bluuebunny/crossref_metadata_2025 huggingface dataset:
Insurance status and access to cervical cancer treatment in a specialized cancer center in Mexico
Authors: Isla-Ortiz David , Torres-Domínguez Juan , Pérez-Peralta Liliana , Jiménez-Barrera Hugo , Bandala-Jacques Antonio , Meneses-García Abelardo , Reynoso-Noverón Nancy
Published: April 2023

To describe access to complete treatment in women with cervical cancer and state-sponsored insurance versus no insurance. We conducted a retrospective observational study. The source population consisted of women treated for cervical cancer from January 2000 to December 2015 in a tertiary care hospital. We included 411 women with state–sponsored insurance and 400 without insurance. We defined access to cervical cancer treatment as complete treatment (according NCCN/ESMO (National Comprehensive Cancer Network/European Society for Medical Oncology) standards) and timely initiation of treatment (less than 4 weeks). Clinical and sociodemographic characteristics were described and analyzed with logistic regression using complete treatment as the main outcome. A total of 811 subjects were included, the median age was 46 (IQR (Interquartile range) 42–50) years. Most of them were married (36.1%), unemployed (50.4%), and had completed primary school (44.0%). The most common clinical stages at diagnosis were II (38.2%) and III (24.7%). In the adjusted regression model, being married (OR (odds ratio): 4.3, 95% CI (confidence interval): 1.74–10.61) and having paid employment (OR: 2.79, 95% CI: 1.59–4.90) or state-sponsored insurance (OR: 1.54, 95% CI: 1.04–2.26) were positively associated with the possibility of having a complete treatment. Women with insurance were likely to be younger and receive timely treatment compared with uninsured women. Complete treatment was associated to insurance status and advanced stages of cervical cancer. State-sponsored insurance improves access to complete treatment. Government policies are needed to avoid social and economic inequity and provide better management of cervical cancer in our country.
Low ALT, a marker of sarcopenia and frailty, is associated with shortened survival amongst myelodysplastic syndrome patients: A retrospective study
Authors: Uliel Noa , Segal Gad , Perri Avital , Turpashvili Natia , Kassif Lerner Reut , Itelman Edward
Published: April 2023

Myelodysplastic Syndrome (MDS) is a common blood dyscrasia that mainly affects the elderly population. Several prognostic scores are available utilizing blood count variables and cytogenetic abnormalities, targeting the disease rather than the patient. Sarcopenia and frailty are associated with shortened survival rates in various disease states. Low Alanine Aminotransferase (ALT) levels are a marker of lowered muscle mass and frailty status. This study aimed to examine the correlation between low ALT levels and prognosis in MDS patients. This is a retrospective cohort study. We obtained the demographic, clinical, and laboratory data of patients in a tertiary hospital. Univariate and multivariate models were used to investigate the potential relationship between low ALT level and survival. The final study included 831 patients (median age 74.3 years, Interquartile range 65.6–81.8), and 62% were males. The median ALT level was 15 international units (IU)/L and 233 patients (28%) had low ALT levels (<12 IU/L). Univariate analysis showed that low ALT levels were associated with a 25% increase in mortality (95% confidence interval [CI]: 1.05–1.50, P = .014). A multivariate model controlling for age, sex, body mass index, hemoglobin and albumin concentrations, and low ALT levels was still significantly associated with increased mortality (hazard ratio [HR] = 1.25, 95% CI: 1.01–1.56, P = .041). Low ALT levels were associated with increased mortality among patients with MDS. Impact: Using ALT as a frailty metric may allow patient-centered, personalized care in this patient population. A low ALT level reflects the pre-morbid robustness of patients and is not intended to replace disease-centered characteristics.
Changes in spinal alignment one month post abdominal surgery: A prospective cohort study
Authors: Ito Akihiro , Iijima Shinno
Published: April 2023

Following abdominal surgery, many patients assume a bending or stooping posture to protect the surgical wound. Such postural changes are known to induce side effects, but the improvement and persistence of these effects are unknown. Therefore, the purpose of this study was to clarify the nature of postural changes in patients undergoing abdominal surgery. In this prospective cohort study, we enrolled 25 patients who underwent abdominal surgery from February 2019 to January 2020. Measurements were obtained during the preoperative, pre-discharge, and first outpatient stages. The sacral tilt, lumbar lordotic, thoracic kyphosis, and overall tilt angles were measured in the static standing position in a private room. Wound pain was measured using a Visual Analogue Scale. Repeated measures analysis of variance was applied to compare spine measurements for each measurement period, followed by the Bonferroni method for each level. Pearson’s product-moment correlation coefficient was performed to examine the relationship between wound pain and spinal column angle. The lumbar kyphosis angle was lower before discharge (−7.2 ± 7.4°) compared to preoperatively (−11.1 ± 7.5°) (95% CI 0.76, 7.08; P < .01, η2 = 0.21). Regarding the overall tilt angle, the anterior tilt angle increased before discharge (3.4 ± 3.9°) compared to preoperatively (1.1 ± 4.1°) (95% CI 0.86, 3.78; P < .01, η2 = 0.33). No statistically significant correlation with pain was observed. Compared to the preoperative period, the patients had an anterior tilt, mainly due to lumbar spine changes, prior to discharge from the hospital. Changes in spinal alignment were not associated with wound pain.
The impact of organizational justice on psychological distress among Chinese public hospitals nurses: A cross-sectional study
Authors: Sun Jing , Yang Zhilan , Zhu Tao , Jiang Zhihong , Zheng Xiuli , Li Chunlian , Cao Xiaoxia
Published: April 2023

