bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment strategies and survival of patients with connective tissue disease and pulmonary arterial hypertension: a COMPERA analysis
Authors: Distler Oliver , Ofner Christian , Huscher Dörte , Jordan Suzana , Ulrich Silvia , Stähler Gerd , Grünig Ekkehard , Held Matthias , Ghofrani H Ardeschir , Claussen Martin , Lange Tobias J , Klose Hans , Rosenkranz Stephan , Vonk-Noordegraaf Anton , Vizza C Dario , Delcroix Marion , Opitz Christian , Pausch Christine , Scelsi Laura , Neurohr Claus , Olsson Karen M , Coghlan J Gerry , Halank Michael , Skowasch Dirk , Behr Jürgen , Milger Katrin , Remppis Bjoern Andrew , Skride Andris , Jureviciene Elena , Gumbiene Lina , Miliauskas Skaidrius , Löffler-Ragg Judith , Wilkens Heinrike , Pittrow David , Hoeper Marius M , Ewert Ralf
Published: July 2023

Objectives

Pulmonary arterial hypertension (PAH) occurs in various connective tissue diseases (CTDs). We sought to assess contemporary treatment patterns and survival of patients with various forms of CTD-PAH.

Methods

We analysed data from COMPERA, a European pulmonary hypertension registry, to describe treatment strategies and survival in patients with newly diagnosed PAH associated with SSc, SLE, MCTD, UCTD and other types of CTD. All-cause mortality was analysed according to the underlying CTD. For patients with SSc-PAH, we also assessed survival according to initial therapy with endothelin receptor antagonists (ERAs), phosphodiesterase type 5 inhibitors (PDE5is) or a combination of these two drug classes.

Results

This analysis included 607 patients with CTD-PAH. Survival estimates at 1, 3 and 5 years for SSc-PAH (n = 390) were 85%, 59% and 42%; for SLE-PAH (n = 34) they were 97%, 77% and 61%; for MCTD-PAH (n = 33) they were 97%, 70% and 59%; for UCTD-PAH (n = 60) they were 88%, 67% and 52%; and for other CTD-PAH (n = 90) they were 92%, 69% and 55%, respectively. After multivariable adjustment, the survival of patients with SSc-PAH was significantly worse compared with the other conditions (P = 0.001). In these patients, the survival estimates were significantly better with initial ERA–PDE5i combination therapy than with initial ERA or PDE5i monotherapy (P = 0.016 and P = 0.012, respectively).

Conclusions

Mortality remains high in patients with CTD-PAH, especially for patients with SSc-PAH. However, for patients with SSc-PAH, our results suggest that long-term survival may be improved with initial ERA–PDE5i combination therapy compared with initial monotherapy.
Strained face during sleep in multiple system atrophy: not just a bad dream
Authors: Rosamaria Lecca , Michela Figorilli , Emma Bouniol , Ana Marques , Bruno Pereira , Philippe Derost , Bérangère Debilly , Raffaele Ferri , Monica Puligheddu , Franck Durif , Maria Livia Fantini
Published: July 2023

Study Objectives

Patients with Parkinson’s disease and multiple system atrophy may be subject to sleep state dissociation. Motivated by the fortuitous observation of prominent facial muscle activity during video-polysomnography in patients with multiple system atrophy, we assessed facial motor activity and chin muscle tone during sleep in multiple system atrophy compared to Parkinson’s disease and controls.

Methods

A sleep expert blinded to pathology and sleep stage retrospectively analyzed facial activity in 62 video-polysomnography (11 multiple system atrophy, 38 Parkinson’s disease, and 13 controls). Facial movements were classified into six categories: “Eyes closing/opening,” “Eyebrows frowning,” “Raising eyebrows,” “Smiling,” “Other mouth movements,” and “Strained face,” an expression involving both the superior and inferior parts of the face. Chin electromyography activity was quantified during Rapid Eye Movement (REM) and Non-Rapid Eye Movement (NREM) sleep using the atonia index, a validated algorithm.

Results

Multiple system atrophy patients had an increased number of all facial movements compared to controls during NREM. “Strained face” was significantly more frequent in multiple system atrophy compared to Parkinson’s disease, even after adjusting for the presence of REM sleep behavior disorder (RBD). Atonia index was lower in multiple system atrophy compared to controls and Parkinson’s disease during REM and NREM sleep. This difference remained significant compared to Parkinson’s disease in NREM sleep during N1 and N2 after adjusting for the presence of RBD.

Conclusions

Facial movements during sleep are frequent in multiple system atrophy, “strained face” appears to be a hallmark of this condition. The presence of increased facial activity and elevated muscle tone during all stages of sleep in multiple system atrophy may be a manifestation of sleep state dissociation, reflecting more severe neurodegeneration.
DNMT3B activates FGFR3‐mediated endoplasmic reticulum stress by regulating PTPN2 promoter methylation to promote the development of atherosclerosis
Authors: Zhang Zhiwen , Guo Quan , Zhao Zhenzhou , Nie Ming , Shi Qingbo , Li En , Liu Kaiyuan , Yu Haosen , Rao Lixin , Li Muwei
Published: July 2023

