bluuebunny/crossref_metadata_2025 huggingface dataset:
A Late Recurrent Metastatic Breast Cancer Mimicking Primary Pancreatic Cancer: Case Report
Authors: Sakhri Saida , Zemni Ines , Jouini Safa , Abidi Fethia , Boujelbene Nadia , Ben Dhiab Tarek
Published: June 2024

Metastasis to the pancreas from malignant tumors is a rare event, representing only 1% to 2% of all pancreatic neoplasms. They occur in 2 different clinicopathological settings: as a manifestation in widespread metastatic disease or as an isolated mass in the pancreas. We report the case of a 41-year-old woman who had a history of invasive lobular breast cancer treated with radical surgery, chemotherapy, and radiotherapy. After 21 years of total remission, she presented for severe lower back pain with jaundice, nausea, and loss of 9 kg in 3 months. Abdominal computed tomography demonstrated a hyper vascularized, irregular solid lesion of 2.6 cm × 2.1 cm in the head of the pancreas with discreet biliary duct dilatation and coelio-mesenteric enlarged lymph nodes measuring 2 cm. The diagnosis of pancreatic metastasis from a lobular breast carcinoma was made by percutaneous biopsy of pancreatic lesion. The multidisciplinary committee decided a palliative treatment. The patient received chemotherapy. The take home message from his case is that we should keep in mind the hypothesis of a solitary metastasis to the pancreas, when the pancreatic lesion develops in a patient who had a clinical history of previous neoplasm especially in those which is known to potentially metastasize to pancreas.
Factors Associated With Quality of Life Among Adolescent With Beta Thalassemia in Indonesia: A Cross-Sectional Study
Authors: Mardhiyah Ai , Panduragan Santhna Letcmi , Mediani Henny Suzana , Yosep Iyus
Published: June 2024

Introduction

Thalassemia is a hereditary condition that causes chronic anemia and is a serious public health concern globally. Quality of life is a concept to help healthcare professional understand the impact of disease or treatment of life. While many quality of life studies have been performed to improve patient care in developed countries, such research and their practical implementation are limited in developing countries such as Indonesia.

Objective

This study aimed to assess the quality of life in adolescent with thalassemia in Indonesia, and determining its main clinical and demographic correlations.

Methods

This was a cross-sectional study. Data were collected between December 2020 and May 2021 from patients diagnosed with beta thalassemia in Indonesia. The study involved adolescent diagnosed with thalassemia major and had been officially recorded in the thalassemia association records at least three months prior data collection. TranQOL was used to measure quality of life. Linear regression with enter method was used to determine factors associated with quality of life.

Results

showed that 63% of thalassemic adolescents were aged at 10 to 15 years old and 76% of them had diagnosed with beta thalassemia at aged less than one year old. About 54% ( n = 130) of the sample were boy and 45% ( n = 108) were junior high school. The highest mean score was reported for physical health (58.3 ± 14.8) and the lowest score was reported for the school and career functioning (52.6 ± 14.3). Age, gender, comorbidity, and hemoglobin concentration explained 10.5% of the variances in the total quality of life.

Conclusions

The results of this study that thalassemia has a detrimental impact on the quality of life of Indonesian adolescents. Healthcare providers must expand their access to information and abilities in order to fulfill new nursing responsibilities as genetic educators and counselors.
Modeling Sex-Bias in Anxiety: Pros and Cons of a Larval Zebrafish Model
Authors: Pretorius Lesha , Balshaw Aidan G. , Ross Kelly S. , Smith Carine
Published: June 2024

Anxiety disorders are the most prevalent psychiatric disorders, exhibiting strong female bias. Clinical studies implicate declining estradiol levels in the exacerbation of anxiety symptoms in the premenstrual phase of the menstrual cycle. This study aimed to simulate estradiol fluctuation-linked anxiety behavior in larval zebrafish, using an estradiol treatment withdrawal model. Contrary to model aims, estradiol treatment withdrawal decreased both basal activity and anxiety-like hyperlocomotion (ANOVA main effect of dose, P < 0.0001 and P < 0.01, respectively) in the light/dark transition test. The accuracy of the estradiol washout model was not improved by longer durations of treatment or withdrawal. Basal activity was slightly altered by supraphysiological concentrations of WAY-200070 in the absence of added estradiol. Estrogen receptor (ER) β expression was not upregulated in larvae exposed to physiologically relevant, low concentrations of estradiol. Longer exposure to low concentrations of estradiol increased antioxidant capacity ( P < 0.01). In addition, acute exposure to low concentrations of estradiol increased basal activity. Data suggest that in the current models, estradiol-associated altered activity levels were linked to more favorable redox status, rather than reflecting altered anxiety levels. As such, it is recommended that zebrafish larval behavioral analysis be conducted in parallel with mechanistic studies such as redox indicators, for investigations focused on ER signaling.
Zygoma Asymmetry in Non-Syndromic Patients with Unilateral Cleft Lip and Palate
Authors: Fotouhi Annahita R. , Chiang Sarah N. , Peterson Andrew M. , Albers Brian , Skolnick Gary B. , Long Katherine D. , Liebendorfer Adam P. , Snyder-Warwick Alison K. , Patel Kamlesh B.
Published: June 2024

Background:

Cleft lip and palate are often accompanied by maxillary asymmetry and midface hypoplasia. However, there has been limited examination of the symmetry of the zygoma in these patients. In this study, computed tomography scans prior to alveolar bone grafting are utilized to examine zygomatic symmetry through width, projection, and volume.