Few studies have explored the association between organizational justice and mental health, particularly in collectivist countries. Hence, the aim of the present study was to evaluate the impact of organizational justice on psychological distress and to discuss the findings in collectivist culture. A cross-sectional survey was conducted among nurses from public hospitals in western of China, July 2022, which followed the STROBE guidelines. This study used Chinese versions of the Organizational Justice Scale and Kesseler Psychological Distress Scale to assess the perceptions of organizational justice and mental health levels, respectively. A total of 663 nurses completed the questionnaires. The psychological distress of university-educated and low-income nurses was poor. There was a moderately positive relationship between organizational justice and psychological distress (R = 0.508, P < .01), indicating that the greater level of organizational injustice, the poorer mental health. Hierarchical regression analysis showed that organizational justice was an strong predictor of psychological distress, accounting for approximately 20.5% of the psychological distress. The findings of this study highlight the importance of interpersonal injustice and distributive injustice on psychological distress specific in Chinese culture, suggesting that nursing management or leaders should notice that the most being taken seriously by nurses is their recognition and respect for subordinate, meanwhile, alerting nurses, in some sense, a negative relationship with leaders as a kind of workplace bullying could harm their mental health. The promulgation of organizational justice policy to protect employees from the government and the real role of employee labor union organizations are urgently needed.
Assessing the effect of transcranial magnetic stimulation on peak cough flow in patients with supratentorial cerebral infarction: A retrospective cohort study
Authors: Yoo Seung Don , Park Eo Jin
Published: April 2023

Respiratory dysfunction following supratentorial cerebral infarction leads to pneumonia and is a major cause of mortality. Decreased voluntary cough function impairs the ability to clear mucus or secretions from the airways and increases the risk of aspiration pneumonia. Peak cough flow (PCF) is one of the objective tools for evaluating voluntary cough function. Repetitive transcranial magnetic stimulation (rTMS) could be applied to the respiratory motor cortex to improve respiratory function. Little is known about the effect of rTMS on PCF in patients with supratentorial cerebral infarction during the subacute period. This study aimed to determine whether rTMS treatment could improve PCF in patients with supratentorial cerebral infarction. We retrospectively recruited patients with subacute supratentorial cerebral infarction who underwent a PCF test. The rTMS group received a combination of rTMS treatment for 2 weeks and conventional rehabilitation for 4 weeks. However, the control group underwent only conventional rehabilitation for 4 weeks. PCF tests were performed before and after treatment and the results were compared between the 2 groups. In total, 145 patients with supratentorial cerebral infarctions were recruited. The PCF parameters before and after treatment increased in both the rTMS and control groups. However, the rTMS group showed a greater increase in PCF values compared with the control group. In patients with supratentorial cerebral infarction, the combination of conventional rehabilitation and rTMS in the subacute period may be helpful in improving voluntary cough function compared with conventional rehabilitation alone.
Painful and restricted hip due to myositis ossificans circumscripta of the pectineus muscle after pelvic fracture: A case report
Authors: Bai Qiushi , Zou Xiongfei , Yang Gang , Fan Yu , Wang Wenze , Zhang Baozhong , Chang Xiao
Published: April 2023

Rationale:

Myositis ossificans circumscripta (MOC) is a rare disorder that causes heterotopic bone formation in soft tissues. It usually occurs after trauma and affects large muscles of the extremities. MOC of the pectineus muscle is extremely rare and has not been reported to be treated surgically.

Patient concerns:

A 52-year-old woman presented with left hip pain and dysfunction 4 months after a traffic accident that caused pelvic and humeral fractures and cerebral hemorrhage.

Diagnoses:

Radiological imaging revealed isolated ossification of the left pectineus muscle. The patient was diagnosed with MOC.

Interventions:

The patient underwent surgical resection of the ossified pectineus muscle followed by local radiation and medical therapy.

Outcomes:

At 12 months postoperatively, she was asymptomatic and had normal hip function. No recurrence was observed on radiography.

Lessons:

MOC of the pectineus muscle is a rare condition that can cause severe hip dysfunction. Surgical resection combined with radiation and anti-inflammatory drugs can be an effective treatment option for patients who do not respond to conservative management.
A randomized, active-controlled, parallel, open-label, multicenter, phase 4 study to compare the efficacy and safety of pregabalin sustained release tablet and pregabalin immediate release capsule in type II diabetic patients with peripheral neuropathic pain
Authors: Kang Seon Mee , Hong Jun Hwa , Ku Bon Jeong
Published: April 2023

Background:

Diabetic peripheral polyneuropathy is the most common chronic complication of type 2 diabetes. Neuropathic pain is challenging to manage, and various drugs are required to control it, decreasing treatment adherence. Pregabalin, a ligand that binds to alpha-2-delta subunits of the presynaptic calcium channel, has been approved by the Food and Drug Administration for the treatment of diabetic neuropathic pain. In this study, we will compare the efficacy, safety, treatment satisfaction, and compliance between pregabalin sustained-release (SR) tablets and pregabalin immediate-release (IR) capsules in type 2 diabetic patients with peripheral neuropathic pain.