Endoplasmic reticulum (ER) stress is closely associated with atherosclerosis (AS). Nevertheless, the regulatory mechanism of ER stress in endothelial cells during AS progression is unclear. Here, the role and regulatory mechanism of DNA (cytosine‐5‐)‐ methyltransferase 3 beta (DNMT3B) in ER stress during AS progression were investigated. ApoE−/− mice were fed with high fat diet to construct AS model in vivo. HE and Masson staining were performed to analyze histopathological changes and collagen deposition. HUVECs stimulated by ox‐LDL were used as AS cellular model. Cell apoptosis was examined using flow cytometry. DCFH‐DA staining was performed to examine ROS level. The levels of pro‐inflammatory cytokines were assessed using ELISA. In addition, MSP was employed to detect PTPN2 promoter methylation level. Our results revealed that DNMT3B and FGFR3 were significantly upregulated in AS patient tissues, whereas PTPN2 was downregulated. PTPN2 overexpression attenuate ox‐LDL‐induced ER stress, inflammation and apoptosis in HUVECs and ameliorated AS symptoms in vivo. PTPN2 could suppress FGFR3 expression in ox‐LDL‐treated HUVECs, and FGFR3 knockdown inhibited ER stress to attenuate ox‐LDL‐induced endothelial cell apoptosis. DNMT3B could negatively regulate PTPN2 expression and positively FGFR2 expression in ox‐LDL‐treated HUVECs; DNMT3B activated FGFR2 expression by increasing PTPN2 promoter methylation level. DNMT3B downregulation repressed ox‐LDL‐induced ER stress, inflammation and cell apoptosis in endothelial cells, which was reversed by PTPN2 silencing. DNMT3B activated FGFR3‐mediated ER stress by increasing PTPN2 promoter methylation level and suppressed its expression, thereby boosting ER stress to facilitate AS progression.
Targeting P21-activated kinase suppresses proliferation and enhances chemosensitivity in T-cell lymphoblastic lymphoma
Authors: Su Ning , Fang Yu , Chen Xu , Chen Xiaoqin , Xia Zhongjun , Huang Huiqiang , Xia Yi , Liu Panpan , Tian Xiaopeng , Cai Qingqing
Published: July 2023

T-cell lymphoblastic lymphoma (T-LBL) is a highly aggressive non-Hodgkin lymphoma with a poor prognosis. P21-activated kinase (PAK) is a component of the gene expression-based classifier that can predict the prognosis of T-LBL. However, the role of PAK in T-LBL progression and survival remains poorly understood. Herein, we found that the expression of PAK1 was significantly higher in T-LBL cell lines (Jurkat, SUP-T1, and CCRF-CEM) compared to the human T-lymphoid cell line. Moreover, PAK2 mRNA level of 32 relapsed T-LBL patients was significantly higher than that of 37 cases without relapse (P = .012). T-LBL patients with high PAK1 and PAK2 expression had significantly shorter median RFS than those with low PAK1 and PAK2 expression (PAK1, P = .028; PAK2, P = .027; PAK1/2, P = .032). PAK inhibitors, PF3758309 (PF) and FRAX597, could suppress the proliferation of T-LBL cells by blocking the G1/S cell cycle phase transition. Besides, PF could enhance the chemosensitivity to doxorubicin in vitro and in vivo. Mechanistically, through western blotting and RNA sequencing, we identified that PF could inhibit the phosphorylation of PAK1/2 and downregulate the expression of cyclin D1, NF-κB and cell adhesion signaling pathways in T-LBL cell lines. These findings suggest that PAK might be associated with T-LBL recurrence and further found that PAK inhibitors could suppress proliferation and enhance chemosensitivity of T-LBL cells treated with doxorubicin. Collectively, our present study underscores the potential therapeutic effect of inhibiting PAK in T-LBL therapy.
Heterozygous CARD9 mutation favors the development of allergic bronchopulmonary aspergillosis
Authors: Xu Xia , Lu Haiwen , Li Jianxiong , Duan Jielin , Wang Zhongwei , Yang Jiawei , Gu Shuyi , Luo Rongguang , Liang Shuo , Tang Wei , Zhang Fengying , Hang Jingqing , Ge Juan , Lin Xin , Qu Jieming , Jia Xinming , Xu Jinfu
Published: July 2023

Background:

Previous research demonstrated that a homozygous mutation of g.136372044G>A (S12N) in caspase recruitment domain family member 9 (CARD9) is critical for producing Aspergillus fumigatus-induced (Af-induced) T helper 2 (TH2)-mediated responses in allergic bronchopulmonary aspergillosis (ABPA). However, it remains unclear whether the CARD9
S12N mutation, especially the heterozygous occurrence, predisposes the host to ABPA.

Methods:

A total of 61 ABPA patients and 264 controls (including 156 healthy controls and 108 asthma patients) were recruited for sequencing the CARD9 locus to clarify whether patients with this heterozygous single-nucleotide polymorphisms are predisposed to the development of ABPA. A series of in vivo and in vitro experiments, such as quantitative real-time polymerase chain reaction, flow cytometry, and RNA isolation and quantification, were used to illuminate the involved mechanism of the disease.