Methods:

Retrospective review was conducted of patients with nonsyndromic unilateral cleft lip and palate with eligible scans prior to alveolar bone grafting at our institution. Anterior zygomatic width, posterior zygomatic width, and zygomatic projection were measured on axial images oriented to the Frankfort horizontal, and three-dimensional digital models of each zygoma were created from the computed tomography data to estimate zygoma volume. These measurements were then compared on cleft and noncleft sides.

Results:

Twenty-two patients were included in this study. The mean (95% CI) zygoma volume of the cleft side and non-cleft side was 4219 mm3 (3858-4574 mm3) and 4286 mm3 (3932-4660 mm3), respectively, with a mean difference of −67 mm3 ([−402-266 mm3]; P = .704). The zygomatic projection of the cleft side was 43 mm (41-45 mm) in comparison to 47 cm (45-49 mm) for the non-cleft side. Mean difference in zygomatic projection was −4 mm (−5 to −2 mm, P < .001). Mean anterior zygomatic width was greater on the cleft side (42 mm [41-44 mm]) than the non-cleft side (41 mm [40-42 mm]; P = .037). No significant difference was found between posterior zygomatic width of the cleft side (59 mm [58-60 mm]) and non-cleft side (58 mm [57-59 mm]; P = .118).

Conclusions:

Upon preoperative image analysis in patients with non-syndromic, unilateral lip and palate clefts, zygomatic projection was significantly different between cleft and non-cleft sides. Evaluation of zygoma asymmetry should be included as a component of the physical exam when assessing a patient with unilateral cleft lip and palate, as improved awareness of existing zygomatic asymmetry could aid in setting patient expectations, improving satisfaction/outcomes, and in planning for potential surgical correction.
Concept paper: The evolution of policy approaches to educational inequality in Hungary and Lithuania
Authors: Dunajeva Jekatyerina , Lőrincz Borbála , Siarova Hanna
Published: June 2024

Over 30 years after restoring independence and a transition to democratic systems with market economy, post-socialist countries emphasised Western values of freedom and equality, which extended to all policy areas, including education. However, research suggests that transformation of the former socialist bloc have had distinct effects on equity in education depending on contextual variables, requiring a deeper investigation into the education sector. To fill this gap, this concept paper describes the historical policy evolution in a comparative perspective in two post-socialist countries, Hungary and Lithuania, evaluating the period between 1945 until today with a focus on educational inequality. The paper demonstrates the temporal dimension of the shifts in the meaning of educational inequality as a policy concept by analysing how historical legacies of socialism, new narratives during regime change, and the growing influence of global and European values have impacted education policy. Evaluation of recent policy shows a considerable influence of neoliberal policy imperatives on education policy. Overall, the analysis revealed numerous parallels between the two countries, as well as the diverging political trajectories after the regime change, and especially in the post-2010 period.
Literature at the frontier of our commonwealth
Authors: Phiri Aretha
Published: June 2024

Taking as its starting point the most recent, failed Australian referendum, this essay considers the efficacy of the Commonwealth of Nations — of the attendant ideological principles and values upon which the political association is based and to which its member states subscribe. Tracing the colonial histories and legacies of two current member states, Australia and South Africa — nations whose genesis in settler colonialism follow somewhat similar contours — the essay explores, in their canonical literature, the evolution of a kind of whitewashed nationalism that is not just racially exclusory but also registers, inversely, the anxieties of the self in relation to the “imagined community” (Anderson, 1983) endorsed in ideologies of nationhood. In a comparative, transnational reading of Patrick White’s Voss and J. M. Coetzee’s Dusklands, this essay probes how this settler-colonial literary tradition simultaneously underwrites and complicates (continued) white imperialism and black un-belonging in ways that both suggest and test the conceptual prospects and limits of a universal, egalitarian “commonwealth”.
Comparison of treatment response measures in cutaneous sclerosis after allogeneic hematopoietic cell transplantation
Authors: Pidala Joseph A. , Onstad Lynn , Baumrin Emily , Carpenter Paul A. , Cutler Corey , Arai Sally , Kitko Carrie L. , Chen George L. , Lee Stephanie J.
Published: June 2024