Methods:

This study is a randomized, active-controlled, parallel, open-label, multicenter, phase 4 clinical trial (trial registration NCT05624853). Type 2 diabetic patients with glycosylated hemoglobin below 10% and peripheral neuropathic pain who have been taking pregabalin 150 mg/d or more for more than 4 weeks will be randomly assigned to pregabalin SR tablet (150 mg once a day, n = 65) or pregabalin IR capsule (75 mg twice a day, n = 65) therapy for 8 weeks. The primary outcome will be the efficacy of SR pregabalin after 8 weeks of treatment, which will be assessed by visual analog scale measurements. The secondary outcomes will include changes in several parameters, such as quality of life, treatment satisfaction, quality of sleep, and drug compliance.

Discussion:

In thus study, we aim to demonstrate that pregabalin SR tablets are associated with better compliance and satisfaction compared with pregabalin IR capsules, despite similar efficacy.
Non-alcoholic fatty liver disease is associated with an increased risk of type 2 diabetes
Authors: Loosen Sven H. , Krieg Sarah , Krieg Andreas , Qvartskhava Natalia , Luedde Tom , Kostev Karel , Roderburg Christoph
Published: April 2023

Objective

Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease worldwide and represents the leading cause of liver-related morbidity and mortality. Its all-cause mortality is often driven by co-existing metabolic diseases such as type 2 diabetes (T2DM), which share many pathophysiological characteristics. The risk of developing T2DM among NAFLD patients in Germany is only poorly described.

Methods

A cohort of 17 245 NAFLD patients and a propensity score-matched cohort of equal size were identified from the Disease Analyzer database (IQVIA) between 2005 and 2020. The incidence of T2DM was evaluated as a function of NAFLD during a 5-year study period using Cox-regression models.

Results

Within 5 years of the index date, 18.8% and 11.7% of individuals with and without NAFLD were diagnosed with T2DM (P < 0.001). Regression analysis revealed a hazard ratio of 1.77 [95% confidence interval (CI), 1.68–1.88] for the development of T2DM among NAFLD patients. Subgroup analyses confirmed this association for all age groups (18–50, 51–60, 61–70 and >70 years), male and female patients, as well as normal weight (BMI < 25 kg/m2), overweighted (BMI 25–30 kg/m2) and obese (BMI > 30 kg/m2) patients.

Conclusion

Our data revealed a significantly increased incidence of T2DM among NAFLD patients in Germany. Given the dramatically increasing global relevance of NAFLD, we believe that prevention and regular screening programs for T2DM in NAFLD patients could help to reduce its high mortality and morbidity in the future.
Recognizing Rohingya adolescent girls’ menstrual hygiene in Bangladesh to enhance reproductive health: a commentary
Authors: Akter Masuda , Jamil Safayet , Kabir Humayun
Published: April 2023

The Rohingya, an ethnic minority group in Myanmar, have been subjected to decades of persecution and violence, forcing them to flee to neighboring countries such as Bangladesh. The correspondence recognizes Rohingya adolescent girls’ menstrual hygiene in Bangladesh to enhance reproductive health. Adolescent girls make up 52% of the Rohingya population in the Cox’s Bazar region’s refugee camps, and there are few resources to help them manage their menstrual hygiene, posing significant health risks. Inadequate menstrual hygiene can result in sexual and urinary tract infections, infertility, and pregnancy complications. Most of the adolescent girls had poor menstrual hygiene practices. Unfortunately, only 10.89% of Rohingya girls wear underwear without disposable sanitary pads, and 17.82% use disposable sanitary pads. Furthermore, 67% of Rohingya girls do not have access to proper menstrual healthcare. Bangladeshi girls, on the other hand, have better access to menstrual hygiene products and have more good practices. There is a need to develop menstrual hygiene-friendly infrastructure as well as menstrual hygiene understanding and practices among the Rohingya. Authorities can help improve the current situation and promote healthy menstrual hygiene practices among Rohingya girls by implementing specific requirements, such as ensuring menstrual hygiene products.
Successful nonoperative treatment of a closed posteromedial ankle dislocation without associated fractures – a case report
Authors: Almotlaqem Nahar , Altammar Abdulaziz , Hassan Adnan , Lari Ali
Published: April 2023

Introduction:

Pure ankle dislocations occurring in the absence of malleolus fractures are extremely rare injuries. These injuries often present with high-energy trauma and ligamentous injury. Comprehensive research is not available due to the rarity of the injury. However, recent literature has supported treatment by nonoperative means. This case report aims to discuss a similar case and offer insight into the prognosis of such injuries.

Case presentation:

A previously healthy 26-year-old male was diagnosed with a closed posteromedial ankle dislocation without associated fractures. Reduction was performed under procedural sedation and confirmed with postreduction radiographs. The patient was immobilized and scheduled for serial follow-up in the outpatient department. Weight bearing was gradually introduced at 6 weeks along with physiotherapy. The American Orthopedic Foot and Ankle Score was 90 and 100 at 6 months and 1 year follow-up, respectively. Return to sports was possible at 1 year postinjury. Range of motion was normal apart from a 5–8° ankle dorsiflexion deficit. Radiographs, computed tomography, and MRI were unremarkable with longer term follow-up.