Results:

The presence of the p.S12N mutation was associated with a significant risk of ABPA in ABPA patients when compared with healthy controls and asthma patients, regardless of Aspergillus sensitivity. Relative to healthy controls without relevant allergies, the mutation of p.S12N was associated with a significant risk of ABPA (OR: 2.69 and 4.17 for GA and AA genotypes, P = 0.003 and 0.029, respectively). Compared with patients with asthma, ABPA patients had a significantly higher heterozygous mutation (GA genotype), indicating that p.S12N might be a significant ABPA-susceptibility locus (aspergillus sensitized asthma: OR: 3.02, P = 0.009; aspergillus unsensitized asthma: OR: 2.94, P = 0.005). The mutant allele was preferentially expressed in ABPA patients with heterozygous CARD9
S12N, which contributes to its functional alterations to facilitate Af-induced TH2-mediated ABPA development. In terms of mechanism, Card9 wild-type (Card9
WT) expression levels decreased significantly due to Af-induced decay of its messenger RNA compared to the heterozygous Card9
S12N. In addition, ABPA patients with heterozygous CARD9
S12N had increased Af-induced interleukin-5 production.

Conclusion:

Our study provides the genetic evidence showing that the heterozygous mutation of CARD9
S12N, followed by allele expression imbalance of CARD9
S12N, facilitates the development of ABPA.
Spindle Cell Lipoma With Florid Primary Follicular Lymphocytic Hyperplasia: A Novel Association With Potential Diagnostic Pitfalls
Authors: Fattah Yasmin H. , Liu Shuo S. , Susa Joseph , Hanly Andrew , Russo Jacqueline , Karai Laszlo J.
Published: July 2023

Spindle cell lipoma (SCL) is a benign subcutaneous lipomatous neoplasm with a heterogeneous histologic appearance that varies greatly depending on the amount of fat, collagen, and myxoid stroma, which define the multiple subtypes of SCL, such as fat poor SCL, pseudoangiomatous SCL, and dendritic fibromyxolipoma. Cutaneous lymphoid hyperplasia is a spectrum of benign conditions characterized by reactive B-cell and T-cell cutaneous lymphocytic infiltrates. Cutaneous B-cell lymphoid hyperplasia is a heterogeneous group of non-neoplastic conditions that can be observed as reactive phenomena to infections, medications, allergens, or neoplasms and must be distinguished from cutaneous B-cell lymphomas. Here, we report a novel case of spindle cell lipoma, associated with B-cell primary lymphoid follicular hyperplasia, mixed within the tumor in a peculiar pattern, while discussing potential diagnostic pitfalls with low-grade B-cell lymphomas. This is the first report of such association in the literature.
Serial feature positive and feature negative discrimination learning in a taste avoidance preparation: implications for interoceptive control of behavior
Authors: Huang Shihui , Cerveny Sydney E. , Ruprecht Anna L. , Steere Ethan R. , Davidson Terry L. , Riley Anthony L.
Published: July 2023

Background

Psychoactive drugs produce interoceptive stimuli that can guide appropriate behaviors by initiating or inhibiting responding.

Objective

The current study investigated whether an interoceptive morphine state produces similar patterns of serial feature positive (FP) and feature negative (FN) discrimination learning under comparable conditions in a taste avoidance design.

Methods

Male Sprague–Dawley rats were trained under 10 cycles of FP or FN discrimination. In the FP task, morphine (10 mg/kg, IP) signaled that a saccharin solution was followed by LiCl (1.2 mEq, IP), while the vehicle (saline) signaled that the LiCl was withheld. In the FN task, the contingency was reversed.

Results

The FP-trained rats acquired the discrimination after three training cycles, consuming significantly less saccharin on morphine, than on vehicle, sessions (P < 0.05). The FN-trained rats acquired the discrimination after six training cycles, consuming more on morphine than on vehicle sessions (P < 0.05). However, FN-trained rats never recovered saccharin consumption to baseline levels and 40% of the rats continued to avoid saccharin (consuming 0 ml) on morphine sessions. Control rats that never received LiCl consumed high levels of saccharin on morphine and vehicle sessions, indicating that morphine did not produce unconditioned suppression of saccharin consumption.

Conclusion

The difficulty to acquire FN discrimination might reflect the limitations of learning about safety contingencies in the taste avoidance design. The rapidity of FP learning when a drug state signals an aversive contingency may have implications for the general role of interoceptive stimuli in the control of behavior.
Sleep-light interventions that shift melatonin rhythms earlier improve perimenopausal and postmenopausal depression: preliminary findings
Authors: Parry Barbara L. , Meliska Charles J. , Sorenson Diane L. , Martinez L. Fernando , Lopez Ana M. , Dawes Sharron E. , Elliott Jeffrey A. , Hauger Richard L.
Published: July 2023

Objective

Testing the hypothesis that a sleep-light intervention, which phase-advances melatonin rhythms, will improve perimenopausal-postmenopausal (P-M; by follicle-stimulating hormone) depression.

Methods

In at-home environments, we compared two contrasting interventions: (1) an active phase-advance intervention: one night of advanced/restricted sleep from 9 pm to 1 am, followed by 8 weeks of morning bright white light for 60 min/d within 30 minutes of awakening, and (2) a control phase-delay intervention: one night of delayed/restricted sleep (sleep from 3 to 7 am) followed by 8 weeks of evening bright white light for 60 min/d within 90 minutes of bedtime. We tested 17 P-M participants, 9 normal controls and 8 depressed participants (DPs) (by Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition] criteria). Clinicians assessed mood by structured interviews and subjective mood ratings. Participants wore actigraphs to measure sleep and activity and collected overnight urine samples for the melatonin metabolite, 6-sulfatoxymelatonin (6-SMT), before, during, and after interventions.