Cutaneous sclerosis, a highly morbid subtype of chronic graft-versus-host disease (GVHD), demonstrates limited treatment response under current National Institutes of Health (NIH) response measures. We explored novel sclerosis-specific response measures using Chronic GVHD Consortium data. A training cohort included patients with cutaneous sclerosis from a randomized trial of imatinib vs rituximab and a consortium observational study. The validation cohort was a different consortium observational study. Clinician-reported measures (baseline and baseline to 6-month change) were examined for association with 6-month clinician-reported response. Patient-reported measures (baseline and baseline to 6-month change) were studied for association with 6-month patient-reported response. A total of 347 patients were included (training 183 and validation 164). Although multiple skin and joint measures were associated with clinician-reported response on univariate analysis, patient range of motion (PROM) total score, PROM total score change, and NIH 0 to 3 skin change were retained in the final multivariate model (area under the receiver operating characteristic curve [AUC], 0.83 training and 0.75 validation). Similarly, many patient-reported measures were associated, but final multivariate analysis retained the human activity profile adjusted activity score (AAS), 36 item short form health survey (SF36) vitality change, Lee symptom scale (LSS) skin, and LSS skin change in the model (AUC, 0.86 training and 0.75 validation). We identified which sclerosis measures have the greatest association with 6-month clinician- and patient-reported treatment responses, a previously unstudied area. However, given the observed performance in the validation cohorts, we conclude that further work is needed. Novel response measures may be needed to optimally assess treatment response in cutaneous sclerosis.
A chromosome-level genome assembly and annotation of the medicinal plant Lepidium apetalum
Authors: Yan Hang , Zhu Yunhao , Jia Haoyu , Li Yuanjun , Han Yongguang , Zheng Xiaoke , Yue Xiule , Zhao Le , Feng Weisheng
Published: June 2024

Objectives

As a traditional Chinese medicine, Lepidium apetalum is commonly used for purging the lung, relieving dyspnea, alleviating edema, and has the significant pharmacological effects on cardiovascular disease, hyperlipidemia, etc. In addition, the seeds of L. apetalum are rich in unsaturated fatty acids, sterols, glucosinolates and have a variety of biological activity compounds. To facilitate genomics, phylogenetic and secondary metabolite biosynthesis studies of L. apetalum, we assembled the high-resolution genome of L. apetalum.

Data description

We completed chromosome-level genome assembly of the L. apetalum genome (2n = 32), using Illumina HiSeq and PacBio Sequel sequencing platform as well as high-throughput chromosome conformation capture (Hi-C) technique. The assembled genome was 296.80 Mb in size, 34.41% in GC content, and 23.89% in repeated sequence content, including 316 contigs with a contig N50 of 16.31 Mb. Hi-C scaffolding resulted in 16 chromosomes occupying 99.79% of the assembled genome sequences. A total of 46 584 genes and 105 pseudogenes were predicted, 98.37% of which can be annotated to Nr, GO, KEGG, TrEMBL, SwissPort, Pfam and KOG databases. The high-quality reference genome generated by this study will provide accurate genetic information for the molecular biology research of L. apetalum.
Diagnostic and prognostic significance of miR-320a-3p in patients with chronic heart failure
Authors: Han Qing , Zhang Li , Liao Ran
Published: June 2024

Aim

The purpose of this study was to investigate the diagnostic and prognostic value of miR-320a-3p in chronic heart failure (CHF).

Methods

A total of 103 patients with CHF and 95 healthy controls were included in the study population. The expression level of serum miR-320a-3p was detected by qRT-PCR. The diagnostic effect of miR-320a-3p on CHF was evaluated by receiver operating characteristic curve. Kaplan-Meier curve and Cox regression were used to analyze the risk factors for 4-year prognosis of CHF patients. Bioinformatics analysis was used to analyze the possible target genes of miR-320a-3p and related signaling pathways.

Results

Serum miR-320a-3p expression was increased in CHF patients, and the levels of BNP and LVEF were positively and negatively correlated with miR-320a-3p, respectively. The AUC value of ROC curve was 0.866, indicating that miR-320a-3p had high diagnostic accuracy for CHF. Survival curve and Cox analysis showed that high expression of miR-320a-3p was associated with poor prognosis in CHF patients, and age and miR-320a-3p were independent risk factors for prognosis in CHF patients. GO and KEGG analysis showed that the downstream target genes of miR-320a-3p were involved in biological processes such as cell adhesion, stem cell differentiation and neural development, and were enriched in mTOR, TNF, AMPK and other signaling pathways.

Conclusions

miR-320a-3p increased abnormally in CHF and was related to the severity of CHF. miR-320a-3p has the potential to be a diagnostic and prognostic marker for CHF.
Dilated common bile duct is commonly associated with main duct Intraductal Papillary Mucinous Neoplasm of the pancreas
Authors: Sbeit Wisam , Shahin Amir , Khoury Tawfik
Published: June 2024

Background

Dilatation of common bile duct (CBD) is mostly pathological and mainly occurs secondary to mechanical causes. We aimed to explore the prevalence of CBD dilatation in Intraductal Papillary Mucinous Neoplasms of the pancreas (IPMN) among patients referred to EUS.

Methods

A retrospective study of all patients who had an EUS diagnosis of IPMN from 2011 to 2019 at Galilee Medical Center were extracted. Control group including patients with other types of pancreatic cysts.

Results

Overall, 2400 patients were included in the study, of them 158 patients were diagnosed with pancreatic cysts, 117 patients (74%) diagnosed with IPMN (group A), and 41 patients (26%) diagnosed with other pancreatic cysts (group B). Univariate analysis showed significant association of IPMN (OR 3.8, 95% CI 1.3–11.5), resected gallbladder (GB) (OR 7.75, 95% CI 3.19–18.84), and age (OR 1, 95% CI 1.01–1.08) with CBD dilatation. Classifying IPMN to sub-groups using adjusted multivariate logistic regression analysis, only main duct-IPMN (MD-IPMN) significantly correlated with CBD dilatation compared to branch duct (BD)-IPMN and mixed type-IPMN (OR 19.6, 95% CI 4.57–83.33, OR 16.3, 95% CI 3.02–88.08).