Conclusion:

Patients who sustain pure ankle dislocations with an intact distal tibiofibular syndesmosis can expect favorable outcomes with immobilization, splinting, and gradual rehabilitation, as evident by the high American Orthopedic Foot and Ankle Score and the time to return to sports. This case report serves to provide prognostic information and anticipate outcomes in patients with similar injuries.
Late recurrence of chromophobe renal cell carcinoma to unusual sites after 12 years of radical nephrectomy and radiotherapy: a rare case report from Syria
Authors: Zahlout Jaafar , Shmayyes Haidar , Zahlout Batoul , Salloum Mariam , Kassab Yahya , Zahlouk Nadim , Alshehabi Zuheir
Published: April 2023

Introduction and Importance:

In 2020, renal cell carcinoma (RCC) had an incidence of 73 750 new cases. This cancer is well known for its ability to give early and late metastases to some usual and unusual sites. The term ‘late recurrence’ is widely used to indicate a period exceeding 10 years from curative nephrectomy. This not-understood behaviour is almost specific to RCC, and it happens in a range between 4.3 and 11% of cases of RCC.

Case Presentation:

We report a case of a 67-year-old nonalcoholic smoker Syrian male presented with a 2-month painful mass located at the left upper posterolateral abdominal wall’s region. He has had a history of left chromophobe cell RCC treated with radical nephrectomy with adjuvant radiotherapy for 12 years. In light of computed tomography’s findings, a surgical biopsy was performed, and a pathological and immunohistochemical examination confirmed the diagnosis of chromophobe RCC.

Clinical Discussion:

Malignant cells seeding the surgical cut path and staying dormant for 12 years is the best theory of many to explain our case.

Conclusion:

We reported evidence for the potential of a relatively indolent histologic type of RCC (i.e. chromophobe cell carcinoma) to cause late recurrence after 12 years to a very rare site (i.e. abdominal wall’s superficial muscles). Research should focus on addressing late recurrence to determine the best surveillance protocols; investigating malignant cells seeding during surgery to improve surgical oncology’s outcomes; and studying late recurrence’s genetics to boost our targeted therapy options.
Risk factors of Helicobacter pylori infection in Bukavu, Democratic Republic of the Congo: a case–control study
Authors: Birato Yannick C. , Armand Masimango Bahati , Katabana Delphin M. , Shindano Tony A.
Published: April 2023

Background:

Helicobacter pylori(H. pylori) is the common etiology of gastric tumors. This study aimed to evaluate the risk factors associated withH. pyloriinfection in the eastern part of the Democratic Republic of the Congo (DR Congo), where these tumors seem to be more frequent than in its western part.

Patients and Methods:

Between January and December 2021, the authors conducted a multicenter case–control study in three hospitals in Bukavu City involving 90 individuals with dyspeptic complaints. Risk factors forH. pyloriinfection were assessed in a participant interview andH. pyloristatus from stool antigen detection.

Results:

Among the risk factors assessed, only history ofH. pyloriin the family and the habit of adding salt to already-seasoned food were found positively associated with the risk ofH. pyloriinfection (adjusted odds ratio: 7, 95 CI: 2.742–17.867;P<0.0001 and 2.911, 95% CI: 1.010–8.526;P=0.048, respectively). On the other hand, low-temperature food storage seems to be protective with a negative association (adjusted odds ratio: 0.044, 95% CI: 0.009–0.206;P=0.0001).

Conclusion:

This study demonstrated again the importance of lifestyle-related factors on the risk of acquisition ofH. pylori. These findings call for preventive interventions for this group of individuals.
Bilateral choanal atresia diagnosed in a 3-month-old female baby: a case report
Authors: Abraham Zephania S. , Kahinga Aveline A.
Published: April 2023

Introduction and Importance:

Bilateral choanal atresia is a congenital anomaly where a newborn baby is born with bilateral imperforate posterior nares. In most cases, the diagnosis is established immediately after birth due to respiratory distress since newborn babies are obligate nasal breathers till 6 weeks of life. Establishing the diagnosis requires a high index of suspicion as it is characterized by paradoxical cyclical cyanosis. Delayed diagnosis of bilateral choanal atresia is a rare encounter in clinical practice. We are hereby reporting a 3-month-old baby with bilateral choanal atresia, and perhaps it is the third latest diagnosed case of bilateral choanal atresia in Tanzania.

Case Presentation:

We present a 3-month-old female baby who was attended to at our department with a history of difficulty in breathing characterized by bilateral nasal obstruction since birth. The baby was admitted for 3 weeks due to episodes of respiratory distress after birth. She was thereafter discharged from the hospital and attended various hospitals without relief since the baby was managed as a case of adenoid hypertrophy.

Clinical Discussion:

The patient underwent bilateral transnasal endoscopic choanal atresia release with stenting under general anesthesia in the operating room. Postoperatively, she was kept on a nasal decongestant, a broad-spectrum antibiotic, and an analgesic. Regular suctioning was done during routine follow-up.

