used the Dutch Nationwide Pathology Databank to identify IBD patients with HGD in seven hospitals. Histopathological specimens of the initial HGD were independently revised by two dedicated GI pathologists. Definitive diagnosis was established in a consensus meeting. Synchronous and metachronous neoplasia incidences were assessed with a competing risk analysis.

Results

We included 54 IBD patients with HGD, of whom 33 (61.1%) with ulcerative colitis and 42 (77.8%) with extensive disease. After consensus, 18 (33.3%) lesions were downgraded to indefinite/low-grade dysplasia, and 6 (11.1%) were revised to colorectal cancer (CRC). Seven patients (13.0%) had synchronous CRC. Patients with downgraded lesions showed a lower cumulative advanced neoplasia (HGD/CRC) incidence compared with confirmed HGD [(Gray’s test P < 0.01), 5-year cumulative incidence 0.0% vs. 26.6%].

Conclusions

We demonstrated frequent downgrading of HGD, associated with lower metachronous neoplasia rates. This underlines the potential impact of dedicated GI pathologist consensus meetings. The high and synchronous and metachronous neoplasia rates after HGD underline the need for close surveillance.
Role of noninvasive tests on the prediction of hepatocellular carcinoma in nonalcoholic fatty liver disease patients without cirrhosis: a systematic review and meta-analysis of aggregate and individual patient data
Authors: Siriwong Nanicha , Sriphoosanaphan Supachaya , Decharatanachart Pakanat , Yongpisarn Tanat , Kerr Stephen J. , Treeprasertsuk Sombat , Tiyarattanachai Thodsawit , Apiparakoon Terapap , Hagström Hannes , Akbari Camilla , Ekstedt Mattias , Yip Terry Cheuk-Fung , Wong Grace Lai-Hung , Ito Takanori , Ishigami Masatoshi , Toyoda Hidenori , Peleg Noam , Shlomai Amir , Seko Yuya , Sumida Yoshio , Kawanaka Miwa , Hino Keisuke , Chaiteerakij Roongruedee
Published: February 2025

Background

Nonalcoholic fatty liver disease (NAFLD) has been identified as an emerging risk factor for hepatocellular carcinoma (HCC). Identifying non-cirrhotic NAFLD patients at risk for HCC is crucial. We aimed to investigate the utility of noninvasive tests (NITs) as predictors for HCC and to determine optimal and cost-effective NIT cutoffs for HCC surveillance in non-cirrhotic NAFLD patients.

Methods

Medline, EMBASE, and Scopus databases were searched for studies evaluating the relationship between NITs and HCC in this population. Random-effects models were used to estimate hazard ratios or risk ratios and 95% confidence interval (95% CI). Cutoffs of NITs for identifying high-risk patients for HCC were determined.

Results

This systematic review comprised 20 studies. A meta-analysis of 379 194 patients was conducted using six studies with individual patient data and five studies with aggregate data. Among NITs studied, fibrosis-4 index (FIB-4), aspartate aminotransferase to platelet ratio index (APRI), and NAFLD fibrosis score (NFS) were significantly associated with HCC, with pooled risk ratio (95% CI) of 9.21 (5.79–14.64), pooled hazard ratio of 12.53 (6.57–23.90), and 13.32 (6.48–27.37), respectively. FIB-4, APRI, and NFS of more than 2.06, 0.65, and 0.51 resulted in the highest area under the receiver operating characteristics of 0.83, 0.80, and 0.85, respectively. Surveillance in patients with FIB-4 ≥ 5.91 and NFS ≥ 2.85 would be cost-effective with an annual HCC incidence of ≥15 per 1000 patient-years.

