bluuebunny/crossref_metadata_2025 huggingface dataset:
Discourse Structures, Weaponization of Language and Ethiopia’s Civil War
Authors: Mafu Lucas
Published: August 2024

The use of language to alienate, ostracize, dehumanize, and mobilize people on racial, ethnic, and other forms of profiling has been a prominent feature of the Ethiopian conflict between the government of Mr Abiy Ahmed and the Tigray People’s Liberation Front (TPLF). In fact, the jingoistic vitriol in the civil war amounted to hate speech which reflected the deeper ethno-regional fissures which have been embedded in Ethiopia’s political tapestry for many years. The Tigray/Addis Ababa conflict not only heightened both the ethno-cultural and political divides in the country, but also, worsened the vitriolic speech in the framing processes of the adversarial “other.” This rendered language itself a choice weapon of warfare. Using discourse analysis, the hermeneutic analysis and the articulatory theory, this paper, therefore, argues that Ethiopia’s ethno-provincialist politics, fragmental federalism and the state’s hegemonic discourses have together exacerbated and further entrenched the political disintegration of the Ethiopian body politic while also rendering post-conflict peace-making and nation-building efforts more hazardous. While the parties to the conflict have agreed an African Union (AU) sponsored ceasefire, genuine peace-building efforts, this paper urges, must begin with the disavowal of inflammatory language by all the belligerents and a concurrent detoxification of the national political discourse.
For the Students: A Teacher’s Explanation of Curricular Pivots
Authors: Bronstein Erin A. , Smith Victoria Davis
Published: August 2024

This paper considers the way a world history teacher structured his world history class around his perception of student needs. Part of a larger project, this single case study highlights the teacher’s efforts to make his curriculum relevant to his students largely from minoritized backgrounds. The researchers analyze the ways in which the world history teacher struggled to prioritize his students’ lived experiences.
Association of blood inflammatory phenotypes and asthma burden in children with moderate-to-severe asthma
Authors: Alizadeh Bahmani Amir Hossein , Vijverberg Susanne J.H. , Hashimoto Simone , Wolff Christine , Almqvist Catarina , Bloemsma Lizan D. , Brandstetter Susanne , Corcuera-Elosegui Paula , Gorenjak Mario , Harner Susanne , Hedman Anna M. , Kabesch Michael , López-Fernández Leyre , Kraneveld Aletta D. , Neerincx Anne H. , Pino-Yanes Maria , Potočnik Uroš , Sardón-Prado Olaia , Dierdorp Barbara S. , Dekker Tamara , Metwally Nariman K.A. , Duitman Jan Willem , Lutter René , Brinkman Paul , Abdel-Aziz Mahmoud I. , Maitland-van der Zee Anke H.
Published: August 2024

Background

Underlying immunological mechanisms in children with moderate-to-severe asthma are complex and unclear. We aimed to investigate the association between blood inflammatory parameters and asthma burden in children with moderate-to-severe asthma.

Methods

Blood inflammatory parameters (eosinophil and neutrophil counts and inflammatory mediators using multiplex immunoassay technology) were measured in children (6–17 years) with moderate-to-severe asthma from the SysPharmPediA cohort across four European countries. Based upon low/high blood eosinophil (LBE/HBE) counts of </≥0.3×109·L−1, respectively and low/high blood neutrophil (LBN/HBN) counts of </≥4×109·L−1, respectively, mixed (HBE-HBN), eosinophilic (HBE-LBN), neutrophilic (LBE-HBN) and paucigranulocytic (LBE-LBN) phenotypes were defined. Inflammatory mediator profiles and burden of disease (asthma control status, exacerbations and school days missed in the past year) were compared between phenotypes using adjusted logistic regression models.

Results

Among 126 included children (41% girls and mean (sd) age of 11.94 (2.76)), 22%, 44%, 11% and 23% were classified as mixed, eosinophilic, neutrophilic and paucigranulocytic phenotypes, respectively. Neutrophilic children had the lowest lung function (forced expiratory volume in 1 s % predicted pre-salbutamol) compared with other groups. Children with mixed asthma were most often uncontrolled and had the highest asthma-related school absence in the past year. Interleukin (IL)-6 and matrix metalloproteinase-9 levels were significantly higher in patients with mixed or neutrophilic asthma, whereas tissue inhibitor of metalloproteinase-2 was lower in patients with neutrophilic asthma compared with eosinophilic or paucigranulocytic asthma. IL-5 was increased in eosinophilic group compared with the neutrophilic and paucigranulocytic groups, irrespective of the chosen cut-off for eosinophilia.

Conclusion

Differences in asthma burden-related clinical expression and distinct blood inflammatory mediator profiles were found between phenotypes, highlighting implications for optimising personalised treatment and management strategies in children with moderate-to-severe asthma.
Anti-interleukin-5/anti-interleukin-5 receptor α treatment improves self-reported work productivity in patients with severe eosinophilic asthma: a prospective cohort trial
Authors: Brinkmann Lina , Fuge Jan , Welte Tobias , Suhling Hendrik , Drick Nora
Published: August 2024

Background

Severe asthma affects the working life of millions of people worldwide. Interleukin (IL)-5/anti-interleukin-5 receptor α (IL-5Rα) antibodies are highly effective in reducing symptoms in patients with severe eosinophilic asthma. We analysed effects of anti-IL-5/anti-IL-5Rα treatment on self-reported productivity and absenteeism at work in patients with severe eosinophilic asthma.

