bluuebunny/crossref_metadata_2025 huggingface dataset:
Free energy behavior in exactly solvable many-fermion interacting systems
Authors: Plastino Angelo , Monteoliva Diana , Plastino Angel Ricardo
Published: July 2023

The objective of this work is to show that simple modifications in the form of the fermion–fermion interacting potential generate widely different thermodynamic behaviors, with macroscopic manifestations reflected by the thermal free energy. This is done by appealing to quantum statistical mechanics, in its Gibbs’ ensemble formalism, employing two different SU2 exactly solvable models. Some intriguing aspects of the fermion dynamics are uncovered. We conclude that, in investigating fermion dynamics, minute changes in the Hamiltonian may lead to dramatic consequences in the behavior of the Helmholtz’ free energy.
Stability analysis of f(Q) gravity models using dynamical systems
Authors: Vishwakarma Pooja , Shah Parth
Published: July 2023

In recent years, the modified theory of gravity known as [Formula: see text] gravity has drawn interest as a potential alternative to general relativity. According to this theory, the gravitational force is determined by a function of the so-called “non-metricity” tensor [Formula: see text], which expresses how far a particle space-time is from the metric geometry. In contrast to general relativity, which describes the gravitational field using the curvature tensor, [Formula: see text] gravity builds a theory of gravity using the non-metricity tensor. For this class of theories, dynamical system analysis of the background and perturbation equations has been carried out in this work to determine how various models behave cosmologically. Here, the critical points are determined for two [Formula: see text] models from the literature: the power law, [Formula: see text], and the logarithmic, [Formula: see text] models. The stability behavior and corresponding cosmology are displayed for each critical point. For the power law model, we achieve a matter-dominated saddle point with the right matter perturbation growth rate. For the logarithmic model, we get a saddle point dominated by the geometric component of the [Formula: see text] model with perturbations in the decomposition of matter. For both models, we later achieved a stable and accelerating Universe with constant matter perturbations.
HEXAGONAL HONEYCOMB PL-GaN NANOSHEET AS ADSORBENT SURFACE FOR GAS MOLECULES SENSING: A QUANTUM CHEMICAL STUDY
Authors: MOLLAAMIN FATEMEH , MONAJJEMI MAJID
Published: July 2023

Regarding two-dimensional (2D) nanomaterials as gas sensors, we have studied the adsorption of gas molecules (NH3, NO2, NO) on the graphitic GaN sheet (PL-GaN) using density functional theory calculations. “Langmuir” adsorption of gas molecules of NH3, NO2, and NO on the graphitic GaN sheet has been accomplished using density functional theory. The changes in charge density have shown a more important charge transfer on the hexagonal honeycomb nanosheet of gallium nitride (GaN) which acts as the electron acceptor while gas molecules act as the stronger electron donors through adsorption on the graphitic-like GaN surface. The adsorption of NH3, NO[Formula: see text] and NO, respectively, on GaN nanosheet has more contribution with high expansion curves of hydrogen, nitrogen and oxygen. The results extracted from PDOS curves after optimization show the electron transferring from nitrogen and oxygen of gas molecules (adsorbate/donor) towards gallium in the active site of GaN surface (adsorbent/acceptor). GaN nanosheet represents enough capability for adsorbing gases of NH3, NO2, and NO through charge transfer from nitrogen and oxygen atoms to the gallium atom regarding the intra-atomic and interatomic interactions. Concerning the change of physicochemical properties of the PL-GaN sheet before and after molecule adsorption, the PL-GaN nanosheet can be applied as an appropriate selective gas sensor for NH3, NO2and NO detection.
IMPACT OF PLAN-DO-CHECK-ACT CYCLE MANAGEMENT INTERVENTION ON NEGATIVE EMOTIONS AND REHABILITATION IN OLDER ADULTS AFTER HIP REPLACEMENT
Authors: JIN YUPING , LI KAI , DAI JIANMING , ZHANG YUN , QIU XUZHONG , CHANG JIHUI , GUO DEHONG , DAI LING , TANG DONGMEI , ZHANG SHUANG
Published: July 2023

Objective: To explore the impact of plan-do-check-act (PDCA) cycle intervention on negative emotion and rehabilitation effects in older adults after hip replacement. Methods: Between January 2019 and 2021, 100 elderly adults who underwent hip replacements were randomly divided into control ([Formula: see text]) and study groups ([Formula: see text]), respectively. The control group received routine nursing, whilst the study group underwent PDCA cycle interventions. Anxiety [self-rating anxiety scale [SAS]), depression (self-rating depression scale (SDS), hip function score (Harris score), daily living activities (ADL score), and adverse complication incidence before and after intervention were compared. Results: No significant difference ([Formula: see text]) in SDS and SAS scores occurred between groups before intervention, but were lower in both groups after intervention Moreover, study group scores were lower than control group ([Formula: see text]). Before intervention, there was no significant difference ([Formula: see text]) in Harris and ADL scores between groups. Scores of both groups increased following intervention, with the study group scoring higher than the control group ([Formula: see text]). Lower limb venous thrombosis, phobia, delirium, and other adverse complications were lower in the study group than in the control group ([Formula: see text]). Conclusion: PDCA is safe and effectively alleviates negative emotions, promotes limb function recovery, and improves the quality of life.
RESEARCH ON GAIT RECOGNITION OF SURFACE EMG SIGNAL BASED ON MPSO-LSTM ALGORITHM
Authors: CHANG YING , WANG LAN , LI MIN , LIU MING , LIN LINGJIE , CUI BO , LIU QIMENG
Published: July 2023