Conclusion:

Clinicians must have a high index of suspicion to establish the diagnosis of bilateral choanal atresia in newborn babies. Immediate surgical perforation of the atretic choanae with or without stenting remains to be the treatment of choice.
Inappropriate Shock Delivery Is Common During Pediatric In-Hospital Cardiac Arrest
Authors: Gray James M. , Raymond Tia T. , Atkins Dianne L. , Tegtmeyer Ken , Niles Dana E. , Nadkarni Vinay M. , Pandit Sandeep V. , Dewan Maya ,   for the pediRES-Q Investigators
Published: April 2023

OBJECTIVES:

To characterize inappropriate shock delivery during pediatric in-hospital cardiac arrest (IHCA).

DESIGN:

Retrospective cohort study.

SETTING:

An international pediatric cardiac arrest quality improvement collaborative Pediatric Resuscitation Quality [pediRES-Q].

PATIENTS:

All IHCA events from 2015 to 2020 from the pediRES-Q Collaborative for which shock and electrocardiogram waveform data were available.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We analyzed 418 shocks delivered during 159 cardiac arrest events, with 381 shocks during 158 events at 28 sites remaining after excluding undecipherable rhythms. We classified shocks as: 1) appropriate (ventricular fibrillation [VF] or wide complex ≥ 150/min); 2) indeterminate (narrow complex ≥ 150/min or wide complex 100–149/min); or 3) inappropriate (asystole, sinus, narrow complex < 150/min, or wide complex < 100/min) based on the rhythm immediately preceding shock delivery. Of delivered shocks, 57% were delivered appropriately for VF or wide complex rhythms with a rate greater than or equal to 150/min. Thirteen percent were classified as indeterminate. Thirty percent were delivered inappropriately for asystole (6.8%), sinus (3.1%), narrow complex less than 150/min (11%), or wide complex less than 100/min (8.9%) rhythms. Eighty-eight percent of all shocks were delivered in ICUs or emergency departments, and 30% of those were delivered inappropriately.

CONCLUSIONS:

The rate of inappropriate shock delivery for pediatric IHCA in this international cohort is at least 30%, with 23% delivered to an organized electrical rhythm, identifying opportunity for improvement in rhythm identification training.
Country of birth is associated with antiretroviral therapy choice in treatment-naive persons living with HIV in France
Authors: Palich Romain , Hentzien Maxime , Hocqueloux Laurent , Duvivier Claudine , Allavena Clotilde , Huleux Thomas , Delobel Pierre , Makinson Alain , Rey David , Cuzin Lise
Published: April 2023

Objectives:

We aimed to describe factors associated with the choice of first ART in PLHIV in France, included the country of birth, as well as the time to undetectable viral load and treatment discontinuation.

Design:

Observational study conducted from the national Dat’AIDS prospectively collected database.

Methods:

We included all adults who started their first ART between 01/01/2014 and 12/31/2020, with a pretherapeutic plasma viral load (pVL)≥400 copies/mL. Uni- and multivariable logistic regressions were used to analyze PLHIV characteristics driving to an INSTI-based first prescribed regimen. We also analyzed time to first line discontinuation, and to a first undetectable pVL, using Kaplan-Meier and Cox models.

Results:

We analyzed data from 9094 PLHIV: 45% men who have sex with men, 27% women and 27% heterosexual men; 48% born abroad; 4.7% and 2.8% with concomitant hepatitis B and tuberculosis, respectively. INSTIs were prescribed as first line therapy in 50% of PLHIV, which increased over time. Native French PLHIV were more likely to receive an INSTI-based regimen than PLHIV born abroad PLHIV (adjusted prevalence ratio 1.47, 95%CI 1.33–1.60), as were high pVL at diagnosis, hepatitis B or concomitant tuberculosis. Time before discontinuation the first ART and reaching a first undetectable pVL was not different according to the place of birth.

Conclusion:

Despite unrestricted access to INSTIs in France, independently from HIV disease parameters, PLHIV born abroad received INSTIs less frequently as a first regimen than those born in France. Qualitative data are needed to better understand physicians’ prescribing practices.
Evaluation of 11C-Choline PET/CT for T Staging and Tumor Volume Delineation in Nasopharyngeal Cancer Patients in Comparison to 18F-FDG PET/CT
Authors: Li Chunyan , Yang Yuhui , Hu Fan , Xu Yuanyuan , Wu Bian , Huang Jing , Yang Kunyu , Lan Xiaoli
Published: April 2023

Purpose

Accurate determination of the primary tumor extension of nasopharyngeal carcinoma (NPC) by 18F-FDG PET/CT is limited by the high physiological 18F-FDG uptake in the surrounding area, especially in the brain tissue. We aimed to assess whether 11C-choline PET/CT could improve the accuracy of T staging and tumor volume delineation for NPC patients.

Methods

Patients with pathologically confirmed diagnosis of NPC were enrolled. The primary tumor extension of each patient was evaluated by 11C-choline PET/CT, 18F-FDG PET/CT, and contrast-enhanced MRI. The PET/CT-based tumor volume (V
PET) was measured by 3 threshold methods, including the threshold of SUV 2.5 (Th2.5), 40% of maximal SUV (Th40%), and the relative background-dependent threshold (Thbgd). Tumor volume and Dice similarity coefficient were compared among V
PET with different segmentation methods and V
MR.