Methods

In this prospective single-centre study, patients with severe eosinophilic asthma received a questionnaire assessing their actual occupational status and the influence asthma has on their work life, productivity and missed days at work prior to initiation of antibody treatment and after 6 and 12 months of therapy. Among others, the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem (WPAI:SHP) was used.

Results

Out of 54 patients with a median age of 60 years, 27 (50%) were employed. In addition to an increase in asthma control and lung function, self-reported productivity increased significantly with a decrease on the WPAI:SHP from 30% (interquartile range (IQR) 20–50%) to 10% (IQR 0–27.5%) under treatment (p=0.001). Furthermore, self-reported missed days at work were reduced from 2 days·month−1(IQR 1.75–6 days·month−1) to 0 days·month−1(IQR 0–2 days·month−1; p=0.067). At baseline 22 employed patients (81%) stated they were affected at work by their asthma. After 12 months of treatment, this number decreased to eight patients (30%; p=0.038).

Conclusions

This prospective analysis could prove the substantial impact severe asthma has on patients’ working life. Anti-IL-5/anti-IL-5Rα treatment in patients with severe eosinophilic asthma leads to a significant increase in self-reported productivity at work, and after 12 months of treatment patients state substantially fewer negative effects on their working situation.
Biomarkers troponin and procalcitonin in addition to CRB-65 enhance risk stratification in patients with community-acquired pneumonia
Authors: Farhat Imrana , Rosolowski Maciej , Ahrens Katharina , Lienau Jasmin , Ahnert Peter , Pletz Mathias , Rohde Gernot , Rupp Jan , Scholz Markus , Witzenrath Martin ,   the CAPNETZ Study Group
Published: August 2024

Background

Community-acquired pneumonia (CAP) remains a leading cause of infectious disease mortality globally, necessitating intensive care unit (ICU) admission for ∼10% of hospitalised patients. Accurate prediction of disease severity facilitates timely therapeutic interventions.

Methods

Our study aimed to enhance the predictive capacity of the clinical CRB-65 score by evaluating eight candidate biomarkers: troponin T high-sensitive (TnT-hs), procalcitonin (PCT), N-terminal pro-brain natriuretic peptide, angiopoietin-2, copeptin, endothelin-1, lipocalin-2 and mid-regional pro-adrenomedullin. We utilised a machine-learning approach on 800 samples from the German CAPNETZ network (competence network for CAP) to refine risk prediction models combining these biomarkers with the CRB-65 score regarding our defined end-point: death or ICU admission during the current CAP episode within 28 days after study inclusion.

Results

Elevated levels of biomarkers were associated with the end-point. TnT-hs exhibited the highest predictive performance among individual features (area under the receiver operating characteristic curve, AUC=0.74), followed closely by PCT (AUC=0.73). Combining biomarkers with the CRB-65 score significantly improved prediction accuracy. The combined model of CRB-65, TnT-hs and PCT demonstrated the best balance between high predictive value and parsimony, with an AUC of 0.77 (95% CI: 0.72–0.82), while CRB-65 alone achieved an AUC of 0.67 (95% CI: 0.64–0.73).

Conclusion

Our findings suggest that augmenting the CRB-65 score with TnT-hs and PCT enhances the prediction of death or ICU admission in hospitalised CAP patients. Validation of this improved risk score in additional CAP cohorts and prospective clinical studies is warranted to assess its broad clinical utility.
Therapeutic doses of efzofitimod demonstrate efficacy in pulmonary sarcoidosis
Authors: Obi Ogugua Ndili , Baughman Robert P. , Crouser Elliott D. , Julian Mark W. , Locke Landon W. , Chandrasekaran Abhijeeth , Ramesh Pavithra , Kinnersley Nelson , Niranjan Vis , Culver Daniel A. , Sporn Peter H.S.
Published: August 2024

Background

In a phase 1b/2a clinical trial of efzofitimod in patients with corticosteroid-requiring pulmonary sarcoidosis, treatment resulted in dose-dependent improvement in key end-points. We undertook apost hocanalysis pooling dose arms that achieved therapeutic concentrations of efzofitimod (Therapeutic group)versusthose that did not (Subtherapeutic group).

Methods

Peripheral blood mononuclear cells incubated with tuberculin-coated beads were exposed to varying concentrations of efzofitimod in anin vitroassay to determine concentrations that inhibited granuloma formation. In thepost hocanalysis, we compared time-to-first-relapse and changes in pulmonary function after a protocolised corticosteroid taper in the Therapeutic and Subtherapeutic groups.

Results

Efzofitimod at ≥300 nM (19 µg·mL−1) inhibited granuloma formationin vitro. Based on mean efzofitimod serum concentrations achieved in the phase 1b/2a study, the 3 and 5 mg·kg−1dose arms were pooled as the Therapeutic group, while the 1 mg·kg−1arm was pooled with the placebo arm as the Subtherapeutic group. Relapse rates were 54.4% and 7.7% in the Subtherapeutic group and Therapeutic group, respectively. Median time-to-first-relapse in the Subtherapeutic group was 126 days, whereas in the Therapeutic group, only one of 17 patients relapsed by the end of the 24-week study (p=0.017). Slopes analysis showed that forced vital capacity increased in the Therapeutic group, but decreased in the Subtherapeutic group, over the course of the trial (p=0.035).