Conclusion

MD-IPMN was significantly correlated with dilated CBD. Assessment of the pancreas is warranted in encountered cases of dilated CBD without obvious mechanical cause.
Patient outcome quality indicators for older persons in acute care: original development data using interRAI AC-CGA
Authors: Martin-Khan Melinda G. , Gray Leonard C. , Brand Caroline , Wright Olivia , Pachana Nancy A. , Byrne Gerard J. , Chatfield Mark D. , Jones Richard , Morris John , Travers Catherine , Tropea Joanne , Xiong Beibei ,   The Research Collaborative for Quality Care: Acute Care Panel, Mudge Alison , Rowland Jeffrey , Lim Kwang ,   The Research Collaborative for Quality Care: Dementia Care Panel, Beattie Elizabeth , Strivens Eddy , Varghese Paul
Published: June 2024

Background

A range of strategies are available that can improve the outcomes of older persons particularly in relation to basic activities of daily living during and after an acute care (AC) episode. This paper outlines the original development of outcome-oriented quality indicators (QIs) in relation to common geriatric syndromes and function for the care of the frail aged hospitalized in acute general medical wards.

Methods

Design QIs were developed using evidence from literature, expert opinion, field study data and a formal voting process. A systematic literature review of literature identified existing QIs (there were no outcome QIs) and evidence of interventions that improve older persons’ outcomes in AC. Preliminary indicators were developed by two expert panels following consideration of the evidence. After analysis of the data from field testing (indicator prevalence, variability across sites), panel meetings refined the QIs prior to a formal voting process.

Setting

Data was collected in nine Australian general medical wards.

Participants

Patients aged 70 years and over, consented within 24 h of admission to the AC ward.

Measurements

The interRAI Acute Care – Comprehensive Geriatric Assessment (interRAI AC-CGA) was administered at admission and discharge; a daily risk assessment in hospital; 28-day phone follow-up and chart audit.

Results

Ten outcome QIs were established which focused on common geriatric syndromes and function for the care of the frail aged hospitalized in acute general medical wards.

Conclusion

Ten outcome QIs were developed. These QIs can be used to identify areas where specific action will lead to improvements in the quality of care delivered to older persons in hospital.
‘It’s where I belong’: what does it mean to age in place from the perspective of people aged 80 and above? A longitudinal qualitative study (wave one)
Authors: Gibson Kate , Brittain Katie , McLellan Emma , Kingston Andrew , Wilkinson Heather , Robinson Louise
Published: June 2024

Background

Most people want to remain at home as they age. Ageing in place – remaining at home and connected to the community – is a national and international policy priority; however, to better understand how policy might be implemented, a more nuanced understanding is required about older adults’ lived experiences of ageing in place, especially the experiences of those aged 80 and above.

Objective

To describe and explore the social processes which enable ageing in place from the perspective of community-dwelling older people (80+).

Methods

Forty-six respondents (80–100+ years) participated in the first wave of a longitudinal qualitative study set in North East England. Semi-structured interviews were conducted in participants’ homes between June 2022 and January 2023. Interviews were analysed using reflexive thematic analysis.

Results

Participants positioned their homes as a place of freedom and as the antithesis of a ‘care home’. Remaining in place was important for all participants; a key priority for them was to remain physically active to enable this. However, many participants faced significant hurdles to remaining in place. These were primarily related to health and mobility issues. Some participants were able to overcome such barriers by drawing on financial resources and available social networks.

Conclusion

The home is central to understanding older peoples’ (80+) experiences of ageing. In a socio-political context which promotes ageing in place, the social factors shaping experiences of ageing in place must be considered. This involves attending to the challenges of later life, particularly health and especially mobility and physical function. Currently, those with resources (social and economic) are better equipped to respond to such challenges, thus potentially exacerbating widening inequalities in ageing. By foregrounding the perspectives of those ageing in place alongside social factors shaping their experiences, our study has important implications for policy and health and social care. We show that a more equitable allocation of resources is vital to fulfil the ageing in place policy agenda. Furthermore, we highlight a need to recognise commitments to ageing in place displayed by people aged 80 and above, especially when remaining in place becomes difficult to achieve.
Study of MIC of silver and zinc oxide nanoparticles, strong and cost-effective antibacterial against biofilm-producing Acinetobacter baumannii in Shiraz, Southwest of Iran
Authors: Kakian Farshad , Arasteh Nawal , Mirzaei Esmaeil , Motamedifar Mohammad
Published: June 2024

Background

Acinetobacter baumannii resistant strains lead to increased mortality, treatment costs, and an increase in the length of hospitalization. Nowadays, nanoparticles are considered a substitute for antibiotics. This study aimed to determine the MIC of Silver (Ag) and Zinc Oxide (ZnO) Nanoparticles (NPs) on Biofilm-Producing Acinetobacter baumannii and determine the relationship between MIC and frequency of efflux pump genes in cutaneous specimens in Shiraz, Southwest Iran in 2021–2022.