Results

Thirty-three patients with treatment-naive NPC and 6 patients with suspicious recurrent disease were enrolled. The NPC lesions were avid for both 11C-choline and 18F-FDG. Visual analysis showed that 11C-choline PET/CT had better contrast and higher discernability than 18F-FDG PET/CT for intracranial, skull base, and orbital involvement. 11C-choline PET/CT also exhibited advantage over MRI for differentiation between local recurrence and radiation-induced alterations. For the tumor delineated, the V
MR was larger than V
PET in general, except for 18F-FDG PET/CT with Th2.5 threshold. For all 3 threshold methods applied, 11C-choline PET/CT produced more consistent and comparable tumor volume to MRI than 18F-FDG PET/CT. 11C-choline PET/CT with Thbgd threshold showed the closest tumor volume and highest similarity to MRI.

Conclusions

11C-choline PET/CT provides a higher accuracy than 18F-FDG PET/CT in mapping tumor extension in locally advanced NPC and may be a promising complement to MRI in delineating the primary tumor.
Education Improves Emergency Department Providers' Knowledge of Human Trafficking
Authors: Arceneaux Stephanie P.
Published: April 2023

The purpose of this quality improvement (QI) initiative was to implement a human trafficking (HT) education module for the emergency department (ED) staff and providers along with implementation of a policy and protocol for screening, identification, and referral of HT victims in the ED to increase provider knowledge of HT and ensure provider compliance with the HT protocol via documentation of red flags and screening questions in the electronic medical record along with social services referrals. The goal of the social services referral was to connect the HT victim with community resources that facilitated placement, food, and shelter in the event the trafficking victim accepted rescue. HT is a public health concern, globally, nationally, and at the state and local levels. ED providers, which include advanced practice registered nurses such as nurse practitioners and clinical nurse specialists, are positioned to be able to identify and treat victims of HT. Therefore, HT victims are being seen and treated in EDs; however, health care providers are not recognizing them. Project design was a QI initiative, which utilized a convenience sample of ED providers. All ED providers and staff completed the HT Education module in Health Stream with pretest/posttest assessments via the PROTECT instrument, which evaluated ED staff/provider knowledge, perceived, actual, and confidence of HT, demographics, previous contact with HT victims, and participant preference for future HT training. HT Education resulted in improved knowledge of participants' perceived, actual, and confidence of HT as demonstrated by statistical significance from pretest to posttest scores; therefore, the HT educational training proved to be beneficial.
Mpox Masquerading as Secondary Syphilis
Authors: Whealon Candice
Published: April 2023

Mpox is a great masquerader requiring emergency nurse practitioners to rely on their clinical acumen to accurately diagnose and treat this public health emergency. The disease is nearly indistinguishable from other pox viruses and similar in presentation to several viral and bacterial infections associated with enanthems and exanthems. The most recent outbreak disproportionally affects men who have sex with men, particularly those individuals with HIV. Early recognition and intervention are key; however, clinicians' lack of knowledge, limited access to testing, and unfamiliarity with appropriate medications and vaccines historically reserved for smallpox create a barrier to treatment. Emergency nurse practitioners must gain an understanding of this disease to provide the care and anticipatory guidance to prevent associated morbidity, mortality, and spread of mpox.
Computer-Generated ECG Interpretation Challenge
Authors: Colio Pedro A. , Palakodeti Vachaspathi
Published: April 2023

The predictive accuracy of 12-lead electrocardiogram (ECG) machines is often challenged across all clinical settings. Emergency clinicians must beware of computer-generated ECG reports specifically during the initial medical screening process. Blindly trusting computer-generated reports may delay care for patients with an acute cardiac disorder. Cardiology consultation is always advised, and there should be no hesitation when it comes to abnormal ECGs. However, cardiologists are often consulted on patients based on incorrect ECG interpretation, misdiagnosis, or overdiagnosis by computer-generated reports. The following 12-lead ECGs should encourage emergency providers to take caution and challenge computer-generated reports. The purpose of this exercise is to carefully review a set of 12-lead ECGs and determine whether the computer-generated interpretations are accurate.
Organ Donation Organization Architecture: Recommendations From an International Consensus Forum
Authors: Williment Claire , Beaulieu Louis , Clarkson Anthony , Gunderson Susan , Hartell David , Escoto Manuel , Ippersiel Richard , Powell Linda , Kirste Gunter , Nathan Howard M. , Opdam Helen , Weiss Matthew J.
Published: April 2023

Background.

This report contains recommendations from 1 of 7 domains of the International Donation and Transplantation Legislative and Policy Forum (the Forum). The purpose is to provide expert guidance on the structure and function of Organ and Tissue Donation and Transplantation (OTDT) systems. The intended audience is OTDT stakeholders working to establish or improve existing systems.

Methods.

The Forum was initiated by Transplant Québec and co-hosted by the Canadian Donation and Transplantation Program partnered with multiple national and international donation and transplantation organizations. This domain group included administrative, clinical, and academic experts in OTDT systems and 3 patient, family, and donor partners. We identified topic areas and recommendations through consensus, using the nominal group technique. Selected topics were informed by narrative literature reviews and vetted by the Forum’s scientific committee. We presented these recommendations publicly, with delegate feedback being incorporated into the final report.

Results.