Conclusion

Treatment with efzofitimod at therapeutic doses, as compared with a subtherapeutic dose or placebo, was associated with a lower rate of relapse as corticosteroids were tapered.
Financial strain and social support as moderators of the relationship between living alone and depressive symptoms in older people
Authors: Chen Tsui-Fang , Pien Li-Chung , Fan Chun-Sung , Liang Kai-Lin , Chiu Yi-Wen
Published: August 2024

This study investigated the moderating effect of financial strain or social support on depressive symptoms among older people living alone in Taiwan. Data were collected from the “Taiwan Longitudinal Study on Aging (TLSA),” which included 1513 participants aged 65 and over, among them, 153 (10.1%) were living alone, while 1360 (89.9%) were living with others. Measurement tools included the Depression scale (CES-D), financial stress scale, social support scale, ADL scale, IADL scale, and stress scale, with Cronbach’s α coefficients were 0.85, 0.78, 0.67, 0.91, 0.90, and 0.70 respectively. Hierarchical multiple regression was used to examine the moderator effect. The findings revealed that (1) Financial strain was found to moderate the relationship between living alone and depressive symptoms, acting as a promotive moderator among older men living alone. For older women, financial stress does not moderate the relationship between living alone and depressive symptoms. However, financial strain was also identified as a significant factor associated with depressive symptoms among older women living alone. (2) Social support does not moderate effect on the relationship between living alone and depressive symptoms in older men or older women. These results underscore the importance of considering financial stress in mental health policy development by government agencies. It is imperative to address the unique challenges faced by older individuals living alone, particularly in relation to financial strain, in order to promote their mental well-being.
Paxlovid reduces the 28-day mortality of patients with COVID-19: a retrospective cohort study
Authors: Zong Kaican , Xu Li , Luo Chun , Luo Chen , Liu Bin , Chen Jiacheng , Wu Huizi , Liu Zhiqiang , Zhuang Rongjuan , Guo Shuliang
Published: August 2024

Purpose

In this study, we aim to explore the efficacy of paxlovid on reducing mortality of COVID-19 patients in clinical setting, especially whether paxlovid modifies the risk of death in these severe and critical patients.

Methods

Our retrospective cohort study was conducted on the medical records of patients, consecutively admitted for COVID-19 to five hospitals in Chongqing, China from Dec 8, 2022 to Jan 20, 2023. Based on whether patients received paxlovid during their hospitalization, patients were grouped as paxlovid group and non-paxlovid group. We used 1:1 ratio propensity score matching (PSM) in our study to adjust for confounding factors and differences between groups. Statistical analysis were performed by SPSS 23.0. The differences in 28-day mortality between these two groups and its influencing factors were the main results we focused on.

Results

There were 1018 patients included in our study cohort. With 1:1 ratio PSM, each of the paxlovid group and non-paxlovid group included 237 patients. The results showed that patients using paxlovid have a lower 28-day mortality in overall population either before PSM (OR 0.594, 95% CI 0.385–0.917, p = 0.019) or after PSM (OR 0.458, 95% CI 0.272–0.774, p = 0.003) with multivariable adjusted logistic regression models. Meanwhile, in severe subgroup, it showed similar findings.With paxlovid treatment, it showed a significantly lower 28-day mortality in severe subgroup both before PSM (28% vs.41%, p = 0.008) and after PSM (19% vs.32%, p = 0.007).

Conclusion

Paxlovid can significantly reduce the risk of 28-day mortality in overall population and severe subgroup patients.This study distinguished the severe subgroup patients with COVID-19 who benefit more from paxlovid treatment.
A case report of empyema caused by Enterococcus gallinarum
Authors: Liu Min , Liu Jixiang , Wu Juanjuan , Liu Shuang , Sun Lu , Li Fajiu , Li Chenghong
Published: August 2024

Background

Enterococcus gallinarum is an infrequently intestinal symbiotic pathogen associated with nosocomial infection in immunocompromised individuals. To date, rare cases of pulmonary infection attributable to Enterococcus gallinarum were reported. Herein, we presented the first case of empyema resulting from Enterococcus gallinarum infection.

Case presentation

An 81-year-old male presented with fever and dyspnea upon admission. Chest CT scan and thoracic ultrasonography confirmed the presence of right pleural effusion. Thoracoscopy revealed extensive adhesion, purulent fluid, and necrotic materials within the thoracic cavity. Enterococcus gallinarum was identified through pleural effusion culture. The patient underwent an intrathoracic injection of urokinase along with thoracic drainage. Following surgery, He took oral linezolid for over one month. Undergoing comprehensive treatment, the patient exhibited favorable recovery.