Results

Baseline depressed mood correlated with delayed 6-SMT offset time (cessation of melatonin metabolite [6-SMT] secretion) (r = +0.733, P = 0.038). After phase-advance intervention versus phase-delay intervention, 6-SMT offset (start of melatonin and 6-SMT decrease) was significantly advanced in DPs (mean ± SD, 2 h 15 min ± 12 min; P = 0.042); advance in 6-SMT acrophase (time of maximum melatonin and 6-SMT secretion) correlated positively with mood improvement (r = +0.978, P = 0.001). Mood improved (+70%, P = 0.007) by both 2 and 8 weeks.

Conclusions

These preliminary findings reveal significantly phase-delayed melatonin rhythms in DP versus normal control P-M women. Phase-advancing melatonin rhythms improves mood in association with melatonin advance. Thus, sleep-light interventions may potentially offer safe, rapid, nonpharmaceutical, well-tolerated, affordable home treatments for P-M depression.
Sarcopenia Best Predicts Complications in Free Flap Breast Reconstruction
Authors: Jain Nirbhay S. , Bingham Elijah , Luvisa B. Kyle , Frydrych Lynn M. , Chin Madeline G. , Bedar Meiwand , Da Lio Andrew , Roostaeian Jason , Crisera Christopher , Slack Ginger , Tseng Charles , Festekjian Jaco H. , Delong Michael R.
Published: July 2023

Background:

Breast reconstruction remains a major component of the plastic surgeon’s repertoire, especially free-flap breast reconstruction (FFBR), though this is a high-risk surgery in which patient selection is paramount. Preoperative predictors of complication remain mixed in their utility. We sought to determine whether the sarcopenia score, a validated measure of physiologic health, outperforms the body mass index (BMI) and modified frailty index (mFI) in terms of predicting outcomes.

Methods:

All patients with at least 6-months follow-up and imaging of the abdomen who underwent FFBR from 2013 to 2022 were included in this study. Appropriate preoperative and postoperative data were included, and sarcopenia scores were extracted from imaging. Complications were defined as any unexpected outcome that required a return to the operating room or readmission. Statistical analysis and regression were performed.

Results:

In total, 299 patients were included. Patients were split into groups, based on sarcopenia scores. Patients with lower sarcopenia had significantly more complications than those with higher scores. BMI and mFI both did not correlate with complication rates. Sarcopenia was the only independent predictor of complication severity when other factors were controlled for in a multivariate regression model.

Conclusions:

Sarcopenia correlates with the presence of severe complications in patients who undergo FFBR in a stronger fashion to BMI and the mFI. Thus, sarcopenia should be considered in the preoperative evaluation in patients undergoing FFBR.
Community Versus Vertically Acquired Neonatal SARS-CoV-2 Infection: The EPICENTRE Cohort Study
Authors: De Luca Daniele , Perkins Elizabeth , Tingay David G. ,   on behalf of the European Society of Pediatric and Neonatal Intensive Care COVID-19 Paediatric and Neonatal Registry Group
Published: July 2023

Neonatal Severe Acute Respiratory Syndrome-CoronaVirus-2 infections can be community-acquired or vertically-acquired. The analysis of neonatal patients requiring hospitalization reported in the EPICENTRE worldwide registry shows that community-acquired cases have clinical features (fever, respiratory signs, feeding difficulties, P < 0.0001) and received antibiotics (P = 0.014) more frequently than vertically-acquired patients. Severe Acute Respiratory Syndrome-CoronaVirus-2 infections should be considered in the clinical workout of neonatal infections.
Safety and Efficacy of Ceftaroline in Neonates With Staphylococcal Late-onset Sepsis: A Case Series Analysis
Authors: Callies Arnaud , Martin-Perceval Lise , Crémet Lise , Gély Lilas , Ruellan Anne-Lise , Verdier Marie-Clemence , Gregoire Matthieu , Flamant Cyril , Guillouzouic Aurélie , Prot-Labarthe Sonia , Butin Marine , Launay Elise
Published: July 2023

Treatment of late-onset neonatal staphylococcal sepsis is sometimes challenging with feared side effects of vancomycin, increasing minimal inhibitory concentrations and questions about catheter management. In case of failure, ceftaroline was administered as a compassionate treatment in 16 infants (gestational age of less than 32 weeks and less than 28 postnatal days), whose first-line treatment failed. We report 11 successes and no severe adverse drug reactions. Larger data are required to confirm these encouraging results.
Large Pedunculated Papule on the Left Axilla
Authors: Ashouri Diana , Jacob Sharon E.
Published: July 2023

Teledermatology is a term to describe the provision of dermatologic medical services through telecommunication technology. This is a case of a large axillary papule in a patient with metabolic syndrome.
Skin Cancer: Back to Basics
Authors: Baumann John R. , Groneck Andrew D. , Martin Kari L.
Published: July 2023

Dermatofibrosarcoma protuberans is a soft tissue tumor that arises from the dermis. This relatively rare, low-grade tumor has a high propensity for local recurrence unless it is completely excised. Dermatofibrosarcoma protuberans classically progresses slowly as a plaque on the trunk of young adults. It often resembles a scar that is slowly growing over months to years. Because of its rarity and subtle progression, this form of skin cancer will often go undiagnosed for years. Over time, dermatofibrosarcoma protuberans can become invasive into the subcutaneous fat, muscle, fascia, and chest wall. Diagnosis of dermatofibrosarcoma protuberans is made by a core needle or incisional biopsy. Once diagnosed, cure rates approach 100%. The purpose of this article is to review the epidemiology, pathophysiology, clinical features, differential diagnosis, diagnosis, staging, and treatment of dermatofibrosarcoma protuberans. Increasing healthcare providers' awareness about this rare form of skin cancer and its recognition may improve patient outcomes.
Patient Perspective Column
Authors: Johnson Tonja , Brickley Sylvana
Published: July 2023