The growing interest in gait recognition based on surface electromyography (sEMG) signals is attributed to their capability to anticipate motion characteristics during human movement. This paper focuses on gait pattern recognition using sEMG signals. Initially, the muscles responsible for collecting sEMG signals are determined based on the distinct characteristics of human gait, and data for 12 different gait patterns are collected. Subsequently, the acquired sEMG signals undergo preprocessing and feature extraction stages. Moreover, various algorithms relevant to gait classification based on surface myoelectric signals are investigated. In this study, we propose an improved particle swarm optimization algorithm (MPSO-LSTM) for accurately classifying gait patterns using surface myoelectric signals. Experimental results demonstrate the effectiveness of the MPSO-LSTM algorithm in gait recognition based on sEMG signals.
AN INTELLIGENT MODEL FOR EVALUATING COLLEGE STUDENTS’ MENTAL HEALTH BASED ON DEEP FEATURES AND A MULTIVIEW FUZZY CLUSTERING ALGORITHM
Authors: ZHOU DANYAN , DONG DANHUI
Published: July 2023

The emotional well-being of college students is of utmost significance. The psychological states of college students who are on the verge of entering the social work field form the key factor that directly influences the quality of social construction because these students constitute the primary driving force in the field. On the other hand, the overwhelming amount of schoolwork, the intense level of competitiveness, and the undeveloped psychological qualities of college students are the primary contributors to their mental health problems. Currently, an increasing number of college students are struggling with mental health issues, which will have a significant impact on the growth of families and schools and the future construction of the nation. In this paper, deep features and a multiview fuzzy clustering technique are presented, as well as a mental health assessment model (CNN-MV-MEC) that is proposed for college students. The primary purpose of this research is to determine the mental state of the input sample by classifying and identifying an EEG that was acquired through the application of CNN-MV-MEC. If a certain number of samples are found to be in negative emotional states on a regular basis or for an extended period of time, this indicates that the sample most likely contains individuals who struggle with mental health issues. At this point in time, university officials are in a position to implement follow-up mental health management actions based on the outcomes of the model evaluation process. The primary contributions of this study are as follows. First, to extract the deep features from the given dataset, this paper makes use of a traditional convolutional neural network (CNN). In the second step, a classification model is trained using a multiview maximum entropy clustering (MV-MEC) technique. In the final step, the input test data are categorized by employing the trained classification model to determine the emotional state of the sample. The SEED dataset is used as the training data for the mental health assessment model proposed in this paper. Thus, the performance of the model can be evaluated. Model comparison experiments demonstrate that the proposed approach yields more accurate results than competing methods when assessing the mental health of college students.
Semi-Analytical Results for the Linear Nonaging Viscoelastic Contact Behaviors
Authors: Nguyen-Sy Tuan , Thai Minh-Quan , Vu Ngoc-Minh
Published: July 2023

This paper investigates the importance of creep and relaxation functions in modeling the Hertzian contact problem between linear nonaging viscoelastic materials and viscoelastic rough surfaces. We provide novel analytical and semi-analytical solutions to these functions for various materials, including Generalized Maxwell, Generalized Kelvin, and Burgers’ rheological materials. Closed-form and semi-analytical solutions are developed for several specific cases with high practical applications, such as the contact between incompressible solids, a rigid material and an incompressible material, and two solids with no volumetric viscous strain. They are extensions of existing solutions given in the literature. A simple computation procedure based on the discretized integral technique is proposed for the general case of contact between linear nonaging viscoelastic materials. This proposed method is easy to implement in practical applications such as the interpretation of viscoelastic indentation tests for material characterization and the implementation of viscoelastic contact in finite/discrete element simulations.
Circadian Rhythm Disturbance in Acute Ischemic Stroke Patients and Its Effect on Prognosis
Authors: Yu Si-Yuan , Sun Qian , Chen Sheng-nan , Wang Fen , Chen Rui , Chen Jing , Liu Chun-Feng , Li Jie
Published: July 2023

Introduction: Poststroke sleep disturbances are common and can affect stroke outcomes, but the clinical studies mainly focus on breathing-related sleep disorders, while the bidirectional impact of circadian rhythm dysfunction in ischemic stroke remains unknown. This study observed the characteristics of melatonin secretion in acute ischemic stroke patients and evaluated whether melatonin rhythm impacts the prognosis after stroke by assessing the neurological function, cognition, emotion, and quality of life 3 months after stroke. Methods: Acute ischemic stroke patients were selected from the Department of Neurology Inpatients of the Second Hospital affiliated with Soochow University from October 2019 to July 2021. Healthy control subjects were recruited at the same time. Demographic and clinical data were collected, and relevant scale scores (including neurological function, cognition, emotion, and sleep) were assessed within 2 weeks of onset and followed up 3 months later. All participants collected salivary melatonin samples on the 4th day of hospitalization and dim light melatonin onset (DLMO) was calculated according to melatonin concentration. Stroke patients were then divided into three groups based on their DLMO values. Results: A total of 74 stroke patients and 33 control subjects were included in this analysis. Compared with healthy controls, stroke patients exhibited a delayed melatonin rhythm during the acute phase of stroke (21:36 vs. 20:38, p = 0.004). Stroke patients were then divided into three groups, namely normal (n = 36), delayed (n = 28), or advanced DLMO (n = 10), based on their DLMO values. A χ2 test showed that there were significant differences in the rate of poor prognosis (p = 0.011) and depression tendency (p = 0.028) among the three groups. A further pairwise comparison revealed that stroke patients with delayed DLMO were more likely to experience poor short-term outcomes than normal DLMO group (p = 0.003). The average melatonin concentration of stroke patients at 5 time points was significantly lower than that of the control group (3.145 vs. 7.065 pg/mL, p < 0.001). Accordingly, we split stroke patients into three groups, namely low melatonin level (n = 14), normal melatonin level (n = 54), or high melatonin level (n = 6). Unfortunately, there were no great differences in the clinical characteristics, cognition, emotion, sleep quality, and short-term outcome among groups. Conclusions: This is a preliminary study, and our results indicate that changes in melatonin secretion phase of stroke patients may have effect on their short-term prognosis.
Symptomatic Postnatal Cytomegalovirus Infection in Less than 32-Week Preterm Infants: 13-Year Retrospective Multicenter Case-Control Study
Authors: Tapawan Sarah Jane Corpuz , Bajuk Barbara , Oei Ju Lee , Palasanthiran Pamela ,   NSW and the ACT Neonatal Intensive Care Units (NICUS) Group
Published: July 2023