Conclusions

We reported the first case of empyema due to Enterococcus gallinarum infection. It should be suspected in patients with impaired immune function and invasive therapies, without responding to conventional anti-infectious treatment.
Nomograms established for predicting microvascular invasion and early recurrence in patients with small hepatocellular carcinoma
Authors: Wang Xi , Chai Xinqun , Zhang Ji , Tang Ruiya , Chen Qinjunjie
Published: August 2024

Background

In this study, we aimed to establish nomograms to predict the microvascular invasion (MVI) and early recurrence in patients with small hepatocellular carcinoma (SHCC), thereby guiding individualized treatment strategies for prognosis improvement.

Methods

This study retrospectively analyzed 326 SHCC patients who underwent radical resection at Wuhan Union Hospital between April 2017 and January 2022. They were randomly divided into a training set and a validation set at a 7:3 ratio. The preoperative nomogram for MVI was constructed based on univariate and multivariate logistic regression analysis, and the prognostic nomogram for early recurrence was constructed based on univariate and multivariate Cox regression analysis. We used the receiver operating characteristic (ROC) curves, area under the curves (AUCs), and calibration curves to estimate the predictive accuracy and discriminability of nomograms. Decision curve analysis (DCA) and Kaplan-Meier survival curves were employed to further confirm the clinical effectiveness of nomograms.

Results

The AUCs of the preoperative nomogram for MVI on the training set and validation set were 0.749 (95%CI: 0.684–0.813) and 0.856 (95%CI: 0.805–0.906), respectively. For the prognostic nomogram, the AUCs of 1-year and 2-year RFS respectively reached 0.839 (95%CI: 0.775–0.903) and 0.856 (95%CI: 0.806–0.905) in the training set, and 0.808 (95%CI: 0.719–0.896) and 0.874 (95%CI: 0.804–0.943) in the validation set. Subsequent calibration curves, DCA analysis and Kaplan-Meier survival curves demonstrated the high accuracy and efficacy of the nomograms for clinical application.

Conclusions

The nomograms we constructed could effectively predict MVI and early recurrence in SHCC patients, providing a basis for clinical decision-making.
“Opportunities and responsibilities”: how do pharmacists assess their professionalism?
Authors: Araújo-Neto Fernando de Castro , Dosea Aline Santana , Tavares Thaís Maria Araújo , Santos Douglas de Menezes , Mesquita Alessandra Rezende , de Araújo Dyego Carlos Souza Anacleto , de Lyra-Jr Divaldo Pereira
Published: August 2024

Introduction

Professionalism is fundamental to the existence of professions. In pharmacy, interest in this theme improved with events that examined the resocialization of pharmacists in care. With this, evaluating professionalism can help the operationalization of the theme and, consequently, the development of strategies for pharmacy consolidation before its challenges. Therefore, this study aimed to evaluate the professionalism of Brazilian pharmacists.

Methods

To meet the objective, a cross-sectional study was conducted between March 2022 and August 2023. Data were collected using the Brazilian version of the “Modification of Hall’s Professionalism Scale for Use with Pharmacists”. The scale has 39 items grouped into the domains: autonomy, vocation, professional council, self-regulation, continuing education, and altruism. Data were analyzed using descriptive statistics and an ANOVA analysis of variance with post-hoc Hochberg or Games-Howell tests with Bootstrapping was conducted to verify differences between groups.

Results

600 pharmacists participated in this study. The majority (69%) was female and carried out their professional activities in community pharmacies (50%). Professionalism scores ranged between 14 and 29 points, with an average of 22.8 points. Pharmacists working in outpatient clinics had higher scores in most factors, namely, altruism, continuing education, professional council, vocation, and autonomy. This indicates that the inclination of pharmacists to occupy areas focused on care can be significant to assess professionalism.

Conclusions

The data obtained indicate that pharmacists working in outpatient clinics had higher professionalism scores compared to others. This corroborates the worldwide trend experienced by pharmacy in recent decades, which is the execution of increasingly patient-centered practice models.
Navigating challenges and opportunities: perspectives on digital service development in substance use disorder treatment
Authors: Kosonen Janika , Shorter Gillian W. , Kuusisto Katja
Published: August 2024

Background

Some people with substance use disorders (SUD) can experience multiple co-occurring social problems. Digital solutions have been developed to support effective and cost-effective social welfare and healthcare in addictions treatment. Given the varying severity of problems from alcohol and other drug use, digital service tools can save money and provide tailored care.

Objective

In this study we aimed to understand the perspectives of those who develop digital service tools on people with SUD and treatment encounters. As a case, we interviewed those who have been involved in the development of a digital client segmentation tool The Navigator.

Methods

Ten (N = 10) semi-structured interviews were conducted with professionals involved in digital client segmentation tool development and were analysed with inductive content analysis. Participants were asked about the development of the Navigator from the perspectives of their own role as developers, the clients, the effectiveness of the services, and decision-making processes.

Findings

Some people with SUD may face several obstacles when using digital services. Digital divide, feared or experienced stigma and biased attitudes, complex life situations, and difficulties in committing to treatment were identified as challenges. Nevertheless, digital solutions can offer the clients alternative ways of using the services that can better meet their individual needs. The anonymity and facelessness of digital solutions can reduce the fear of immediate judgement. Implementing digital solutions in substance use work poses challenges due to chronic staff shortages. Digitalisation often results in the creation of multiple simultaneously managed channels, potentially reducing time-consumption but increasing the perceived workload. There is a call for multi-professionalism, acknowledging inequalities between various disciplines within the field.
Evolution of continuing medical education in radiology: on-site vs remote
Authors: Adriaensen M. , Ricci P. , Prosch H. , Rupreht M.
Published: August 2024

Objectives

To assess the evolution of continuing medical education/continuous professional development (CME/CPD) in European Radiology with a particular focus on on-site (live educational events, LEE) vs remote (electronic learning materials, ELM) participation and the impact of the COVID-19 pandemic.