The Beautifully Unblemished Vitiligo Support Group is based in Florida, United States. In this article, Tonja Johnson, the founder of the Beautifully Unblemished Vitiligo Support Group, talks about her experience with having vitiligo and offers her perspective on how nurses can provide excellent care to patients with vitiligo.
Evaluation of acute asthma management among emergency doctors using simulation-based assessment
Authors: Nagaretnam Bhasyani , Md Jamal Shamsuriani , Abu Bakar Afliza , Zaini Ida Zarina , Saiboon Ismail M.
Published: July 2023

Assessment of asthma management competency using conventional methods remains challenging. This study aimed to explore the baseline knowledge, diagnosis accuracy and clinical management accuracy of acute asthma among emergency doctors using simulation-based assessment. We conducted a cross-sectional study involving 65 emergency department medical officers at a tertiary center. Participants were evaluated using 2 components: knowledge assessment of acute asthma and clinical performance assessment. Knowledge was evaluated using a standardized knowledge questionnaire. Clinical performance in managing acute asthma was assessed using a simulated acute asthma scenario and a standardized asthma management checklist using real-time assessments. The mean knowledge score was 14.69 ± 2.16. No significant differences were found in diagnosis and management accuracy in relation to knowledge (H = 0.644, P = .725, df = 6; H = 1.337, P = .512, df = 2). Acute-asthma attacks of all severities were poorly assessed, with accuracies of 27.3, 41.9, and 20.1% in mild, moderate, severe, and life-threatening cases, respectively. However, all participants provided high-quality treatment (accuracy = 82.3%) regardless of severity. Knowledge score does not influence the ability to differentiate asthma severity and management accuracy according to established asthma guidelines. The overall treatment accuracy was high, regardless of the severity of asthma. However, assessment of acute asthma requires further refinement.
A successful management of fungal peritonitis caused by Rhodotorula glutinis in CAPD patient, coincident with onychomycosis by Penicillium sp: Case report
Authors: Panggabean Steven David , Hustrini Ni Made
Published: July 2023

Rationale:

Rhodotorula glutinis is a rare cause of fungal peritonitis in peritoneal dialysis (PD) patients. The combination treatment between aggressive PD catheter replacement and adequate antifungal treatment is crucial in managing peritonitis due to fungal infection and onychomycosis.

Patient concerns:

A 37-year-old man PD patient presented with cloudy effluent, abdominal pain, and black debris in the lumen of his PD catheter. Twelve days before admission, the patient traveled for 10 days to a high-temperature country, Saudi Arabia, for purpose of accomplishing haj. From the physical examinations, there was an onychomycosis in his right toenail.

Diagnoses:

The result of the dialysate cell count confirmed the evidence of peritonitis (i.e., cell count of 187 cells per µL, however with polymorphonuclear 31%). The dialysate culture indicated R glutinis, with no growth of bacteria. Fungal culture of his toenail scrapings was obtained and the result was Penicillium sp.

Interventions:

Based on the high clinical suspicion of fungal peritonitis, fluconazole intraperitoneal (IP) was immediately given on the first day in addition to empirical antibiotics, that is, cefazolin and gentamycin IP. His peritoneal catheter was simultaneously removed and reinserted on the 4th day of treatment. Since there was a sign of fluconazole resistance, fluconazole IP was switched into oral voriconazole, without any antimicrobial treatment intraperitoneally. After 21 days of voriconazole, oral itraconazole was given until 3 months for his onychomycosis.

Outcomes:

Clinical improvement was seen on the effluent where the leucocyte count falls below 100 cells after 21 days of giving voriconazole.

Lessons:

This case report suggests the need for comprehensive evaluations of the risk for fungal infection in continuous ambulatory PD patients, especially those who live in a tropical country.
The clinical value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester: A systematic review and meta-analysis
Authors: Shi Bingye , Han Zhe , Zhang Wei , Li Wenxiu
Published: July 2023

Background:

This meta-analysis aimed to investigate the diagnostic value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester in China.

Methods:

A literature search was conducted to evaluate the clinical value of color ultrasound screening for fetal cardiovascular abnormalities during the second trimester using English and Chinese databases. Numerical values for sensitivity and specificity were obtained from false-negative, false-positive, true-negative, and true-positive rates, presented alongside graphical representations with boxes marking the values and horizontal lines showing the confidence intervals. Summary receiver operating characteristic (SROC) curves were applied to assess the performance of the diagnostic tests. Data were processed using Review Manager 5.3.

Results:

Four studies (151 patients with fetal cardiovascular abnormalities and 3397 undiagnosed controls) met our evaluation criteria. The sensitivity was 0.91 and 0.96, respectively, and the specificity was 1.00. The Area Under the Curve (AUC) from the SROC curves was >90%; therefore, it was classified as excellent. Furthermore, there were 6 types of fetal cardiovascular abnormalities, and the pooled screening rate of atrioventricular septal defects was the highest.