Introduction: Reports on the influence of postnatal cytomegalovirus (pCMV) infection in neonatal outcomes of preterm babies vary while guidance on management including screening is lacking. We aim to determine the association between symptomatic pCMV infection and chronic lung disease (CLD) and mortality in preterm infants born less than 32 weeks gestation. Methods: We used data from the Neonatal Intensive Care Units’ (NICUS) population-based prospective data registry of infants in 10 neonatal units in New South Wales and the Australian Capital Territory, Australia. De-identified perinatal and neonatal outcome data for 40,933 infants were examined. We identified 172 infants <32 weeks gestation with symptomatic pCMV infection. Each was matched with one control infant. Results: Infants with symptomatic pCMV infection were 2.7 times more likely to develop CLD (OR 2.7, 95% CI: 1.7–4.5) and spend 25.2 days more in hospital (95% CI: 15.2–35.2). Seventy-five percent (129/172) of infants with symptomatic pCMV were extremely preterm (<28 weeks). The mean age of symptomatic pCMV diagnosis was 62.5 ± 20.5 days or 34.7 ± 3.6 weeks-corrected gestational age. Ganciclovir treatment did not decrease CLD and death. CLD was 5.5 times predictive of death in patients with symptomatic pCMV infection. Symptomatic pCMV infection did not influence mortality nor increase neurologic impairment. Conclusion: Symptomatic pCMV is a modifiable factor affecting extreme preterm infants with significant impact on CLD. Prospective study on screening and treatment will help unveil potential benefits in our already at-risk preterm infants.
Effects of Acute Caffeine Intake on Insulin-Like Growth Factor-1 Responses to Total Sleep Deprivation: Interactions with COMT Polymorphism – A Randomized, Crossover Study
Authors: Drogou Catherine , Sauvet Fabien , Erblang Mégane , Leger Damien , Thomas Claire , Chennaoui Mounir , Gomez-Merino Danielle ,   Investigators group
Published: July 2023

Introduction: Genes encoding catechol-O-methyl-transferase (COMT) and adenosine A2A receptor (ADORA2A) have been shown to influence cognitive performances and responses to caffeine intake during prolonged wakefulness. The rs4680 single-nucleotide polymorphism (SNP) of COMT differentiates on memory score and circulating levels of the neurotrophic factor IGF-1. This study aimed to determine the kinetics of IGF-1, testosterone, and cortisol concentrations during prolonged wakefulness under caffeine or placebo intake in 37 healthy participants, and to analyze whether the responses are dependent on COMT rs4680 or ADORA2A rs5751876 SNPs. Methods: In caffeine (2.5 mg/kg, twice over 24 h) or placebo-controlled condition, blood sampling was performed at 1 h (08:00, baseline), 11 h, 13 h, 25 h (08:00 next day), 35 h, and 37 h of prolonged wakefulness, and at 08:00 after one night of recovery sleep, to assess hormonal concentrations. Genotyping was performed on blood cells. Results: Results indicated a significant increase in IGF-1 levels after 25, 35, and 37 h of prolonged wakefulness in the placebo condition, in subjects carrying the homozygous COMT A/A genotype only (expressed in absolute values [±SEM]: 118 ± 8, 121 ± 10, and 121 ± 10 vs. 105 ± 7 ng/mL for A/A, 127 ± 11, 128 ± 12, and 129 ± 13 vs. 120 ± 11 ng/mL for G/G, and 106 ± 9, 110 ± 10, and 106 ± 10 vs. 101 ± 8 ng/mL for G/A, after 25, 35, and 37 h of wakefulness versus 1 h; p < 0.05, condition X time X SNP). Acute caffeine intake exerted a COMT genotype-dependent reducing effect on IGF-1 kinetic response (104 ± 26, 107 ± 27, and 106 ± 26 vs. 100 ± 25 ng/mL for A/A genotype, at 25, 35, and 37 h of wakefulness vs. 1 h; p < 0.05 condition X time X SNP), plus on resting levels after overnight recovery (102 ± 5 vs. 113 ± 6 ng/mL) (p < 0.05, condition X SNP). Testosterone and cortisol concentrations decreased during wakefulness, and caffeine alleviated the testosterone reduction, unrelated to the COMT polymorphism. No significant main effect of the ADORA2A SNP was shown regardless of hormonal responses. Conclusion: Our results indicated that the COMT polymorphism interaction is important in determining the IGF-1 neurotrophic response to sleep deprivation with caffeine intake (NCT03859882).
Normobaric Hyperoxia Combined with Endovascular Treatment in Patients with Acute Ischemic Stroke (OPENS-2) Trial: Protocol for a Prospective, Multicenter, Randomized Controlled Study
Authors: Li Weili , Wei Ming , Liu Lan , Lan Jing , Wu Chuanjie , Zhao Wenbo , Li Chuanhui , Chen Jian , Hou Chengbei , Ma Qingfeng , Ji Xunming ,   OPENS-2 Investigators
Published: July 2023