Methods

In this study, specimens were collected from April 2021 to June 2022 at Namazi and Faqihi Hospitals in Shiraz. Investigation of biofilm production in multidrug resistance (MDR) isolates was done by the microtiter plate method. Synthesized nanoparticles were characterized by UV–vis spectrum, X-ray diffraction (XRD), and electron microscopy. The MIC of AgNPs and ZnONPs for isolates was done using the method described in the CLSI guideline (2018). The antibacterial effect of MIC of NPs on inanimate objects was done by colony counts. The prevalence of efflux pump genes (adeR, adeC, adeA, abeM, adeK, adeI) was also investigated by PCR technique.

Results

The highest ceftriaxone resistance (68%) and lowest colistin resistance (7%) were identified. 57% of isolates were MDR. In addition, 71.9% could produce biofilm and 28.1% of isolates could not produce biofilm. The average size of AgNPs and ZnONPs in the present study is 48 and < 70 nm, respectively. The nanoparticles were spherical. The MIC and the MBC of the ZnONPs were in the range of 125 to 250 µg/mL respectively. Also, for AgNPs, the MIC and the MBC were in the range of 62.5 to 250 µg/ml, respectively. AbeM gene had the highest frequency and the AdeK gene had the lowest frequency. Statistical analysis showed that there is a relationship between the frequency of adeA, adeC, and adeM genes with the MIC of AgNPs and ZnONPs.

Conclusion

According to the results of the present study, inanimate objects such as scalpels in contact with AgNPs (6000 µg/ml for 240 min) or ZnONPs (5000 µg/ml for 120 min) can be free of biofilm producing Acinetobacter baumannii  with efflux pump genes.
Development and validation of a risk prediction model for invasiveness of pure ground-glass nodules based on a systematic review and meta-analysis
Authors: Yang Yantao , Zhang Libin , Wang Han , Zhao Jie , Liu Jun , Chen Yun , Lu Jiagui , Duan Yaowu , Hu Huilian , Peng Hao , Ye Lianhua
Published: June 2024

Background

Assessing the aggressiveness of pure ground glass nodules early on significantly aids in making informed clinical decisions.

Objective

Developing a predictive model to assess the aggressiveness of pure ground glass nodules in lung adenocarcinoma is the study’s goal.

Methods

A comprehensive search for studies on the relationship between computed tomography(CT) characteristics and the aggressiveness of pure ground glass nodules was conducted using databases such as PubMed, Embase, Web of Science, Cochrane Library, Scopus, Wanfang, CNKI, VIP, and CBM, up to December 20, 2023. Two independent researchers were responsible for screening literature, extracting data, and assessing the quality of the studies. Meta-analysis was performed using Stata 16.0, with the training data derived from this analysis. To identify publication bias, Funnel plots and Egger tests and Begg test were employed. This meta-analysis facilitated the creation of a risk prediction model for invasive adenocarcinoma in pure ground glass nodules. Data on clinical presentation and CT imaging features of patients treated surgically for these nodules at the Third Affiliated Hospital of Kunming Medical University, from September 2020 to September 2023, were compiled and scrutinized using specific inclusion and exclusion criteria. The model’s effectiveness for predicting invasive adenocarcinoma risk in pure ground glass nodules was validated using ROC curves, calibration curves, and decision analysis curves.

Results

In this analysis, 17 studies were incorporated. Key variables included in the model were the largest diameter of the lesion, average CT value, presence of pleural traction, and spiculation. The derived formula from the meta-analysis was: 1.16×the largest lesion diameter + 0.01 × the average CT value + 0.66 × pleural traction + 0.44 × spiculation. This model underwent validation using an external set of 512 pure ground glass nodules, demonstrating good diagnostic performance with an ROC curve area of 0.880 (95% CI: 0.852–0.909). The calibration curve indicated accurate predictions, and the decision analysis curve suggested high clinical applicability of the model.

Conclusion

We established a predictive model for determining the invasiveness of pure ground-glass nodules, incorporating four key radiological indicators. This model is both straightforward and effective for identifying patients with a high likelihood of invasive adenocarcinoma.
Successful pregnancy in a patient with IgA nephropathy treated with telitacicept: a case report
Authors: Du Xinru , Tian Geng , Lu Xuehong
Published: June 2024

Background

IgA nephropathy (IgAN) is the most common cause of primary glomerulonephritis, with complex pathogenic mechanisms involving abnormal B-cell activation. As a novel biologic agent, telitacicept inhibits both B-lymphocyte stimulating factor and a proliferation-inducing ligand. It also inhibits both B cells and plasma cells and the production of galactose-deficient IgA1 (Gd-IgA1) and its autoantibodies, thus exerting an immunosuppressive effect. Women with IgAN are at a higher risk of adverse pregnancy outcomes such as preeclampsia and miscarriage, especially those with uncontrolled massive proteinuria and advanced chronic kidney disease. Therefore, IgAN disease control before and during pregnancy is essential. Here, we report the case of a woman with IgAN who had a successful pregnancy with significant improvement and long-term remission after treatment with telitacicept. This is the first report of a pregnancy following exposure to telitacicept.

Case report.