Conclusion:

Our meta-analysis showed that the use of color ultrasound during the second trimester can be an excellent diagnostic tool for fetal cardiovascular abnormalities.
Effect of constraint-induced movement therapy combined with neuromuscular electrical stimulation on upper extremity function in stroke survivors: A protocol for systematic review
Authors: Dboba Mahmoud M. , Mohd Nordin Nor Azlin , Manaf Haidzir , Mohd Rasdi Hanif Farhan
Published: July 2023

Background:

Motor impairment is common after a stroke and directly affects the function and quality of life of stroke survivors. Constraint-induced movement therapy and neuromuscular electrical stimulation are interventions that facilitate functional recovery of the upper extremities of a particular subgroup of stroke survivors. The objective of this study was to summarize the available evidence on the effects of neuromuscular electrical stimulation combined with constraint-induced movement therapy in patients with stroke.

Methods:

We conducted a comprehensive search of published articles in electronic databases, including PubMed, Scopus, PEDro, Medline (via Ovid), EMBASE, Cochrane Library, and Web of Science, using the following search terms: “stroke”; “upper extremity”; “Constraint-Induced Movement Therapy”; and “Neuromuscular Electrical Stimulation.” The search included published studies, conferences, and presentations. The article selection, data extraction, and quality evaluation will be conducted independently by 2 reviewers. The 3rd and 4th reviewers will assist in resolving any disagreements that may arise between the 2 reviewers. The risk of bias in the included studies will be assessed using the PEDro scale and Cochrane risk of bias assessment tool. Narrative synthesis and meta-analysis will be performed based on the characteristics of the included articles, including the risk of bias (if sufficient information is available).

Results:

This review summarizes the available evidence and could assist therapists in choosing the best treatment for poststroke upper extremity dysfunction.

Conclusion:

This study will provide the available evidence on the effectiveness of CIMT and NMES on upper extremity function in patients with stroke.

Ethics and dissemination:

Ethical approval is not required because the review will be based on publicly available literature. The findings of this study will be published in a peer-reviewed journal, and updates will be made depending on whether sufficient additional evidence modifies the conclusions of the review. Any changes made to the methods throughout the review will be stated in the article.

Systematic review registration:

PROSPERO CRD42023415645.
A novel prognosis prediction of esophageal cancer based on chromatin regulator-related lncRNA
Authors: Wang Yuchen , Shi Zhihua , Sun Xusheng , Liu Junfeng
Published: July 2023

It has been reported that chromatin regulators (CRs), as one of the essential upstream regulators of tumor development, were screened to construct a prognostic model for predicting the outcome of tumor patients. However, the prognostic model based on CRs-related long noncoding RNAs (lncRNAs) in esophageal cancer (EC) has never been researched. This study aims to construct a novel CRs-related lncRNA signature to evaluate the prognostic ability of EC patients. We obtained the transcriptome data and clinical information of patients with EC from the Cancer Genome Atlas database, 870 CRs-related genes from previous topic research. Univariate, multivariate Cox, the least absolute shrinkage and selection operator regression analyses were used to establish the risk model. The receiver operating characteristic curve, principal component analysis, nomogram, quantitative real-time PCR were performed to evaluate the independence and accuracy of the model. The biological functions and immune microenvironment of the risk model were analyzed by gene set enrichment analyses and R softwares. A novel 3 CRs-related lncRNAs risk model composed of AC079684.1, TMEM75, LINC00365, as an independent and superior factor, was established for prognosis prediction of EC patients. Quantitative real-time PCR analysis verified upregulated AC079684.1 and TMEM75 mRNA levels and downregulated LINC00365 mRNA level in EC tissues compared with normal tissues. Gene set enrichment analysis analysis displayed Kyoto encyclopedia of genes and genomes and gene ontology pathways enriched in risk groups, such as focal adhesion, pathways in cancer, epidermal cell differentiation. Immune cells and immune checkpoints were more likely to be activated in the high-risk group. Finally, we found most of the compounds in the high-risk group exhibited higher sensitivity through therapeutic drug screening. The 3 CRs-related lncRNAs risk model could independently predict the prognosis of EC and provide immunotherapy guidance for patients with EC.
Effect of tibial rotation after uniplane medial open-wedge high tibial osteotomy in genu varum patients: An observational study
Authors: Li Ke , Zhang Hao , Sun Fenglong , Guo Hengbing , Shi Zhanjun , Wang Hongqing , Yao Ran , Dong Xin
Published: July 2023