Normobaric hyperoxia (NBO) is a potentially promising stroke treatment strategy that could protect the ischemic penumbra and could be administered as an adjunct before vascular recanalization. However, the efficacy and safety of NBO have not been confirmed by randomized controlled trials. The study aims to assess the efficacy and safety of NBO for ischemic stroke due to large artery occlusion (LVO) of acute anterior circulation among patients who had endovascular treatment (EVT) and were randomized within 6 h from symptom onset. Based on the data of the modified Rankin Scale (mRS) score at 90 days from the normobaric hyperoxia combined with EVT for acute ischemic stroke (OPENS: NCT03620370) trial, 284 patients will be included to achieve a 90% power by using Wilcoxon-Mann-Whitney test and the proportional odds model to calculate the sample size. The study is a prospective, multicenter, blinded, randomized controlled trial. The NBO group is administered with mask oxygen therapy of 10 L/min, while the sham NBO group is with that of 1 L/min. The primary outcome is the mRS score at 90 days. Secondary endpoints include cerebral infarct volume at 24–48 h, functional independence (mRS ≤2) at 90 days, and improvement in neurological function at 24 h. Safety outcomes include 90-day mortality, oxygen-related adverse events, and serious adverse events. This study will indicate whether NBO combined with EVT is superior to EVT alone for acute ischemic stroke caused by LVO in subjects randomized within 6 h from symptom onset and will provide some evidence for NBO intervention as an adjunct to thrombectomy for acute stroke.
Evaluating Injury Severity in Neonatal Encephalopathy Using Automated Quantitative Electroencephalography Analysis: A Pilot Study
Authors: Catenaccio Eva , Smith Rachel J. , Chavez-Valdez Raul , Burton Vera J. , Graham Ernest , Parkinson Charlamaine , Vaidya Dhananjay , Tekes Aylin , Northington Frances J. , Everett Allen D. , Stafstrom Carl E. , Ritzl Eva K.
Published: July 2023

Quantitative analysis of electroencephalography (qEEG) is a potential source of biomarkers for neonatal encephalopathy (NE). However, prior studies using qEEG in NE were limited in their generalizability due to individualized techniques for calculating qEEG features or labor-intensive pre-selection of EEG data. We piloted a fully automated method using commercially available software to calculate the suppression ratio (SR), absolute delta power, and relative delta, theta, alpha, and beta power from EEG of neonates undergoing 72 h of therapeutic hypothermia (TH) for NE between April 20, 2018, and November 4, 2019. We investigated the association of qEEG with degree of encephalopathy (modified Sarnat score), severity of neuroimaging abnormalities following TH (National Institutes of Child Health and Development Neonatal Research Network [NICHD-NRN] score), and presence of seizures. Thirty out of 38 patients met inclusion criteria. A more severe modified Sarnat score was associated with higher SR during all phases of TH, lower absolute delta power during all phases except rewarming, and lower relative delta power during the last 24 h of TH. In 21 patients with neuroimaging data, a worse NICHD-NRN score was associated with higher SR, lower absolute delta power, and higher relative beta power during all phases. QEEG features were not significantly associated with the presence of seizures after correction for multiple comparisons. Our results are consistent with those of prior studies using qEEG in NE and support automated qEEG analysis as an accessible, generalizable method for generating biomarkers of NE and response to TH. Additionally, we found evidence of an immature relative frequency composition in neonates with more severe brain injury, suggesting that automated qEEG analysis may have a use in the assessment of brain maturity.
Case Report: Vision Loss Induced by Capecitabine in Patient with Preexisting Left Eyes Blind
Authors: Matte Paul , Ducreux Michel
Published: July 2023

Capecitabine is an orally administered fluoropyrimidine carbamate antineoplastic agent, widely used to treat different tumor types. Eye toxicity is not well established with this type of drug. Here, we report the case of a 57-year-old man with a low rectal cancer whose vision decreased 3 weeks after starting a daily treatment of capecitabine and radiotherapy. After eliminating all other diagnoses, toxicity of antineoplastic agents remains the most likely hypothesis, making it the first case of vision loss induced by this capecitabine.
Additional Wide Resection of Infantile Dermatofibrosarcoma Protuberans after Unplanned Excision: A Case Report
Authors: Tanaka Tomoharu , Nakayama Robert , Mori Tomoaki , Asano Naofumi , Aramaki-Hattori Noriko , Nakamura Masaya , Matsumoto Morio
Published: July 2023

Dermatofibrosarcoma protuberans (DFSP) is a locally aggressive intermediate soft tissue neoplasm that occurs in the dermis. DFSP generally occurs in young to middle-aged adults and rarely in infancy. Because of its extreme rarity, DFSP is difficult to diagnose and treat, especially when it occurs in infancy. In this paper, we reported a case of infantile DFSP in which we performed additional wide resection with a 3-cm horizontal margin for a mass that had previously undergone unplanned excision. No tumor recurrence has been seen for 3 years postoperatively. We suggest that the possibility of DFSP should always be considered when an enlarging superficial mass is identified on the trunk, even in an infant. Additionally, radical local treatment is as important for DFSP in infancy as it is for DFSP in adults, even after unplanned excision.
A Genetic Counselor’s Reflections on Lessons Learned, Challenges, and Successes Experienced during a One-Year Pilot Integration in a Primary Care Clinic
Authors: Carrion Prescilla B. , Austin Jehannine , Elliott Alison M
Published: July 2023