Conclusion

FIB-4, APRI, and NFS are associated with HCC development in non-cirrhotic NAFLD patients. Different NIT cutoffs may be used to enroll high-risk NAFLD patients for HCC surveillance, according to resource availability in different settings.
Biliary stenting with and without endoscopic sphincterotomy in patients with malignant biliary obstruction: meta-analysis of randomized controlled trials
Authors: Saeed Aamir , Yousuf Saira , Khan Muhammad Ali , Gangwani Manesh Kumar , Aziz Muhammad , Arnab Ray , Shah Janak , Kumar Anand , Schlachterman Alexander , Kowalski Thomas , Kamal Faisal
Published: February 2025

Endoscopic biliary sphincterotomy (EBS) is commonly performed during endoscopic retrograde cholangiopancreatography (ERCP) in patients with malignant biliary obstruction (MBO) before stent placement. Studies comparing adverse events between patients with MBO undergoing ERCP with and without EBS have reported conflicting results. We conducted an updated meta-analysis including randomized controlled trials (RCTs) only to evaluate the safety of EBS in these patients and its efficacy in decreasing the risk of post-ERCP pancreatitis (PEP). We reviewed several databases from inception to 10 January 2024 to identify RCTs that compared adverse events of biliary stenting with and without EBS in the patients with MBO. Our outcomes of interest were PEP, successful stent insertion, and adverse events such as cholangitis, bleeding, perforation, stent migration, and stent occlusion. We calculated pooled risk ratio with 95% confidence intervals (CIs) for all of the outcomes and used a random effect model to analyze the data. We included six RCTs with 1070 patients. There was no significant difference in rate of PEP between groups [risk ratio (95% CI): 0.50 (0.23–1.08)]. We found no significant difference in the rate of successful stent insertion between groups [risk ratio (95% CI): 1.01 (0.99–1.02)]. The rate of post-ERCP bleeding was significantly higher in EBS group [risk ratio (95% CI): 7.43 (2.45–22.53)]. We found no significant difference in rates of cholangitis, perforation, stent migration, and stent occlusion between groups. EBS does not decrease the risk of PEP in patients with MBO and is associated with increased risk of bleeding.
Directionality of endoscopic and histologic healing in ulcerative colitis: a prospective pilot study
Authors: Hanžel Jurij , Novak Gregor , Jairath Vipul , Zou Guangyong , Dong Hannah , Gui Xianyong Sean , Hindryckx Pieter , Beaton Melanie , Bressler Brian , Löwenberg Mark , Panaccione Remo , D’Haens Geert R. , Feagan Brian G. , Ma Christopher
Published: February 2025

Objective

Endoscopic and histologic healing in ulcerative colitis (UC) is hypothesized to progress proximally to distally, with healing of the distal rectosigmoid occurring last. However, this has not been empirically verified.

Methods

We performed a prospective cohort study in patients with pancolonic UC commencing treatment with a tumor necrosis factor (TNF) antagonist or vedolizumab. Four biopsies were obtained from each of the five colonic segments at colonoscopy, both at baseline and 16–24 weeks after treatment initiation. Independent, blinded central reading of both endoscopic [modified Mayo Endoscopic Subscore (mMES) (score = 1 excludes any friability), UC Endoscopic Index of Severity (UCEIS)] and histologic disease activity [Robarts Histopathology Index (RHI), Nancy Histological Index (NHI), and Geboes Score] was performed for each colonic segment, and changes per segment were calculated.

Results

A total of eight patients were recruited (five TNF antagonists, three vedolizumab). There was no significant difference in the mean change between colonic segments for any of the endoscopic disease activity indices (P value based on Kruskal–Wallis test for differences between ascending, transverse, descending, sigmoid colon, and rectum: 0.328 for mMES and 0.317 for UCEIS). Similarly, there was no difference in change in histologic activity between colonic segments (P = 0.357 for RHI, P = 0.410 for NHI, P = 0.734 for Geboes score).

Conclusion

We did not observe evidence of an anatomical healing gradient in UC across different colonic segments, nor evidence of delayed distal improvement. Larger studies are required to validate whether the rectum truly does heal last in UC.
Post-COVID general health symptoms in patients with immune-mediated inflammatory diseases
Authors: van de Pol Natasja , van der Woude C. Janneke , Vis Marijn , van Doorn Martijn B.A. , Schrauwen Saskia L. , Cetinözman-Teunissen Fatos , West Rachel L. , Pan Qiuwei , de Vries Annemarie C.
Published: February 2025

Background

Post-COVID entails persistent symptoms following a presumed or confirmed SARS-CoV-2 infection. This study aims to evaluate post-COVID general health symptoms reported by patients with IMIDs.