Methods

Results related to CME/CPD of surveys conducted by the Accreditation Council of Imaging (ACI) between 2017 and 2020 are summarized. Additional insights from the survey conducted in spring 2023, exploring online education trends since the start of the COVID-19 pandemic, are presented. Finally, the results of the surveys are correlated with the total number of CME/CPD applications received annually from 2018 to 2022.

Results

Pre-pandemic, 90% of European radiologists supported mandatory CME and unified CME/CPD-system. A trend among younger radiologists towards ELM was observed. Only 20% of employers fully endorsed CME/CPD. In 2020, LEE attendance dropped significantly (95.5–33%), with a simultaneous surge (33–58%) in time spent on ELM. Post-pandemic, the majority (52%) of LEE attendees participated in 1–5 events, whereas the majority (38%) of attendees of live-streamed events participated in 6–20 meetings. Content remains a priority of respondents in all formats: 79% for online, 75% for on-site, and 74% for on-demand. While the assessed quality of LEE remained at the same level (no change (36%) or good/very good (48%)), a considerably higher percentage of respondents noticed the quality of live-streamed events was good/very good (83%).

Conclusion

The majority of European radiologists support mandatory CME and a unified CME/CPD system. Despite the post-pandemic resurgence in LEE, ELM and hybrid events are predicted to gain further prominence.

Critical relevance statement

The CME/CPD system dynamically adapts to evolving professional, technical, and environmental circumstances, with human interaction gaining heightened significance post-COVID-19.

Key Points

Professionals expressed a desire to return to on-site participation, highlighting its desirability for social interaction.

Electronic learning materials are poised for continued growth, particularly among younger generations.

Professionals expressed a desire towards a unified CME/CPD system in Europe.

Graphical Abstract
Myocardial hypertrophy: the differentiation of uremic, hypertensive, and hypertrophic cardiomyopathies by cardiac MRI
Authors: Tian Zhaoxin , Jin Shiqi , Huo Huaibi , Zheng Yue , Li Yue , Liu Hui , Geng Zhaodi , Liu Shutong , Li Shinuo , Liu Zequn , Wang Xinru , Liu Ting
Published: August 2024

Objectives

To apply cardiac magnetic resonance imaging (CMR) for detailed myocardial characterization in uremic cardiomyopathy (UC), hypertensive cardiomyopathy (HTN), and hypertrophic cardiomyopathy (HCM) aiming to enrich the understanding of UC’s etiology and further support the development of therapeutic strategies.

Methods

A total of 152 patients (age: 49.2 ± 9.9 years; 65.8% male) underwent routine CMR from June 2016 to March 2023. Retrospectively, 53 patients with UC, 39 patients with HTN, 30 patients with HCM, and 30 healthy controls were included. Functional analysis, feature tracking of the left ventricle and left atrium, and myocardial T1, T2, and T2* mapping were performed. Statistical analysis included Pearson correlation and ROC analysis to define correlations and discriminators between groups.

Results

UC patients demonstrated significantly higher native T1 (p < 0.001 for all) and T2 (p < 0.002 for all) values compared with the other three groups. UC patients revealed higher left atrial reservoir strain rate (p < 0.001 for all) and left atrial conduit strain rate (p < 0.001 for all) absolute values as compared with HTN and HCM patients. A significant correlation between T1 and T2 values in UC patients (r = 0.511, p < 0.001) was found. The combination of T1 values and strain parameters was the best discriminator between UC and HTN patients (AUC = 0.872, 95% CI: 0.801–0.943) and between UC and HCM patients (AUC = 0.840, 95% CI: 0.746–0.934).

Conclusion

UC reveals distinguishing tissue characteristics as evidenced by T1 and T2 mapping, as well as distinguishing functional strain parameters as compared with other hypertrophic phenotypes such as HTN and HCM.

Critical relevance statement

The use of CMR imaging in UC patients offers incremental information to elucidate its complex etiology, contributing to ongoing discourse on effective treatment pathways.

Key Points

This study investigated uremic, hypertensive, and hypertrophic cardiomyopathies using cardiac MRI.

UC patients have higher T1 and T2 values and better preserved cardiac function.

Combined strain and T1 values distinguish UC from other cardiomyopathies.

Graphical Abstract
Differentiating lung neuroendocrine neoplasms from tumor-like infection using CT in patients with ectopic ACTH syndrome
Authors: Song Lan , Miao Hui , Zhu Zhenchen , Zhu Huijuan , Wang Jinhua , Xing Xiaoping , Zhu Zhaohui , Jiang Yuanyuan , Feng Ruie , Xiao Yu , Duan Lian , Sui Xin , Liu Qingxing , Wang Linjie , Chen Shi , Song Wei , Jin Zhengyu , Lu Lin
Published: August 2024

Objectives

Pulmonary neuroendocrine neoplasms (NENs) are the most frequent cause of ectopic adrenocorticotropic hormone syndrome (EAS); lung infection is common in EAS. An imaging finding of infection in EAS patients can mimic NENs. This retrospective study investigated EAS-associated pulmonary imaging indicators.