Conclusion

This report describes the efficacy of telitacicept in patients with IgAN and explores its value in women of childbearing age, suggesting effective and safe treatment options for women who wish to conceive.
Childcare needs as a barrier to healthcare among women in a safety-net health system
Authors: Gaur Priyanka , Ganguly Anisha P. , Kuo Madyson , Martin Robert , Alvarez Kristin S. , Bhavan Kavita P. , Kho Kimberly A.
Published: June 2024

Background

Childcare needs are an understudied social determinant of health. The effect of childcare needs on access to healthcare must be understood to inform health system interventions and policy reform. This study sought to characterize childcare needs, access to childcare, and prior experience with navigating childcare needs in healthcare settings among women in a safety-net population.

Methods

We conducted a cross-sectional study of patient-reported survey data collected in-person between April and October 2019. Surveys were administered in waiting rooms of ambulatory services in a large, urban safety-net health system in Dallas, Texas. Survey respondents were derived from a random convenience sample of women waiting for outpatient appointments. Participants were screened for having children under the age of 13 and/or childcare responsibilities for inclusion in the sample. Outcomes of interest included self-reported delayed or missed care, reasons for delayed or missed care, perceived difficulty in accessing childcare, prior methods for managing childcare during healthcare appointments, and prior experience with childcare centers.

Results

Among the 336 respondents (96.7% response rate), 121 (36.0%) reported delaying or missing a mean 3.7 appointments/year. Among women with delayed or missed care, 54.5% reported childcare barriers as the primary reason for deferral of care, greater than transportation (33%) or insurance (25%) barriers. Respondents rated childcare access as more difficult than healthcare access. Delayed or missed care due to childcare was more common among White (68.8%) and Black (55.0%) women compared to Hispanic women (34.3%). Common methods of navigating childcare needs during scheduled appointments included bringing children to appointments (69.1%) and re-scheduling or missing the scheduled appointment (43.0%). 40.6% of patients reported leaving an appointment before completion due to childcare needs.

Conclusions

Childcare needs are a leading barrier to healthcare among women accessing care in safety-net settings. Unmet childcare needs result in deferral of care, which may impact health outcomes. Childcare access is perceived as more challenging than healthcare access itself. Health system and policy interventions are needed to address childcare as a social determinant of health.
The safety and efficacy of five surgical treatments in prostate enucleation: a network meta-analysis
Authors: Chen Yun-Yi , Hua Wen-Xi , Huang Yu-Hua , Shen Xin-Yu , You Jia-Nan , Ding Xiang
Published: June 2024

Purpose

The aim of our study was to investigate the comparative outcomes of five different energy types on surgical efficacy and postoperative recovery in patients with benign prostate hyperplasia.

Methods

The literature was systematically reviewed on December 1st, 2023, encompassing studies retrieved from PubMed, Embase, Web of Science, and The Cochrane Library databases that incorporated clinical studies of holmium laser enucleation of the prostate (HoLEP), Thulium:YAG laser enucleation of the prostate (ThuLEP), transurethral plasmakinetic enucleation of prostate (PKEP), diode laser enucleation of the prostate (DiLEP) and thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of prostatic hyperplasia. Two independent reviewers extracted study data and conducted quality assessments using the Cochrane Collaboration's Risk of Bias tool and Newcastle–Ottawa Scale (NOS). Network meta-analysis (NMA) was employed to indirectly analyze the outcomes of endoscopic enucleation of the prostate (EEP) techniques.

Results

The study included a total of 38 studies, comprising 21 non-randomized controlled trials (nRCTs) and 17 randomized controlled trials (RCTs), incorporating five distinct techniques: holmium laser, Thulium:YAG laser, bipolar plasma, diode laser and thulium fiber laser. In comparing treatment durations, ThuLEP and HoLEP had shorter overall hospital stays than PKEP, while the enucleation time of ThuLEP and HoLEP was shorter than that of ThuFLEP. Moreover, the enucleation tissue weight of both thulium fiber laser and holmium laser was heavier than bipolar plasma. However, the analysis did not reveal any statistically significant variation in complications among the various types of enucleation. In postoperative follow-up, the IPSS at 3 months post-operation was superior in the Thulium:YAG laser group compared to the holmium laser group. The thulium fiber laser technique demonstrated significant advantages over other enucleation methods in terms of QoL and PVR at 12 months after surgery.

Conclusion

Theoretical properties may vary among different energy sources; however, there are no discernible clinical differences in operation-related parameters, postoperative complications, and postoperative follow-up. Therefore, the choice of laser does not significantly impact the outcome. However, due to the limited number of included studies, future research should focus on larger sample sizes and multicenter investigations to further validate the findings of this study.
GEN-RWD Sandbox: bridging the gap between hospital data privacy and external research insights with distributed analytics
Authors: Gottardelli Benedetta , Gatta Roberto , Nucciarelli Leonardo , Tudor Andrada Mihaela , Tavazzi Erica , Vallati Mauro , Orini Stefania , Di Giorgi Nicoletta , Damiani Andrea
Published: June 2024

Background

Artificial intelligence (AI) has become a pivotal tool in advancing contemporary personalised medicine, with the goal of tailoring treatments to individual patient conditions. This has heightened the demand for access to diverse data from clinical practice and daily life for research, posing challenges due to the sensitive nature of medical information, including genetics and health conditions. Regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the U.S. and the General Data Protection Regulation (GDPR) in Europe aim to strike a balance between data security, privacy, and the imperative for access.