Methods

An online questionnaire was distributed to IMID patients on systemic therapy at dermatology, rheumatology, and gastroenterology departments in the Netherlands. General health symptoms were compared between patients with and without prior SARS-CoV-2 infection. Multivariable logistic regression was used to adjust for disease-related factors and known post-COVID risk factors. Self-reported prevalence of post-COVID symptoms was assessed by asking patients if they linked their symptoms to the previous SARS-CoV-2 infection.

Results

A total of 1518 patients were included, and 58% (n = 877) reported ≥1 SARS-CoV-2 infections. When assessing self-reported prevalence of post-COVID symptoms, 13.9% (122/877) linked their symptoms to a previous infection. Patients with a previous infection showed higher prevalence of symptoms than those without (56.2%, 43.9%; P < 0.001), and higher prevalence of fatigue (42%, 32%; P < 0.001). After adjusting for potential risk factors, previous infection was associated with symptoms (OR: 1.53; 95% CI: 1.23–1.91; P < 0.001), and fatigue (OR: 1.31; 95% CI: 1.04–1.64; P = 0.021). Subanalysis showed an association between self-reported COVID-19 severity and symptoms, while presumed SARS-CoV-2 variant (based on date of reported infection) and number of infections were not associated.

Conclusion

The self-reported prevalence of general health symptoms, particularly fatigue, is significantly higher in IMID patients with a previous SARS-CoV-2 infection. The cause of this increase requires further investigation and might provide insights into the pathogenesis of post-COVID, both relevant for IMID patients as well as the general population.
Psychometric Analysis of Disrespect and Abuse Scale
Authors: Alzyoud Fatima
Published: February 2025

Background

Disrespect and abuse of laboring and child-birthing women in health care is a global problem that violates the universal human rights of childbearing women. There is a lack of reliable and valid tools for measuring these behaviors. One instrument, the Disrespect and Abuse scale, has preliminary data with no established psychometrics in diverse populations. Further analysis is required to ensure the reliability and validity of this tool in diverse populations and health care settings.

Objectives

We examined the psychometric properties of the Disrespect and Abuse scale in diverse international nursing and midwifery populations.

Methods

A cross-sectional descriptive design was used to measure disrespect and abuse toward women during childbirth. Data were collected from 231 nurses and midwives across international labor and delivery units. Exploratory factor analysis was conducted using principal component analysis with oblimin rotation as the factor extraction method.

Results

The psychometric assessment yielded a two-factor structure. Factor 1 consisted of 13 items characterizing physical and verbal abuse. Factor 2 contained nine items reflecting disrespectful behaviors. The Cronbach’s alpha coefficients reflected high internal consistency.

Discussion

The scale was shown to be reliable and valid in assessing self-reported disrespectful and abusive behaviors among nurses and midwives in a diverse international sample. Use could assist in the assessment of these behaviors in maternal health care facilities. Further research is warranted to confirm the scale’s robustness and applicability across various populations and settings and use the Disrespect and Abuse scale to identify the burden and predictors of mistreatment of women in different health care settings.
Systematic Review to Inform the Developmental Coordination Disorder Clinical Practice Guideline Update: Physical Therapy Intervention
Authors: Iwamoto Kai , Pines Kalala , Lochala Carly , Long Danielle , Hess Paula , Sargent Barbara
Published: February 2025

Purpose:

Systematically review current evidence on physical therapy (PT) intervention for developmental coordination disorder (DCD) to inform the update to the 2020 DCD Clinical Practice Guideline (CPG).

Methods:

Eight databases were searched for qualitative studies, randomized controlled trials (RCTs) and systematic reviews (SRs) that informed PT management of DCD. Risk of bias and certainty of evidence were assessed.

Results:

Sixteen studies were included. Three SRs, 3 RCTs, and 1 qualitative study supported task-oriented interventions, the first-choice intervention recommended by the 2020 DCD CPG. One SR and 7 RCTs supported supplemental activities, including a meta-analysis of 2 studies on active video gaming. One qualitative study informed how physical therapists adapt motor learning strategies for children with DCD.