Methods

Forty-five pulmonary NENs and 27 tumor-like infections from 59 EAS patients (45 NEN and 14 infection patients) were included. Clinical manifestations, CT features, 18F-FDG, or 68Ga-DOTATATE-PET/CT images and pathological results were collected.

Results

High-sensitivity C-reactive protein (p < 0.001) and expectoration occurrence (p = 0.04) were higher, and finger oxygen saturation (p = 0.01) was lower in the infection group than the NENs group. Higher-grade NENs were underrepresented in our cohort. Pulmonary NENs were solitary primary tumors, 80% of which were peripheral tumors. Overlying vessel sign and airway involvement were more frequent in the NENs group (p < 0.001). Multifocal (p = 0.001) and peripheral (p = 0.02) lesions, cavity (p < 0.001), spiculation (p = 0.01), pleural retraction (p < 0.001), connection to pulmonary veins (p = 0.02), and distal atelectasis or inflammatory exudation (p = 0.001) were more frequent in the infection group. The median CT value increment between the non-contrast and arterial phases was significantly higher in NENs lesions (p < 0.001). Receiver operating characteristic curve analysis indicated a moderate predictive ability at 48.3 HU of delta CT value (sensitivity, 95.0%; specificity, 54.1%).

Conclusion

Chest CT scans are valuable for localizing and characterizing pulmonary lesions in rare EAS, thereby enabling prompt differential diagnosis and treatment.

Critical relevance statement

Thin-slice CT images are valuable for the localization and identification of pulmonary ectopic adrenocorticotropic hormone syndrome lesions, leading to prompt differential diagnosis and effective treatment.

Key Points

Lung tumor-like infections can mimic neuroendocrine neoplasms (NENs) in ectopic adrenocorticotropic hormone syndrome (EAS) patients.

NENs are solitary lesions, whereas infections are multiple peripheral pseudotumors each with identifying imaging findings.

Typical CT signs aid in localization and creating an appropriate differential diagnosis.

Graphical Abstract
The accuracy and quality of image-based artificial intelligence for muscle-invasive bladder cancer prediction
Authors: He Chunlei , Xu Hui , Yuan Enyu , Ye Lei , Chen Yuntian , Yao Jin , Song Bin
Published: August 2024

Purpose

To evaluate the diagnostic performance of image-based artificial intelligence (AI) studies in predicting muscle-invasive bladder cancer (MIBC). (2) To assess the reporting quality and methodological quality of these studies by Checklist for Artificial Intelligence in Medical Imaging (CLAIM), Radiomics Quality Score (RQS), and Prediction model Risk of Bias Assessment Tool (PROBAST).

Materials and methods

We searched Medline, Embase, Web of Science, and The Cochrane Library databases up to October 30, 2023. The eligible studies were evaluated using CLAIM, RQS, and PROBAST. Pooled sensitivity, specificity, and the diagnostic performances of these models for MIBC were also calculated.

Results

Twenty-one studies containing 4256 patients were included, of which 17 studies were employed for the quantitative statistical analysis. The CLAIM study adherence rate ranged from 52.5% to 75%, with a median of 64.1%. The RQS points of each study ranged from 2.78% to 50% points, with a median of 30.56% points. All models were rated as high overall ROB. The pooled area under the curve was 0.85 (95% confidence interval (CI) 0.81–0.88) for computed tomography, 0.92 (95% CI 0.89–0.94) for MRI, 0.89 (95% CI 0.86–0.92) for radiomics and 0.91 (95% CI 0.88–0.93) for deep learning, respectively.

Conclusion

Although AI-powered muscle-invasive bladder cancer-predictive models showed promising performance in the meta-analysis, the reporting quality and the methodological quality were generally low, with a high risk of bias.

Critical relevance statement

Artificial intelligence might improve the management of patients with bladder cancer. Multiple models for muscle-invasive bladder cancer prediction were developed. Quality assessment is needed to promote clinical application.

Key Points

Image-based artificial intelligence models could aid in the identification of muscle-invasive bladder cancer.

Current studies had low reporting quality, low methodological quality, and a high risk of bias.

Future studies could focus on larger sample sizes and more transparent reporting of pathological evaluation, model explanation, and failure and sensitivity analyses.

Graphical Abstract
Implementation of a soft grading system for chemistry in a Moodle plugin: reaction handling
Authors: Plyer Louis , Marcou Gilles , Perves Céline , Bonachera Fanny , Varnek Alexander
Published: August 2024

Here, we present a new method for evaluating questions on chemical reactions in the context of remote education. This method can be used when binary grading is not sufficient as some tolerance may be acceptable. In order to determine a grade, the developed workflow uses the pairwise similarity assessment of two considered reactions, each encoded by a single molecular graph with the help of the Condensed Graph of Reaction (CGR) approach. This workflow is part of the ChemMoodle project and is implemented as a Moodle Plugin. It uses the Chemdoodle engine for reaction drawing and visualization and communicates with a REST server calculating the similarity score using ISIDA fragment descriptors. The plugin is open-source, accessible in GitHub (https://github.com/Laboratoire-de-Chemoinformatique/moodle-qtype_reacsimilarity) and on the Moodle plugin store (https://moodle.org/plugins/qtype_reacsimilarity?lang=en). Both similarity measures and fragmentation can be configured.