This practice-related insight article describes the experience of a genetic counselor being integrated into a multidisciplinary primary care clinic that provides care for a predominantly marginalized patient population in Victoria, British Columbia, Canada. Reflections on the lessons learned, including challenges and successes during this 1-year pilot integration are shared by the genetic counselor in the context of exploring the potential value a genetic counselor can provide while embedded in a primary care clinic. The relationship between clinical genetic counseling practice and a culturally safe and trauma-informed approach in primary care is explored, and additional steps are described that can be taken to facilitate more equitable and inclusive access to genetic counseling services for underserved and vulnerable patient populations.
Clinical Features of Non-Alcoholic Fatty Liver Disease in the Non-Lean Population
Authors: Li Min-ran , Li Jin-zhong , Li Jie-ying , Wang Cun-chuan , Yuan Rui-kun , Ye Li-hong , Liu Yun-yan , Liang Xu-jing , Zhang Hai-cong , Liu Zhi-quan , Zeng Dong-yu , Zhang Xue-dong , Wang De-hua , Li Jun-qing , Li Tao-yuan , Yang Liu , Cao Yang , Pan Yun , Lin Xun-ge , Pan Calvin Q. , Dai Er-hei , Dong Zhi-yong
Published: July 2023

Introduction: The prevalence of non-alcoholic fatty liver disease (NAFLD) in non-lean patients is significantly increased, and obesity significantly increases the risk of cirrhosis and HCC in NAFLD patients. However, whether there is a difference in clinical manifestations of NAFLD between overweight and obesity remains unclear. The objective of this study was to assess the clinical and histological features of NAFLD among a non-lean population. Methods: Current study enrolled consecutive non-lean (body mass index [BMI] >23 kg/m2) patients with NAFLD and available liver biopsy results. Patients were stratified by BMI into two groups for the comparison of their clinical and histological variables, which included the overweight (BMI 23∼<28 kg/m2) and the obese (BMI ≥28 kg/m2). Risk factors for moderate to severe fibrosis (stage >1) were also analyzed through the logistic regression model. Results: Among 184 non-lean patients with metabolic-associated fatty liver disease enrolled, 65 and 119 were overweight and obese, respectively. Patients in the obesity group had a significantly lower level of gamma-glutamyl transpeptidase, higher levels of platelet, glucose, prothrombin time, and more common of moderate to severe inflammatory activity when compared to those in the overweight group. However, a significant low frequency of moderate to severe fibrosis was found in the obesity group versus the overweight group (19.33% vs. 40.00%, p = 0.002). Binary logistics regression analysis of fibrosis found that aspartate transaminase (AST), BMI, alanine transaminase (ALT), and cholesterol (CHOL) were independent predictors for moderate to severe fibrosis in non-lean patients with NAFLD. Compared with the traditional fibrosis-4 (AUC = 0.77) and aminotransferase to platelet ratio index (AUC = 0.79) indexes, the combined index based on AST, BMI, ALT, and CHOL was more accurate in predicting moderate to severe fibrosis in non-lean patients with NAFLD (AUC = 0.87). Conclusions: Clinical and histological features differed between obesity and overweight patients with NAFLD. When compared to the traditional serum markers, the combination index including AST, BMI, ALT, and CHOL provided a better model to predict moderate to severe fibrosis in non-lean patients with NAFLD.
Key Points of the Banff 2019 Classification of Renal Allograft Pathology
Authors: Tsuji Takahiro
Published: July 2023

The Banff 2019 Kidney Meeting Report was published following the 15th Banff Conference for Allograft Pathology, which was held in Pittsburgh on September 23–28, 2019. The diagnosis of renal transplant rejection based on the Banff 2019 classification is globally utilized. The Banff 2019 classification of renal allograft pathology includes several changes. This mini-review summarizes the key points and issues of the Banff 2019 classification. The criteria for borderline change have been reverted to ≥ i1, the t-IFTA score has been incorporated into the classification, the histological classification of polyoma virus nephropathy has been adopted, and a category was added for chronic (inactive) antibody-mediated rejection. In addition, whether the spread is diffuse or focal should now be noted in the presence of peritubular capillaritis. One of the issues with the Banff 2019 classification is the continuing lack of clarity regarding the definition of the t score, which is used to evaluate tubulitis not only in non-scarred areas but also in moderately atrophic tubules that are assumed to be present in scarred areas, which constitutes a contradiction in the definition.
The Diet Quality of Australian Stroke Survivors in a Community Setting
Authors: Zacharia Karly , Ramage Emily , Galloway Margaret , Burke Meredith , Hankey Graeme J , Lynch Elizabeth , Said Catherine M , English Coralie , Patterson Amanda , Macdonald-Wicks Lesley
Published: July 2023

Introduction: Diet quality is a marker of how closely eating patterns reflect dietary guidelines. The highest tertile for diet quality scores is associated with 40% lower odds of first stroke compared with the lowest tertile. Little is known about the diet of stroke survivors. We aimed to assess dietary intake and quality of Australian stroke survivors. Methods: Stroke survivors enrolled in the ENAbLE pilot trial (2019/ETH11533, ACTRN12620000189921) and Food Choices after Stroke study (2020ETH/02264) completed the Australian Eating Survey Food Frequency Questionnaire (AES), a 120-item, semiquantitative questionnaire of habitual food intake over the previous 3–6 months. Diet quality was determined by calculating the Australian Recommended Food Score (ARFS): a higher score indicates higher diet quality. Results: Eighty-nine adult, stroke survivors (female: n = 45, 51%) of mean age 59.5 years (±9.9) had a mean ARFS of 30.5 (±9.9) (low diet quality). Mean energy intake was similar to the Australian population: 34.1% from noncore (energy-dense/nutrient-poor) and 65.9% from core (healthy) foods. However, participants in the lowest tertile for diet quality (n = 31) had significantly lower intake of core (60.0%) and higher intake from noncore foods (40.0%). Most participants did not meet daily requirements for fiber, potassium, or omega 3 fatty acids (2%, 15%, and 18%), nutrients important to reduce stroke risk. Conclusion: The diet quality of stroke survivors was poor, with inadequate intake of nutrients important for reducing recurrent stroke risk. Further research is needed to develop effective interventions to improve diet quality.
Association between Sleep Factors and Parkinson’s Disease: A Prospective Study Based on 409,923 UK Biobank Participants
Authors: Chen Yancong , Gao Yinyan , Sun Xuemei , Wang Betty Huan , Qin Lang , Wu Irene XY , Li Guowei
Published: July 2023