Conclusion:

Newer evidence reaffirms 3 of the 5 recommendations on intervention of the 2020 DCD CPG and adds low to very low-quality evidence on new evidence-informed supplemental activities.
The Reliability and Validity of Data Obtained With the Functional Gait Assessment Modified for Children
Authors: Chiao Amanda , Patterson Jessie N. , Cochrane Graham D. , Christy Jennifer B. , Janky Kristen. L.
Published: February 2025

Purpose:

This study investigated the Functional Gait Assessment modified for Children (FGA-mC) in children with cochlear implant and with and without vestibular loss (VL), and the FGA-mC’s reliability and validity.

Methods:

Fifty-nine children completed the FGA-mC and vestibular and functional testing. Twenty children were video-recorded to assess the FGA-mC’s inter- and intra-rater reliability, and 10 repeated the FGA-mC for test-retest reliability. Ten physical therapists reviewed the videos, scored the child’s FGA-mC performance, and provided test administration feedback.

Results:

Children without VL had significantly higher FGA-mC scores compared to children with bilateral VL and a <26 cutoff score was identified for normal function versus VL with good discrimination, sensitivity and specificity. The FGA-mC had good inter- and intra-rater reliability, construct validity, but poor test-retest reliability.

Conclusions:

The FGA-mC shows decreased performance in children with bilateral VL compared to children without VL. There was overall good-to-excellent reliability and validity of the FGA-mC, supporting its use for a pediatric population.
Bone mineral density changes in breastfeeding women living with HIV on antiretroviral therapy in Eastern and Southern Africa
Authors: Matovu Kiweewa Flavia , Stranix-Chibanda Lynda , Yende-Zuma Nonhlanhla , Dadabhai Sufia , Owor Maxensia , Hanley Sherika , Nyati Mandisa , Chinula Lameck , Pettifor John M. , Brummel Sean S. , Aizire Jim , Taha Taha E. , Brown Todd T. , Fowler Mary Glenn
Published: February 2025

Objective:

To describe postpartum bone mineral density (BMD) change among breastfeeding African women living with HIV (WLHIV) on life-long antiretroviral therapy (ART).

Design:

In IMPAACT P1084 s, postpartum BMD declines were greater in WLHIV randomized to ART to prevent breastmilk transmission compared to infant nevirapine prophylaxis). This analysis extends the observation period through entry to a follow-on observational study, PROMOTE.

Methods:

Lumbar spine (LS), total hip (TH) and femoral neck (FN) BMD were assessesd using dual energy x-ray absorptiometry (DXA) at postpartum weeks 1 and 74 in P1084 s, and at PROMOTE entry. Participants were included if DXA data were available from PROMOTE entry and > 1 earlier timepoint. Country-specific Z-scores were created by internal standardization to week 1 values. Linear mixed models, adjusted for country, estimated the annualized rate of change in BMD z-scores between postpartum week 1 and PROMOTE entry. Linear regression assessed the association between maternal characteristics and BMD z-score rate of change.

Results:

We included BMD data from 519 participants between postpartum week 1 through PROMOTE entry (median (IQR) 4.6 (3.5–5.1) years postpartum). For every 5 years passed, LS BMD Z-scores increased by + 0.250 units, while TH and FN BMD z-scores decreased by -0.173 and -0.141 units, respectively. LS, TH and FN BMD increased between postpartum week 74 and PROMOTE entry, but only LS BMD fully recovered to week 1 values.

Conclusion:

Given dampened TH and FN BMD recovery post-breastfeeding, longer term monitoring is needed to assess peri-/post-menopausal fracture risk, and interventions to optimize bone health among WLHIV on life-long ART.
FDG PET/CT in a Case of Marjolin Ulcer of the Scalp Over a Long-standing Burn Scar
Authors: Dulet Mehul , Taywade Sameer , Verma Vikrant , Kumar Rajesh
Published: February 2025

Marjolin ulcer is a malignant degeneration of previously injured skin, long-established scars, and wounds. This malignant transformation is most implicated in full-thickness burns; however, it may be associated with vaccination sites, pressure sores, venous stasis, and many other conditions causing chronic scar or wound formation. These lesions are aggressive and carry a poor prognosis. FDG PET/CT is an excellent diagnostic aid to differentiate these lesions from benign inflammation, to evaluate the primary malignant site and its extent and depth, and to evaluate metastasis.