The change in axial tibial rotation after uniplane medial open-wedge high tibial osteotomy (uniplane OWHTO) and its relevant influence factor is not known. Therefore, the aim of this study was to evaluate the change in axial tibial rotation after uniplane OWHTO, and the factors affecting tibia rotational change were analyzed. Between January 2022 and April 2022, the study was retrospectively conducted on genu varum patients who underwent uniplane OWHTO. In the weight-bearing anteroposterior long leg view, the hip-knee-ankle angle and medial proximal tibial angle (MPTA) were evaluated. The posterior tibial slope were measured from the lateral view. A CT scan of the knee joint was performed to evaluate the distal tibial rotation angle (TRA), femorotibial rotation angle and tibial tuberosity-trochlear groove distance. In addition, the foot morphology was assessed by the ankle deformity angle and ankle rotation angle using an angle measuring instrument. All parameters were measured preoperatively and 14 days after surgery. The mean change in hip-knee-ankle, MPTA was 10.5°±2.9°, 8.8°±2.6°. The mean preoperative and postoperative TRA were 25.1°±6.9° and 22.2°±6.2° respectively (P = .007). Thus, the mean ∆TRA was −3.0°±3.4° (IR) with a range of −9.6° to +2.8° after surgery. No significant differences were found in the femorotibial rotation angle and tibial tuberosity-trochlear groove distance before and after surgery (P > .05). The postoperative ankle rotation angle and ankle deformity angle changed significantly compared with preoperative values (P < .001). In the multiple regression analysis, ∆MPTA was the only predictor of distal tibial rotation (β = 0.667, P = .003). The current study confirms an unintended internal rotation in the distal tibia following uniplane MOWHTO and the rotation in the distal tibia was influenced by the opening width. Surgeron should keep in mind to avoid the osteotomy complication leading to excessive rotation change during surgery.
Early diagnosis for pulmonary embolism: A systematic review and meta-analysis
Authors: Ma Minjun , Li Yu , Xu Xiujuan , Ji Conghua
Published: July 2023

Background:

The incidence of acute pulmonary embolism (APE) (especially early diagnosis) has increased annually in recent years, but the diagnosis of APE is a great challenge for every clinician. However, few studies have evaluated multiple diagnostic indicators simultaneously.

Methods:

A systematic search was performed using CNKI, Wan fang data, VIP, PubMed and Web of Science for studies on the diagnosis of pulmonary embolism published up to October 31, 2022. Using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2), we evaluated the risk of bias in included studies, and used a random-effects meta-analysis to obtain the summary sensitivity and specificity. The data that were extracted and calculated for this study included the first author, year of publication, country, study type, sample size, disease type, gold standard, diagnostic indicators and 4-compartment table data. We strictly followed the Preferred Reporting Items for Systematics reviews and Meta-Analysis (PRISMA) guidelines in this review.

Results:

This study included 30 articles with a total sample size of 8947 cases, involving 4 detection methods: D-dimer, Geneva rules, Wells rules, and lung imaging. The combined effect size showed that lung imaging had the highest diagnostic value (SEN = 0.95, SPE = 0.89), followed by D-dimer (SEN = 0.92, SPE = 0.60), Geneva rules (SEN = 0.78, SPE = 0.68), and Wells rules (SEN = 0.77, SPE = 0.67). The area of lung imaging was largest under the Summary Receiver Operator Characteristic (SROC) curve (AUC = 0.97), followed by Geneva rules (AUC = 0.80), Wells rules (AUC = 0.79), and D-dimer (AUC = 0.74).

Conclusion:

All 4 detection methods showed good ability to diagnose PE, and lung imaging was the best. Clinical trials are recommended to build an early decision-making model for the diagnosis of pulmonary embolism in order to increase the detection rate and improve prognosis.
Individual and Organizational Factors Associated With Nurse Manager Success
Authors: Schlotzhauer Ann E. , Cramer Emily , Grandfield Elizabeth M. , Warshawsky Nora E.
Published: July 2023

OBJECTIVE

The aim of this study was to synthesize previous findings and provide practical guidance for maximizing nurse manager and nurse performance.

BACKGROUND

Two recent studies have linked nurse manager job design factors and individual differences to a variety of valued outcomes, but practical implications remain unclear.

METHODS

A large US sample of nurse managers was divided on the basis of nurse and patient outcomes. Various characteristics are compared across the highest and lowest performers.

RESULTS

Wider nurse manager span of control is associated with negative outcomes; the availability of support positions does not fully alleviate the consequences of wide spans. Nurse managers with fewer subordinates can effectively manage multiple units. Nurse manager experience is critical for success and cannot be fully replaced by leadership training programs.

CONCLUSIONS

Staffing and job design decisions have critical downstream implications. The present research provides guidance for effective staffing and job design.
Leveraging Multiyear, Geospatial Social Media Data for Health Policy Evaluations: Lessons From the Philadelphia Beverage Tax
Authors: Ali Shahmir H. , Lowery Caitlin M. , Trude Angela C. B.
Published: July 2023

Context:

Public reactions to health policies are vital to understand policy sustainability and impact but have been elusively difficult to dynamically measure. The 2021 launch of the Twitter Academic Application Programming Interface (API), allowing for historical tweet analyses, represents a potentially powerful tool for complex, comprehensive policy analyses.

Objective:

Using the Philadelphia Beverage Tax (implemented January 2017) as a case study, this research extracted longitudinal and geographic changes in sentiments, and key influencers in policy-related conversations.

Design:

The Twitter API was used to retrieve all publicly available tweets related to the Tax between 2016 and 2019.

Setting:

Twitter.

Participants:

Users who posted publicly available tweets related to the Philadelphia Beverage Tax (PBT).

Main Outcome:

Tweet content, frequency, sentiment, and user-related information.

Measures:

Tweet content, authors, engagement, and location were analyzed in parallel to key PBT events. Published emotional lexicons were used for sentiment analyses.