Introduction: Limited evidence indicates an association between sleep factors and the risk of Parkinson’s disease (PD). However, large prospective cohort studies including both sexes are needed to verify the association between daytime sleepiness, sleep duration, and PD risk. Furthermore, other sleep factors like chronotype and snoring and their impact on increased PD risk should be explored by simultaneously considering daytime sleepiness and snoring. Methods: This study included 409,923 participants from the UK Biobank. Data on five sleep factors (chronotype, sleep duration, sleeplessness/insomnia, snoring, and daytime sleepiness) were collected using a standard self-administered questionnaire. PD occurrence was identified using linkages with primary care, hospital admission, death register, or self-report. Cox proportional hazard models were used to investigate the association between sleep factors and PD risk. Subgroup (age and sex) and sensitivity analyses were performed. Results: During a median follow-up of 11.89 years, 2,158 incident PD cases were documented. The main association analysis showed that prolonged sleep duration (hazard ratio [HR]: 1.20, 95% confidence interval [CI]: 1.05, 1.37) and occasional daytime sleepiness (HR: 1.15, 95% CI: 1.04, 1.26) increased the PD risk. Compared to those who self-reported never or rarely having sleeplessness/insomnia, participants who reported usually having sleeplessness/insomnia had a decreased risk of PD (HR: 0.85, 95% CI: 0.75, 0.96). Subgroup analysis revealed that women who self-reported no snoring had a decreased PD risk (HR: 0.85; 95% CI: 0.73, 0.99). Sensitivity analyses indicated that the robustness of the results was affected by potential reverse causation and data completeness. Conclusion: Long sleep duration increased the PD risk, especially among men and participants ≥60 years, while snoring increased the risk of PD in women. Additional studies are needed to (i) further consider other sleep traits (e.g., rapid eye movement sleep behavior disorder and sleep apnea) that might be related to PD, (ii) objectively measure sleep-related exposure, and (iii) confirm the effects of snoring on PD risk by considering the impact of obstructive sleep apnea and investigating its underlying mechanisms.
Sporadic Case of Heterozygous X-Linked Alport Syndrome
Authors: Zuckerman Jonathan E. , Srivastava Rachana
Published: July 2023

Alport syndrome is a genetically and phenotypically heterogeneous disorder that can be transmitted in an X-linked, autosomal recessive, or autosomal dominant fashion and can affect glomerular, cochlear, and ocular basement membranes. The disorder results from mutations in the collagen IV genes COL4A5 (X chromosome), COL4A3, and COL4A4. Alport patients are at lifetime risk for kidney failure, sensorineural deafness, and ocular abnormalities. Males with Alport syndrome typically present with severe phenotype with progression to end-stage kidney disease and/or sensorineural deafness and eye changes. Females generally having less severe presentation and diagnosis of X-linked Alport syndrome are generally not considered. Here, we report a case of a 3-year-old girl with gross hematuria, proteinuria, and chronic kidney disease who was found to have features of Alport syndrome on kidney biopsy and a sporadic heterozygous pathogenic COL4A5 deletion on molecular testing. This case report emphasizes the importance of kidney biopsy and molecular testing in the work up of pediatric patients with hematuria, proteinuria, and/or chronic kidney disease. It is also a poignant illustration that females with heterozygous X-linked COL4A5 mutations are often affected patients. It further illustrates the phenomenon of sporadic occurrence of genetic kidney disease in the absence of family history of kidney disease.
Performance of Immunohistochemical and Molecular Methods in Detecting Microsatellite Instability in Gastric Cancer: A Multicenter Study
Authors: Sousa Marques Diogo , Gullo Irene , Mascarenhas-Lemos Luís , Silva João Ricardo , Neto do Nascimento Catarina , Pontes Patrícia , Pinho Lídia , Cirnes Luis , Wen Xiaogang , Cravo Marília , Carneiro Fátima
Published: July 2023

Introduction: Microsatellite instability (MSI) is an important prognostic molecular biomarker for gastric cancer (GC). MSI status may be detected by immunohistochemistry (IHC) for mismatch repair (MMR) proteins and polymerase chain reaction (PCR). Idylla™ MSI assay has not been validated for GC but may prove to be a valid alternative. Methods: In a series of 140 GC cases, MSI status was evaluated by IHC for MLH1, PMS2, MSH2, and MSH6; gold-standard pentaplex PCR panel (PPP) (BAT-25, BAT-26, NR-21, NR-24, and NR-27); and Idylla. Statistical analysis was performed using SPSS 27.0. Results: PPP identified 102 microsatellite stable (MSS) cases and 38 MSI-high cases. Only 3 cases showed discordant results. Compared with PPP, the sensitivity was 100% for IHC and 94.7% for Idylla. Specificity was 99% for IHC and 100% for Idylla. MLH1 IHC alone showed sensitivity and specificity of 97.4% and 98.0%, respectively. IHC identified three indeterminate cases; all were MSS according to PPP and Idylla. Conclusion: IHC for MMR proteins represents an optimal screening tool for MSI status in GC. If resources are limited, isolated MLH1 evaluation may constitute a valuable option for preliminary screening. Idylla may help detect rare MSS cases with MMR-loss and define MSI status in indeterminate cases.
Clinical Characteristics of Genuine Acute Autoimmune Hepatitis
Authors: Oliveira Elze Maria Gomes , Amaral Ana Cristina de Castro , Oliveira Patricia Marinho Costa , Lanzoni Valeria Pereira , Perez Renata Mello , Narciso-Schiavon Janaina Luz , Whale Raul Carlos , Carvalho-Filho Roberto Jose , Silva Antonio Eduardo Benedito , Ferraz Maria Lucia Cardoso Gomes
Published: July 2023