Results

We present the Gemelli Generator - Real World Data (GEN-RWD) Sandbox, a modular multi-agent platform designed for distributed analytics in healthcare. Its primary objective is to empower external researchers to leverage hospital data while upholding privacy and ownership, obviating the need for direct data sharing. Docker compatibility adds an extra layer of flexibility, and scalability is assured through modular design, facilitating combinations of Proxy and Processor modules with various graphical interfaces. Security and reliability are reinforced through components like Identity and Access Management (IAM) agent, and a Blockchain-based notarisation module. Certification processes verify the identities of information senders and receivers.

Conclusions

The GEN-RWD Sandbox architecture achieves a good level of usability while ensuring a blend of flexibility, scalability, and security. Featuring a user-friendly graphical interface catering to diverse technical expertise, its external accessibility enables personnel outside the hospital to use the platform. Overall, the GEN-RWD Sandbox emerges as a comprehensive solution for healthcare distributed analytics, maintaining a delicate equilibrium between accessibility, scalability, and security.
WeChat assisted electronic symptom measurement for patients with adenomyosis
Authors: Xu Wei , Zhang Xin , Xu Fan , Yuan Yuan , Tang Ying , Shi Qiuling
Published: June 2024

Purpose

Symptom assessment is central to appropriate adenomyosis management. Using a WeChat mini-program-based portal, we aimed to establish a valid symptom assessment scale of adenomyosis (AM-SAS) to precisely and timely identify needs of symptom management and ultimately, to alert disease recurrence.

Methods

A combination of intensive interviews of patients with adenomyosis and natural language processing on WeChat clinician-patient group communication was used to generate a pool of symptom items-related to adenomyosis. An expert panel shortened the list to form the provisional AM-SAS. The AM-SAS was built in a Wechat mini-programmer and sent to patients to exam the psychotically validity and clinical applicability through classic test theory and item response theory.

Results

Total 338 patients with adenomyosis (29 for interview, 179 for development, and 130 for external validation) and 86 gynecologists were included. The over 90% compliance to the WeChat-based symptom evaluate. The AM-SAS demonstrated the uni-dimensionality through Rasch analysis, good internal consistency (all Cronbach’s alphas above 0.8), and test-retest reliability (intraclass correlation coefficients ranging from 0.65 to 0.84). Differences symptom severity score between patients in the anemic and normal hemoglobin groups (3.04 ± 3.17 vs. 5.68 ± 3.41, P < 0.001). In external validation, AM-SAS successfully detected differences in symptom burden and physical status between those with or without relapse.

Conclusion

Electronic PRO-based AM-SAS is a valuable instrument for monitoring AM-related symptoms. As an outcome measure of multiple symptoms in clinical trials, the AM-SAS may identify patients who need extensive care after discharge and capture significant beneficial changes of patients may have been overlooked.

Trial registration

This trial was approved by the institutional review board of the Chongqing Medical University and three participating hospitals (Medical Ethics Committee of Nanchong Central Hospital, Medical Ethics Committee of Affiliated Hospital of Southwest Medical University, and Medical Ethics Committee of Haifu Hospital) and registered in the Chinese Clinical Trial Registry (registration number ChiCTR2000038590), date of registration was 26/10/2020.
Protocols and their effects for medical device-related pressure injury prevention among critically ill patients: a systematic review
Authors: Lee Haeyoung , Choi Seunghye
Published: June 2024

Background

A pressure injury refers to localized damage to the skin and/or tissue due to prolonged pressure, and it has recently been defined to include pressure injuries related to medical devices. Medical device-related pressure injuries occur in various sites and are difficult to detect. Even if it is detected, medical devices are essential to life for critically ill patients. Thus, it is difficult to remove or change the position of the medical device; therefore, prevention is essential. This study aims to integrate the literature on medical device-related pressure injury prevention protocols among critically ill patients.

Methods

The literature inclusion criteria were (1) critically ill patients, (2) device-related pressure injury interventions, (3) randomized controlled trials and quasi-experimental designs, and (4) written in Korean or English. The literature search and selection were performed following the Cochrane Handbook for Systematic Reviews of Interventions with the support of the PRISMA Guidelines.

Results

Twelve articles were finally selected. The incidence of medical device-related pressure injury decreased from 8.1–96.7% before intervention to 0.3–53.3% after intervention, respectively. Medical device-related pressure injury prevention was effective in reducing medical device-related pressure injury incidence when applied to patients of all ages, from neonates to adults, in a variety of intensive care units. Medical device-related pressure injury prevention strategies include nurse education, assessment, documentation, and interventions (hygiene, repositioning, emergent therapy such as protective dressing or designed equipment reducing pressure) of pressure injury. Pressure injury dressings primarily included hydrocolloid foam dressings, but transparent hydrocolloid formulations also effectively reduced medical device-related pressure injury incidence rates.

Conclusions

In the future, it is necessary to increase the level of evidence by applying specialized medical device-related pressure injury prevention methods for different medical devices and areas of pressure injuries, and verifying their effectiveness.