This report has 33 recommendations grouped into 10 topic areas. Topic areas include the need for public and professional education, processes to assure timely referral of patients who are potential donors, and processes to ensure that standards are properly enforced.

Conclusions.

The recommendations encompass the multiple roles organ donation organizations play in the donation and transplantation process. We recognize the diversity of local conditions but believe that they could be adapted and applied by organ donation organizations across the world to accomplish their fundamental objectives of assuring that everyone who desires to become an organ donor is given that opportunity in a safe, equitable, and transparent manner.
Non-severe burns induce a prolonged systemic metabolic phenotype indicative of a persistent inflammatory response post-injury
Authors: Ryan Monique J. , Raby Edward , Whiley Luke , Masuda Reika , Lodge Samantha , Nitschke Philipp , Maker Garth L. , Wist Julien , Holmes Elaine , Wood Fiona M. , Nicholson Jeremy K. , Fear Mark W. , Gray Nicola
Published: April 2023

Globally, burns are a significant cause of injury that can cause substantial acute trauma as well as lead to increased incidence of chronic co-morbidity and disease. To date, research has primarily focused on the systemic response to severe injury, with little in the literature reported on impact of non-severe injuries (<15% total burn surface area; TBSA). To elucidate the metabolic consequences of non-severe burn injury, longitudinal plasma was collected from adults (n=35) who presented at hospital with a non-severe burn injury at admission, and at 6 week follow up. A cross-sectional baseline sample was also collected from non-burn control participants (n=14). Samples underwent multiplatform metabolic phenotyping using1H nuclear magnetic resonance spectroscopy and liquid chromatography-mass spectrometry to quantify 112 lipoprotein and glycoproteins signatures and 852 lipid species from across 20 subclasses.

Multivariate data modelling (Orthogonal projection to latent structures-discriminate analysis) revealed alterations in lipoprotein and lipid metabolism when comparing baseline control to hospital admission samples, with the phenotypic signature found to be sustained at follow up. Univariate (Mann-Whitney U) testing and OPLS-DA indicated specific increases in GlycB (p-value <1.0e-4), low density lipoprotein-2 subfractions (Variable importance in projection score; VIP >6.83e-1) and monoacyglyceride (20:4)(p-value <1.0e-4) and decreases in circulating anti-inflammatory high-density lipoprotein-4 subfractions (VIP >7.75e-1), phosphatidylcholines, phosphatidylglycerols, phosphatidylinositols and phosphatidylserines.

The results indicate a persistent systemic metabolic phenotype that occurs even in cases of non-severe burn injury. The phenotype is indicative of an acute inflammatory profile which continues to be sustained post-injury, suggesting an impact on systems health beyond the site of injury. The phenotypes contained metabolic signatures consistent with chronic inflammatory states reported to have elevated incidence post-burn injury. Such phenotypic signatures may provide patient stratification opportunities, to identify individual responses to injury, personalise intervention strategies and improve acute care, reducing risk of chronic co-morbidity.
FUME-TCRseq: Sensitive and accurate sequencing of the T-cell receptor from limited input of degraded RNA
Authors: Baker Ann-Marie , Nageswaran Gayathri , Nenclares Pablo , Ronel Tahel , Smith Kane , Kimberley Christopher , Lacle Miangela M , Bhide Shree , Harrington Kevin J , Melcher Alan , Rodriguez-Justo Manuel , Chain Benny , Graham Trevor A
Published: April 2023

Genomic analysis of the T-cell receptor (TCR) reveals the strength, breadth and clonal dynamics of the adaptive immune response to pathogens or cancer. The diversity of the TCR repertoire, however, means that sequencing is technically challenging, particularly for samples with low quality, degraded nucleic acids. Here, we have developed and validated FUME-TCRseq, a robust and sensitive RNA-based TCR sequencing methodology that is suitable for formalin-fixed paraffin-embedded samples and low amounts of input material. FUME-TCRseq incorporates unique molecular identifiers into each molecule of cDNA, allowing correction for sequencing errors and PCR bias. We used RNA extracted from colorectal and head and neck cancers to benchmark the accuracy and sensitivity of FUME-TCRseq against existing methods, and found excellent concordance between the datasets. Furthermore, FUME-TCRseq detected more clonotypes than a commercial RNA-based alternative, with shorter library preparation time and significantly lower cost. The high sensitivity and the ability to sequence RNA of poor quality and limited amount enables quantitative analysis of small numbers of cells from archival tissue sections, which is not possible with other methods. To demonstrate this we performed spatially-resolved FUME-TCRseq of colorectal cancers using macrodissected archival samples, revealing the shifting T-cell landscapes at the transition to an invasive phenotype, and between tumour subclones containing distinct driver alterations. In summary, FUME-TCRseq represents an accurate, sensitive and low-cost tool for the characterisation of T-cell repertoires, particularly in samples with low quality RNA that have not been accessible using existing methodology.
Time-series Classification for Patients under Active Surveillance and Screening Using Echo State Network
Authors: Li Zonglun , Zaikin Alexey , Blyuss Oleg
Published: April 2023