Results:

A total of 45 891 tweets were retrieved (1311 with geolocation data). Changes in the tweet volume and sentiment were strongly driven by Tax-related litigation. While anger and fear increased in the months prior to the policy's implementation, they progressively decreased after its implementation; trust displayed an inverse trend. The 50 tweeters with the highest positive engagement included media outlets (n = 24), displaying particularly high tweet volume/engagement, and public personalities (n = 10), displaying the greatest polarization in tweet sentiment. Most geo-located tweets, reflecting 321 unique locations, were from the Philadelphia region (55.2%). Sentiment and positive engagement varied, although concentrations of negative sentiments were observed in some Philadelphia suburbs.

Conclusions:

Findings highlighted how longitudinal Twitter data can be leveraged to deconstruct specific, dynamic insights on public policy reactions and information dissemination to inform better policy implementation and evaluation (eg, anticipating catalysts for both heightened public interest and geographic, sentiment changes in policy conversations). This study provides policymakers a blueprint to conduct similar cost and time efficient yet dynamic and multifaceted health policy evaluations.
Facial Contour Features Measured on CT Reflects Upper Airway Morphology in Patients With OSA
Authors: Zhang Zishanbai , Sun Dance , Jia Yajie , Fei Nanxi , Li Yanru , Han Demin
Published: July 2023

Objective:

To determine facial contour features, measured on computed tomography (CT), related to upper airway morphology in patients with obstructive sleep apnea (OSA); certain phenotype of facial abnormalities implying restriction of craniofacial skeleton and adipose tissue nimiety has predicted the value of the severity of OSA.

Materials and Method:

Sixty-four male patients with OSA [apnea-hypopnea index (AHI) ≥10/h] who had upper airway CT were randomly selected to quantitatively measure indicators of facial contour and upper airway structures. Pearson correlation analyses were performed. Partial correlation procedure was used to examine correlations while controlling body mass index (BMI).

Results:

Upper airway anatomy can nearly all be reflected in the face, except retroglossal airway. Upper face width can be measured to assess the overall skeletal structures of the airway. Lower face width can be used to represent how much adipose tissue deposited. Hard palate, retropalatal, and hypopharyngeal airways have corresponding face indicators respectively. Midface width is a better predictor of AHI severity and minimum blood oxygen even than neck circumference because it contains the most anatomical information about the airway, including RP airway condition, soft palate length, tongue volume, etc. These correlations persisted even after correction for BMI.

Conclusions:

All anatomical features of the upper airway except retroglossal airway can be reflected in the face, and midface width is the best predictor of AHI severity and minimum blood oxygen, even better than neck circumference and BMI.
Clinical and neuroimaging features of the progressive supranuclear palsy- corticobasal degeneration continuum
Authors: Whitwell Jennifer L.
Published: July 2023

Purpose of review

The aim of this study was to discuss how recent work has increased our understanding of progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). The investigation of large and autopsy-confirmed cohorts, imaging modalities to assess different aspects of pathophysiology, clinical phenotypes and the application of advanced machine learning techniques, have led to recent advances in the field that will be discussed.

Recent findings

Literature over the past 18 months will be discussed under the following themes: studies assessing how different neuroimaging modalities can improve the diagnosis of PSP and CBD from other neurodegenerative and parkinsonian disorders, including the investigation of pathological targets such as tau, iron, neuromelanin and dopamine and cholinergic systems; work improving our understanding of clinical, neuroanatomical and pathological heterogeneity in PSP and CBD; and work using advanced neuroimaging tools to investigate patterns of disease spread, as well as biological mechanisms potentially driving spread through the brain in PSP and CBD.

The findings help improve the imaging-based diagnosis of PSP and CBD, allow more targeted prognostic estimates for patients accounting for phenotype or disease, and will aid in the development of appropriate and better-targeted disease biomarkers for clinical treatment trials.
Exploring the Association between Contraceptive Use and Women’s tolerance towards Domestic Violence: Evidence from MICS 2019 Survey
Authors: Haider Tanvir , Al Fidah Md Fuad , Hossain Md Emam , Mahdee Syed Nafi , Efa Syeda Sumaiya
Published: July 2023

Background

Access to contraception is crucial for preventing unintended pregnancies and promoting reproductive rights. In Bangladesh, the contraceptive prevalence rate (CPR) has increased over the decades. However, domestic violence (DV) remains a major concern. Women who experience DV are more likely to have unintended pregnancies and abortions. They are also more likely to live in poverty and experience depression and anxiety.

Objective

This study aimed to assess the relationship between contraceptive use and women’s tolerance of DV in Bangladesh.

Methods

Data from the Bangladesh Multiple Indicator Cluster Survey (MICS) 2019 was used for the study. The sample size was 47,692 women aged 15-49; data were analyzed using Jamovi software (version 2.3.26). Ethical considerations were strictly followed.Results

The study found a contraception utilization rate of 66.5% among Bangladeshi women of reproductive age. Factors associated with contraceptive use included age, residence, education level of the woman, marital structure, wealth index, and tolerance for domestic violence. Women with high tolerance towards domestic violence had higher odds (AOR: 1.1; 95% CI: 1.017-1.189; p = 0.017) of using contraception than women with no tolerance.

Conclusion

The study’s result suggest a complex relationship between contraceptive use, women’s tolerance of domestic violence, and other factors such as age, education, wealth, location, etc. Programs and policies are needed to promote contraceptive use in Bangladesh. Efforts should target socioeconomic, cultural, and psychological factors and barriers which are faced by women exposed to domestic violence. By tackling these challenges, programs, and policies can effectively promote contraception use and improve women’s reproductive health.