Metabolic activity has been noted to be significantly higher in Marjolin ulcer than in benign conditions.
Facial Anthropometry Study Using Stereophotogrammetry Analysis Among Mozambique Adults
Authors: Saíde Alarquia Aly , Nogueira Vanessa Ota , Sforza Chiarella , Neppelenbroek Karin Hermana , Soares Simone
Published: February 2025

This cross-sectional observational study aimed to establish facial linear and angular measurement values for Mozambique adults and to determine the morphologic differences between sexes and ages using stereophotogrammetry. One hundred and sixty-six Mozambique individuals categorized into 8 groups by age (20–65 y) and sex were assessed. Anthropometric points were marked on the face, and 3D images were captured. Linear and angular measurements were obtained and evaluated. Two-way ANOVA and Tukey’s test were used to determine differences among groups and sexes, with significance set at P<0.05. Significant differences in linear and angular measurements were observed between the groups and sexes. Differences were evident in 13 of 15 linear measurements, with higher values observed in men than in women. Women showed higher angular measurements than men in 4 of 6 measurements. Sexual dimorphism was confirmed by significantly higher linear measurements in men and increased angular measurements in women. Morphologic changes with aging included decreased eye width and lip height, increased mouth width, and augmented nose measurements, particularly in men. In addition, the nasolabial angle widened with age, and women exhibited more pronounced facial convexity than men. This study aims to gain insights into the facial metrics of diverse populations and utilize these findings in clinical practice to enhance prosthetic flow and forensic training and develop a comprehensive population database.
Serologic Responses to COVID-19 Vaccination in Pediatric Kidney Transplant Recipients
Authors: Goggin Kathryn P. , Sun Elizabeth , Yun Emily , Kamel Margret , Perez Maria A. , Hsiao Hui-Mien , DiMaggio Langdon S. , Liverman Rochelle , Anderson Evan J. , Shane Andi L. , Garro Rouba , George Roshan P. , Rostad Christina A.
Published: February 2025

Background.

There are limited data describing the immune responses to COVID-19 vaccination in pediatric kidney transplant recipients, and expanding upon this information could help inform vaccination strategies in this unique population.

Methods.

We performed a prospective, observational, single-center cohort study using remnant blood samples of pediatric kidney transplant recipients from routine clinic visits to examine longitudinal serological responses after COVID-19 vaccination. We enrolled 61 pediatric kidney transplant recipients who had at least 1 sample available for analysis. Sera or plasma were analyzed for ancestral SARS-CoV-2 and Omicron (B.1.1.529; BA.1) spike IgG and nucleocapsid IgG using a Meso Scale Discovery platform.

Results.

One month after a 3-dose COVID-19 vaccination series, the IgG geometric mean titer to the SARS-CoV-2 ancestral spike was 684 binding antibody units/mL (95% confidence interval, 269-1739), but titers waned by 4–6 mo. A fourth dose of the COVID-19 vaccine boosted IgG geometric mean titer to 1606 binding antibody units/mL (95% confidence interval, 868-2972), and titers persisted through 6 mo. IgG titers against Omicron (B.1.1.529; BA.1) were overall lower than ancestral SARS-CoV-2. They were higher in participants with prior infection and were not significantly impacted by receipt of belatacept.

Conclusions.

Additional doses of the COVID-19 vaccine bolstered durable serologic responses in pediatric kidney transplant recipients, and this study broadens our understanding of immune responses to COVID-19 vaccinations in this population.
Additional Diagnoses Other Than Rejection in the Kidney Allograft Biopsy: Pitfalls for Biopsy-based Transcript Diagnostics
Authors: Rho Elena , Weidmann Lukas , Korach Raphael , Bortel Nicola , Schmid Nicolas , Harmacek Dusan , Castrezana Lopez Kai , George Britta , von Moos Seraina , Helmchen Birgit Maria , Gaspert Ariana , Rössler Fabian , Schachtner Thomas
Published: February 2025

Background.