Introduction: Autoimmune hepatitis (AIH) has a spectrum of symptoms ranging from asymptomatic disease to acute severe hepatitis, chronic hepatitis, and decompensated cirrhosis. The acute presentation is not rare and could represent genuine acute AIH (GAAIH) or acute exacerbation of chronic autoimmune hepatitis. We aimed to identify the prevalence, clinical features, and prognostic factors associated with GAAIH and compare these cases with acute exacerbation of chronic AIH. Methods: This cross-sectional observational study evaluated patients with acute AIH presentation, defined as total bilirubin >5 times the upper limit of normality (xULN) and/or alanine aminotransferase >10 xULN, and no prior history of liver disease. Histology findings of acute disease defined GAAIH. Bivariate analyses were performed to identify factors associated with the GAAIH, when compared with acute exacerbation of chronic AIH. Results: Seventy-two patients with acute presentation of AIH were included and six (8.3%) of them presented GAAIH. Comparative analysis between patients with GAAIH and patients with acute exacerbation of chronic AIH revealed that prothrombin activity (96% [74–100] vs. 61% [10–100]; p = 0.003) and albumin levels (3.9 ± 0.2 g/dL vs. 3.4 ± 0.5 g/dL; p < 0.001) were higher in patients with GAAIH. The International Autoimmune Hepatitis Group score was higher in patients with acute exacerbation of chronic AIH (18.5 [8–23] vs. 16.5 [15–17]; p = 0.010). Compared to 15.2% of acute exacerbation of chronic AIH, complete therapeutic response to treatment was achieved in 67.7% of cases with GAAIH (p = 0.018). Conclusions: GAAIH was rare (8.3%), and patients with this presentation exhibited more preserved liver function tests, suggesting that most cases presenting with loss of function are acute exacerbation of chronic AIH. Additionally, patients with GAAIH had a better complete therapeutic response, suggesting a more preserved liver function at presentation, and early diagnosis has a positive therapeutic implication.
Treatment with Brivudine in Immunocompromised Pediatric Patients with Herpes Zoster
Authors: Vogel Clara , Wetzel Laura , Wutzler Peter , Gruhn Bernd
Published: July 2023

Introduction: Herpes zoster (HZ) is caused by endogenous reactivation of latent varicella-zoster virus (VZV) that persists in sensory ganglia after primary infection. The incidence and severity of HZ increase during immunosuppression. Especially, immunocompromised patients are at high risk of developing a cutaneous rash and suffering from delayed healing of lesions. Bromovinyl deoxyuridine (brivudine), one of the most potent oral inhibitors of VZV replication, is widely used in the therapy of HZ in adult patients, particularly in Europe. In this study, we investigated the efficacy of brivudine in immunocompromised children to provide an outpatient treatment option. Methods: In this retrospective study, we included 64 immunocompromised pediatric patients with a median age of 14 years. Forty-seven patients received immunosuppressive therapy as part of hematopoietic stem cell transplantation and 17 patients as part of chemotherapy. Primary diagnosis was made clinically by examining the nature and the localization of the skin lesions. Laboratory confirmation was conducted based on the detection of VZV DNA in vesicle fluid and blood samples. Brivudine was administered orally at a single dose of 2 mg/kg per day. We monitored the patients’ response for the full time of treatment and observed the time of full crusting of lesions, loss of crusts, and any adverse effects that occurred. Results: Patients received medication for 7–21 days (median: 14 days). All children responded promptly to antiviral treatment and recovered completely from their HZ infections without complications. Crusting of lesions was reached after 3–14 days (median: 6 days). Full healing of skin lesions was ascertained within 7–21 days (median: 12 days). Overall, brivudine therapy was well tolerated. No clinical side effects during or after the treatment were observed. High compliance was achieved due to the once-daily dosing regimen. All patients were treated in an outpatient manner. Conclusion: Oral brivudine was a very effective and well-tolerated therapy in immunocompromised children with HZ infection. The oral administration offers the potential for outpatient treatment of HZ in these patients.
Utility of Galactomannan Screening for Early Detection of Invasive Aspergillosis in High-Risk Hemato-Oncology Patients
Authors: Sabbah Rozan , Korem Maya , Shaulov Adir , Aumann Shlomzion , Nachmias Boaz
Published: July 2023