Scientific contribution

This work introduces an open-source method for evaluating chemical reaction questions within Moodle using the CGR approach. Our contribution provides a nuanced grading mechanism that accommodates acceptable tolerances in reaction assessments, enhancing the accuracy and flexibility of the grading process.
Nutritional and metabolic modulation of inflammation in critically ill patients: a narrative review of rationale, evidence and grey areas
Authors: Rousseau Anne-Françoise , Martindale Robert
Published: August 2024

Background

Inflammation is the hallmark of critical illness and triggers the neuro-endocrine stress response and an oxidative stress. Acute inflammation is initially essential for patient’s survival. However, ongoing or exaggerated inflammation, due to persistent organ dysfunction, immune dysfunction or poor inflammation resolution, is associated to subsequent hypermetabolism and hypercatabolism that severely impact short and long-term functional status, autonomy, as well as health-related costs. Modulation of inflammation is thus tempting, with the goal to improve the short- and long-term outcomes of critically ill patients.

Findings

Inflammation can be modulated by nutritional strategies (including the timing of enteral nutrition initiation, the provision of some specific macronutrients or micronutrients, the use of probiotics) and metabolic treatments. The most interesting strategies seem to be n-3 polyunsaturated fatty acids, vitamin D, antioxidant micronutrients and propranolol, given their safety, their accessibility for clinical use, and their benefits in clinical studies in the specific context of critical care. However, the optimal doses, timing and route of administration are still unknown for most of them. Furthermore, their use in the recovery phase is not well studied and defined.

Conclusion

The rationale to use strategies of inflammation modulation is obvious, based on critical illness pathophysiology and based on the increasingly described effects of some nutritional and pharmacological strategies. Regretfully, there isn’t always substantial proof from clinical research regarding the positive impacts directly brought about by inflammation modulation. Some arguments come from studies performed in severe burn patients, but such results should be transposed to non-burn patients with caution. Further studies are needed to explore how the modulation of inflammation can improve the long-term outcomes after a critical illness.
On some common fixed point results for two infinite families of uniformly L-Lipschitzian total asymptotically quasi-nonexpansive mappings
Authors: Nuntadilok Buraskorn , Kingkam Pitchaya , Nantadilok Jamnian , Samanmit Khanitin
Published: August 2024

In this manuscript, we introduce a new class of uniformly L-Lipschitzian and total asymptotically quasi-nonexpansive mappings, which is significantly more general than many known nonexpansive mappings that appeared before. We establish some convergence and Δ-convergence theorems for two infinite families of such mappings in the setting of CAT(κ) spaces. Our results refine, generalize, and improve several corresponding results in the existing literature.
Molecular epidemiology and phylogenetic analysis of influenza viruses A (H3N2) and B/Victoria during the COVID-19 pandemic in Guangdong, China
Authors: Zeng Zhiqi , Liu Yong , Jin Wenxiang , Liang Jingyi , Chen Jinbin , Chen Ruihan , Li Qianying , Guan Wenda , Liang Lixi , Wu Qiubao , Lai Yuanfang , Deng Xiaoyan , Lin Zhengshi , Hon Chitin , Yang Zifeng
Published: August 2024

Background

Non-pharmaceutical measures and travel restrictions have halted the spread of coronavirus disease 2019 (COVID-19) and influenza. Nonetheless, with COVID-19 restrictions lifted, an unanticipated outbreak of the influenza B/Victoria virus in late 2021 and another influenza H3N2 outbreak in mid-2022 occurred in Guangdong, southern China. The mechanism underlying this phenomenon remains unknown. To better prepare for potential influenza outbreaks during COVID-19 pandemic, we studied the molecular epidemiology and phylogenetics of influenza A(H3N2) and B/Victoria that circulated during the COVID-19 pandemic in this region.

Methods

From January 1, 2018 to December 31, 2022, we collected throat swabs from 173,401 patients in Guangdong who had acute respiratory tract infections. Influenza viruses in the samples were tested using reverse transcription-polymerase chain reaction, followed by subtype identification and sequencing of hemagglutinin (HA) and neuraminidase (NA) genes. Phylogenetic and genetic diversity analyses were performed on both genes from 403 samples. A rigorous molecular clock was aligned with the phylogenetic tree to measure the rate of viral evolution and the root-to-tip distance within strains in different years was assessed using regression curve models to determine the correlation.

Results

During the early period of COVID-19 control, various influenza viruses were nearly undetectable in respiratory specimens. When control measures were relaxed in January 2020, the influenza infection rate peaked at 4.94% (39/789) in December 2021, with the influenza B/Victoria accounting for 87.18% (34/39) of the total influenza cases. Six months later, the influenza infection rate again increased and peaked at 11.34% (255/2248) in June 2022; influenza A/H3N2 accounted for 94.51% (241/255) of the total influenza cases in autumn 2022. The diverse geographic distribution of HA genes of B/Victoria and A/H3N2 had drastically reduced, and most strains originated from China. The rate of B/Victoria HA evolution (3.11 × 10−3, P < 0.05) was 1.7 times faster than before the COVID-19 outbreak (1.80 × 10−3, P < 0.05). Likewise, the H3N2 HA gene’s evolution rate was 7.96 × 10−3 (P < 0.05), which is 2.1 times faster than the strains’ pre-COVID-19 evolution rate (3.81 × 10−3, P < 0.05).