Abstract

Over the past few decades, more and more patients come on follow-up studies such as active surveillance and screening, which results in a vast amount of time-series data in the health department. Each Patient typically has a small but different number of visits to the doctor and the time interval between the visits is heterogeneous. Nowadays, many machine learning tasks in relation to time series data are carried out using deep recurrent neural networks (RNN). However, deep neural networks consume enormous computational power as all weights in the network need to be trained through back-propagation. Conversely, echo state network (ESN), another form of RNN, demonstrates low training cost and the potential of it is still largely untapped. Therefore, in this article we will develop a new methodology that can classify aforementioned time-series data using the echo state network. We will also discuss how to address the heterogeneity in the time interval arising from the data of this type and how our model can also potentially fit other time-series data.
EnGens: a computational framework for generation and analysis of representative protein conformational ensembles
Authors: Conev Anja , Rigo Mauricio Menagatti , Devaurs Didier , Fonseca André Faustino , Kalavadwala Hussain , de Freitas Martiela Vaz , Clementi Cecilia , Zanatta Geancarlo , Antunes Dinler Amaral , Kavraki Lydia
Published: April 2023

Proteins are dynamic macromolecules that perform vital functions in cells. A protein structure determines its function, but this structure is not static, as proteins change their conformation to achieve various functions. Understanding the conformational landscapes of proteins is essential to understand their mechanism of action. Sets of carefully chosen conformations can summarize such complex landscapes and provide better insights into protein function than single conformations. We refer to these sets as representative conformational ensembles. Recent advances in computational methods have led to an increase in number of available structural datasets spanning conformational landscapes. However, extracting representative conformational ensembles from such datasets is not an easy task and many methods have been developed to tackle it. Our new approach, EnGens (short for ensemble generation), collects these methods into a unified framework for generating and analyzing protein conformational ensembles. In this work we: (1) provide an overview of existing methods and tools for protein structural ensemble generation and analysis; (2) unify existing approaches in an open-source Python package, and a portable Docker image, providing interactive visualizations within a Jupyter Notebook pipeline; (3) test our pipeline on a few canonical examples found in the literature. Representative ensembles produced by EnGens can be used for many downstream tasks such as protein-ligand ensemble docking, Markov state modeling of protein dynamics and analysis of the effect of single-point mutations.
Uncovering the hidden structure of dynamic T cell composition in peripheral blood during cancer immunotherapy: a topic modeling approach
Authors: Peng Xiyu , Lee Jasme , Adamow Matthew , Maher Colleen , Postow Michael A. , Callahan Margaret K. , Panageas Katherine S. , Shen Ronglai
Published: April 2023

Immune checkpoint inhibitors (ICIs), now mainstays in the treatment of cancer treatment, show great potential but only benefit a subset of patients. A more complete understanding of the immunological mechanisms and pharmacodynamics of ICI in cancer patients will help identify the patients most likely to benefit and will generate knowledge for the development of next-generation ICI regimens. We set out to interrogate the early temporal evolution of T cell populations from longitudinal single-cell flow cytometry data. We developed an innovative statistical and computational approach using a Latent Dirichlet Allocation (LDA) model that extends the concept of topic modeling used in text mining. This powerful unsupervised learning tool allows us to discover compositional topics within immune cell populations that have distinct functional and differentiation states and are biologically and clinically relevant. To illustrate the model’s utility, we analyzed ∼17 million T cells obtained from 138 pre- and on-treatment peripheral blood samples from a cohort of melanoma patients treated with ICIs. We identified three latent dynamic topics: a T-cell exhaustion topic that recapitulates a LAG3+ predominant patient subgroup with poor clinical outcome; a naive topic that shows association with immune-related toxicity; and an immune activation topic that emerges upon ICI treatment. We identified that a patient subgroup with a high baseline of the naïve topic has a higher toxicity grade. While the current application is demonstrated using flow cytometry data, our approach has broader utility and creates a new direction for translating single-cell data into biological and clinical insights.
InterOpt: Improved gene expression quantification in qPCR experiments using weighted aggregation of reference genes
Authors: Salimi Adel , Rahmani Saeid , Sharifi-Zarchi Ali
Published: April 2023

Quantification of gene expression is a crucial task in biomedical studies. Although high-throughput methods enable rapid and simultaneous expression quantification of coding or non-coding regions, qPCR is still vastly used due to its high availability, sensitivity, specificity, reproducibility, low cost, and ease of use. A limitation of qPCR has been the need of internal controls or reference genes (RGs) with stable expression in different conditions, to normalize the expression level of the other target genes. So far, several stability criteria and numerous methods for selecting a group of RGs have been proposed, however, important challenges must be addressed. Here we introduce a mathematical basis for precise modeling of qPCR expression normalization and justify widely used stability measures of RGs. We then propose a family of scale-invariant functions, as an alternative to the geometric mean, to optimize aggregated expression of RGs. We provide closed-form optimizations for several scale-invariant aggregation functions. Among them, we show the superiority of weighted geometric mean, whose parameters optimize standard deviation as the stability measure of aggregated RGs expression. We provide experimental support for this finding using real data of solid tumors and liquid biopsies of different sample sizes.

The proposed methods can be easily integrated in the existing qPCR expression normalization pipelines of genes and non-coding RNAs. We also provide an implementation of the proposed methods as an R package, with GPU acceleration.

Availability and implementation

https://github.com/asalimih/InterOpt

Contact

asalimih@gmail.com