Introduction: Invasive aspergillosis (IA) affects mainly patients with hematological malignancies, and early diagnosis is crucial for timely treatment. Most diagnoses are based on clinical and mycological criteria, mostly galactomannan (GM) test in serum or bronchoalveolar fluid, which is performed in case of clinical suspicion or as routine screening in patients at high risk who are not receiving anti-mold prophylaxis, for early detection of IA. The aim of this study was to assess in a real-world setting the efficacy of biweekly serum GM screening for the early detection of IA. Methods: A retrospective cohort that included 80 adult patients treated at the Hematology Department, Hadassah Medical Center, 2016–2020, with a diagnosis of IA. Clinical and laboratory data were collected from patients’ medical files and the rate of GM-driven, GM-associated, and non-GM-associated IA was calculated. Results: There were 58 patients with IA. The rate of GM-driven diagnosis was 6.9%, GM-associated diagnosis was 43.1%, and non-GM-associated diagnosis was 56.9%. The GM test as a screening tool had led to IA diagnosis in only 0.2% of screened serums with a number needed to screen in order to find 1 patient with IA of 490. Conclusion: Clinical suspicion outweighs GM screening as a tool for early diagnosis of IA. Nevertheless, GM has an important role as a diagnostic tool for IA.
Barrett’s Esophagus in Eosinophilic Esophagitis in Swiss Eosinophilic Esophagitis Cohort Study (SEECS)
Authors: Scherer Roger , Schreiner Philipp , Rossel Jean-Benoit , Greuter Thomas , Burri Emanuel , Saner Catherine , Schlag Christoph , Safroneeva Ekaterina , Schoepfer Alain , Straumann Alex , Biedermann Luc ,   on behalf of the SEECS group
Published: July 2023

Introduction: There is a complex interrelationship between gastroesophageal reflux disease (GERD) and eosinophilic esophagitis (EoE) potentially promoting the occurrence and modulating severity of each other reciprocally. Presence of Barrett’s esophagus (BE) is a defining factor for the diagnosis of GERD. While several studies investigated the potential impact of concomitant GERD on the presentation and course of EoE, little was known with regards to BE in EoE patients. Methods: We analyzed prospectively collected clinical, endoscopic, and histological data from patients enrolled in the Swiss Eosinophilic Esophagitis Cohort Study (SEECS) regarding differences between EoE patients with (EoE/BE+) versus without BE (EoE/BE−) and determined the prevalence of BE in EoE patients. Results: Among a total of 509 EoE patients included in our analysis, 24 (4.7%) had concomitant BE with a high male preponderance (EoE/BE+ 83.3% vs. EoE/BE− 74.4%). While there were no differences in dysphagia, odynophagia was significantly (12.5 vs. 3.1%, p = 0.047) more common in EoE/BE+ versus EoE/BE−. General well-being at last follow-up was significantly lower in EoE/BE+. Endoscopically, we observed an increased incidence of fixed rings in the proximal esophagus in EoE/BE+ (70.8 vs. 46.3% in EoE/BE−, p = 0.019) and a higher fraction of patients with a severe fibrosis in the proximal histological specimen (8.7 vs. 1.6% in EoE/BE, p = 0.017). Conclusion: Our study reveals that BE is twice as frequent in EoE patients compared to general population. Despite many similarities between EoE patients with and without BE, the finding of a more pronounced remodeling in EoE patients with Barrett is noteworthy.
Determination of Vitamin K1, MK-4, MK-7, and D Levels in Human Serum of Postmenopausal Osteoporosis Women Based on High Stability LC-MS/MS: MK-7 May Be a New Marker of Bone Metabolism
Authors: Li Chunyan , Liang Cuiying , Kong Ziqing , Su Yu , Ren Wenhua , Dong Huiran , Wu Yuqi , Yang Nana , Liu Ruichen , Wu Jun , Zheng Yang
Published: July 2023

Introduction: Vitamin K (VK) as well as vitamin D (VD) plays an important role in osteoporosis. Vitamin K1 (VK1), vitamin K2 (VK2, menaquinone-4 (MK-4), and menaquinone-7 (MK-7)) are significant for the metabolism of skeletal muscle. 25-hydroxyvitamin D2 and 25-hydroxyvitamin D3 (25(OH)D2 and 25(OH)D3) reflect circulating VD levels. More sensitive measurements remain to be developed. In the present study, a new high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed for the determination of VK1, VK2 (MK-4 and MK-7), as well as 25(OH)D2 and 25(OH)D3 levels in human serum. Methods: We developed a simple LC-MS/MS method for the determination of VK1, MK-4, MK-7, 25(OH)D2, and 25(OH)D3 levels in human serum and validated the method in a study cohort of 200 patients divided into the premenopausal women group and postmenopausal osteoporosis patient group. Results: The overall precision (coefficient of variation) ranged from 2.66 to 10.11% in the specified working range (0.05–5 ng/mL) for VK1, MK-4, and MK-7. Serum VK1, MK-4, and MK-7 levels in postmenopausal women with osteoporosis were 1.187 ± 0.094 ng/mL, 0.058 ± 0.009 ng/mL, and 0.885 ± 0.064 ng/mL, respectively (mean ± standard deviation). Serum VK1, MK-4, and MK-7 levels in premenopausal women were 1.143 ± 0.103 ng/mL, 0.028 ± 0.003 ng/mL, and 1.553 ± 0.226 ng/mL, respectively. Serum 25(OH)D2 and 25(OH)D3 levels in postmenopausal women with osteoporosis were 0.757 ± 0.056 ng/mL and 11.72 ± 0.632 ng/mL, respectively. Serum 25(OH)D2 and 25(OH)D3 levels in premenopausal were 1.793 ± 0.575 ng/mL and 12.42 ± 1.069 ng/mL, respectively. Conclusion: A new LC-MS/MS method for determination of serum VK and VD levels was evaluated and validated. MK-7 in plasma decreased earlier than VD in postmenopausal osteoporosis patients. MK-7 status is significantly associated with osteoporosis and could be considered a predictable biomarker in the diagnosis of osteoporosis in postmenopausal women.