Conclusions

Despite the extraordinarily low detection rate of influenza infection, concealed influenza transmission may occur between individuals during strict COVID-19 control. This ultimately leads to the accumulation of viral mutations and accelerated evolution of H3N2 and B/Victoria viruses. Monitoring the evolution of influenza may provide insights and alerts regarding potential epidemics in the future.
Effects of multistrain Bifidobacteria and Lactobacillus probiotics on HMO compositions after supplementation to pregnant women at threatening preterm delivery: design of the randomized clinical PROMO trial
Authors: Welp A. , Laser E. , Seeger K. , Haiß A. , Hanke K. , Faust K. , Stichtenoth G. , Fortmann-Grote C. , Pagel J. , Rupp J. , Göpel W. , Gembicki M. , Scharf JL. , Rody A. , Herting E. , Härtel C. , Fortmann I.
Published: August 2024

Background

As an indigestible component of human breast milk, Human Milk Oligosaccharides (HMOs) play an important role as a substrate for the establishing microbiome of the newborn. They have further been shown to have beneficial effects on the immune system, lung and brain development. For preterm infants HMO composition of human breast milk may be of particular relevance since the establishment of a healthy microbiome is challenged by multiple disruptive factors associated with preterm birth, such as cesarean section, hospital environment and perinatal antibiotic exposure. In a previous study it has been proposed that maternal probiotic supplementation during late stages of pregnancy may change the HMO composition in human milk. However, there is currently no study on pregnancies which are threatened to preterm birth. Furthermore, HMO composition has not been investigated in association with clinically relevant outcomes of vulnerable infants including inflammation-mediated diseases such as sepsis, necrotizing enterocolitis (NEC) or chronic lung disease.

Main body

A randomized controlled intervention study (PROMO = probiotics for human milk oligosaccharides) has been designed to analyze changes in HMO composition of human breast milk after supplementation of probiotics (Lactobacillus acidophilus, Bifidobacterium lactis and Bifidobacterium infantis) in pregnancies at risk for preterm birth. The primary endpoint is HMO composition of 3-fucosyllactose and 3’-sialyllactose in expressed breast milk. We estimate that probiotic intervention will increase these two HMO levels by 50% according to the standardized mean difference between treatment and control groups. As secondary outcomes we will measure preterm infants’ clinical outcomes (preterm birth, sepsis, weight gain growth, gastrointestinal complications) and effects on microbiome composition in the rectovaginal tract of mothers at delivery and in the gut of term and preterm infants by sequencing at high genomic resolution. Therefore, we will longitudinally collect bio samples in the first 4 weeks after birth as well as in follow-up investigations at 3 months, one year, and five years of age.

Conclusions

We estimate that probiotic intervention will increase these two HMO levels by 50% according to the standardized mean difference between treatment and control groups. The PROMO study will gain insight into the microbiome-HMO interaction at the fetomaternal interface and its consequences for duration of pregnancy and outcome of infants.
DSC-Net: learning discriminative spatial contextual features for semantic segmentation of large-scale ancient architecture point clouds
Authors: Zhao Jianghong , Liu Rui , Hua Xinnan , Yu Haiquan , Zhao Jifu , Wang Xin , Yang Jia
Published: August 2024

Semantic segmentation of point cloud data of architectural cultural heritage is of significant importance for HBIM modeling, disease extraction and analysis, and heritage restoration research fields. In the semantic segmentation task of architectural point cloud data, especially for the protection and analysis of architectural cultural heritage, the previous deep learning methods have poor segmentation effects due to the complexity and unevenness of the data, the high geometric feature similarity between different components, and the large scale changes. To this end, this paper proposes a novel encoder-decoder architecture called DSC-Net. It consists of an encoder-decoder structure based on point random sampling and several fully connected layers for semantic segmentation. To overcome the loss of key features caused by random downsampling, DSC-Net has developed two new feature aggregation schemes: the enhanced dual attention pooling module and the global context feature module, to learn discriminative features for the challenging scenes mentioned above. The former fully considers the topology and semantic similarity of neighboring points, generating attention features that can distinguish categories with similar structures. The latter uses spatial location and neighboring volume ratio to provide an overall view of different types of architectural scenes, helping the network understand the spatial relationships and hierarchical structures between different architectural elements. The proposed modules can be easily embedded into various network architectures for point cloud semantic segmentation. We conducted experiments on multiple datasets, including the ancient architecture dataset, the ArCH architectural cultural heritage dataset, and the publicly available architectural segmentation dataset S3DIS. The results show that the mIoU reached 63.56%, 55.84%, and 71.03% respectively. The experimental results prove that our method has the best segmentation effect in dealing with challenging architectural cultural heritage data and also demonstrates its practicality in a wider range of architectural point cloud segmentation applications.