Biopsy-based transcripts associated with antibody-mediated rejection (AMR) hold promise as substitutes for C4d positivity. However, their utility in cases with additional diagnoses other than rejection remains inadequately studied.

Methods.

In our comprehensive analysis of 326 kidney allograft biopsies, assessed by histology and the Molecular Microscope Diagnostic System, we identified 68 cases characterized by additional pathologies, including pyelonephritis (n = 15), BK nephropathy (n = 20), acute interstitial nephritis (n = 5), and glomerular diseases (n = 28).

Results.

Among cases with pyelonephritis, 7 of 15 cases (46%) showed a rejection-like signal, 4 above (16%) and 3 (20%) below diagnostic thresholds. Notably, the T cell–mediated rejection (TCMR) archetype score R2 (median, 0.13; interquartile range [IQR], 0.04–0.34) predominantly contributed to this observation. In BK nephropathy, 13 of 20 cases (65%) showed a rejection-like signal, 10 (50%) above and 3 (15%) below diagnostic thresholds. Elevated TCMR R2 (median, 0.07; IQR, 0.00–0.41) and all AMR archetype scores R4–6 (median, 0.23; IQR, 0.07–0.53) were driving factors. Among cases with acute interstitial nephritis, 3 of 5 cases (60%) showed TCMR-like signal with elevated R2 scores (median, 0.13; IQR, 0.00–0.54). Conversely, only 5 of 28 cases (18%) showed a rejection-like signal in glomerular disease cases, whereas 57% displayed all AMR archetype scores of ≥0.30.

Conclusions.

Additional pathologies can affect the Molecular Microscope Diagnostic System output, giving a molecular rejection-like signal. The prevalence of rejection-like signals below diagnostic thresholds is noteworthy, warranting caution and prompting further investigation.
Efficacy and Safety of Allogeneic Islet Transplantation Demonstrated by a Multicenter Clinical Trial in Japan
Authors: Anazawa Takayuki , Marubashi Shigeru , Kodama Shohta , Goto Masafumi , Maruyama Michihiro , Eguchi Hidetoshi , Shimoda Masayuki , Noguchi Hirofumi , Yamaguchi Takuhiro , Ito Taihei , Kenmochi Takashi , Gotoh Mitsukazu
Published: February 2025

Background.

Islet transplantation in type 1 diabetes mellitus restores endogenous insulin secretion and hypoglycemia awareness. Although high-quality prospective clinical trials have demonstrated the efficacy of islet transplantation, reports on the clinical outcomes in Asia remain scarce. Therefore, we conducted a clinical trial in Japan to verify the effectiveness of islet transplantation.

Methods.

This multicenter, single-arm study aimed to evaluate the clinical efficacy and safety of immunosuppressive therapy for allogeneic islet transplantation. The immunosuppressive regimens included antithymocyte globulin, calcineurin inhibitors, and mycophenolate mofetil. The primary endpoint was a glycated hemoglobin level of <7.4% on day 365 and the absence of severe hypoglycemic events from 1 mo to 1 y after the first transplantation.

Results.

Eight recipients with evaluation data obtained 1 y after the initial transplantation were included in the efficacy analysis. Of the 8 recipients, 3, 3, and 2 recipients received 1, 2, and 3 islet infusions, respectively. Six recipients (75%) achieved the primary endpoint. The median glycated hemoglobin levels declined from an initial 7.3% to 6.3% and 6.1% on days 375 and 730, respectively, with related improvements in hypoglycemia awareness and glucose variability. No complications associated with intraportal transplantation, such as intraperitoneal hemorrhage or portal vein embolism, were observed.

Conclusions.

Islet transplantation provided near-normal glycemic control and protection against severe hypoglycemic events in patients with type 1 diabetes mellitus in this Japanese cohort. Future studies are needed to confirm whether long-term graft survival can be achieved and whether it is possible to prevent the progression of diabetic complications.