Trial registration

The review protocol was registered (PROSPERO registration number: CRD42022346450).
Implementation of an “opt-out” tobacco treatment program in six hospitals in South Carolina
Authors: Cummings K. Michael , Talbot Vincent , Roberson Avery , Bliss Asia A. , Likins Emily , Brownstein Naomi C. , Stansell Stephanie , Adams-Ludd Demetress , Harris Bridget , Louder David , McCutcheon Edward , Zebian Rami , Rojewski Alana M. , Toll Benjamin A.
Published: June 2024

Objective

Describe the screening, referral, and treatment delivery associated with an opt-out tobacco treatment program (TTP) implemented in six hospitals varying in size, rurality and patient populations.

Methods

Between March 6, 2021 and December 17, 2021, adult patients (≥ 18 years) admitted to six hospitals affiliated with the Medical University of South Carolina were screened for smoking status. The hospitals ranged in size from 82 to 715 beds. Those currently smoking were automatically referred to one of two tobacco treatment options: 1) Enhanced care (EC) where patients could receive a bedside consult by a trained tobacco treatment specialist plus an automated post-discharge follow-up call designed to connect those smoking to the South Carolina Quitline (SCQL); or 2) Basic care (BC) consisting of the post-discharge follow-up call only. An attempt was made to survey patients at 6-weeks after hospitalization to assess smoking status.

Results

Smoking prevalence ranged from 14 to 49% across the six hospitals; 6,000 patients were referred to the TTP.The delivery of the bedside consult varied across the hospitals with the lowest in the Charleston hospitals which had the highest caseload of referred patients per specialist. Among patients who received a consult visit during their hospitalization, 50% accepted the consult, 8% opted out, 3% claimed not to be current smokers, and 38% were unavailable at the time of the consult visit. Most of those enrolled in the TTP were long-term daily smokers.Forty-three percent of patients eligible for the automated post-discharge follow-up call answered the call, of those, 61% reported smoking in the past seven days, and of those, 34% accepted the referral to theSCQL. Among the 986 of patients surveyed at 6-weeks after hospitalization quit rates ranged from 20%-30% based on duration of reported cessation and were similar between hospitals and for patients assigned to EC versus BC intervention groups.

Conclusion

Findings demonstrate the broad reach of an opt-out TTP. Elements of treatment delivery can be improved by addressing patient-to-staffing ratios, improving systems to prescribe stop smoking medications for patients at discharge and linking patients to stop smoking services after hospital discharge.
Reproductive concerns and its correlation with fear of recurrence and level of family support in patients of childbearing age with gynecologic malignancies
Authors: He Xinying , Wu Ying , Zhou Yaqing , Chen Qin , Li Xuping , Fan Xuemei , Xia Chengjun , Ma Jiao , Han Jing , Han Xue
Published: June 2024

Background

To discuss the current status of reproductive concerns and its correlation with fear of recurrence and level of family support in patients of childbearing age with gynecologic malignancies.

Methods

A convenient sampling method was used to enroll 188 patients with gynecologic malignancies in Nanjing Maternity and Child Health Care Hospital, Nanjing Drum Tower Hospital, General Hospital of Ningxia Medical University, and Haian Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Chinese Medicine from September 2022 to April 2023. Patients were assessed using general information questionnaire, Reproductive Concerns After Cancer Scale (RCAC), Fear of Cancer Recurrence Inventory (FCRI) questionnaire, and Perceived Social Support-Family (PSS-FA) Scale.

Results

Among patients of childbearing age with gynecologic malignancies, the total RCAC score was (54.35 ± 7.52), indicating a moderate level of reproductive concerns. Patients scored (20.98 ± 4.51) on FCRI, implying a moderate level of fear of recurrence. The PSS-FA score was (9.57 ± 2.76), denoting a moderate level of family support. The total score and each dimensional score of RCAC were positively correlated with FCRI total score (P < 0.05), and negatively correlated with PSS-FA total score (P < 0.05). Fear of recurrence, family support level, number of children, educational background, treatment modality, and fertility intention were influencing factors for reproductive concerns in patients of childbearing age with gynecologic malignancies (all P < 0.05).

Conclusion

The reproductive concerns, fear of recurrence and family support are all at moderate levels in patients of childbearing age with gynecologic malignancies, and reproductive concerns are positively correlated with fear of recurrence and negatively correlated with family support.
Correlation of tuberculosis-related anemia severity with tuberculosis-induced inflammation in children: a six-year retrospective study
Authors: Han Chunjiao , Fang Yulian , Dong Lili , Guo Detong , Lei Min , Guo Wei , Cai Chunquan
Published: June 2024

Background

Anemia is a common complication of tuberculosis (TB), and there is evidence that its prevalence is higher in patients with TB. Although TB is very important in epidemiology, careful investigation of TB-related anemia in children has not been carried out systematically. This study aimed to describe the details of anemia in children with TB and its association with clinical characteristics and the severity of inflammation.

Methods

In this retrospective study, we explored Hb levels in 103 children with pulmonary TB (PTB) and they were divided into anemic or non-anemic groups. Logistics regression analysis was used to study the associations between anemia and demographic characteristics. Spearman correlations analysis was performed to analyse the associations between the biochemical parameters and hemoglobin levels in blood.

Results

The prevalence of anemia in children with TB was 37.9% (48.7% showed microcytic hypochromic anemia, and 5.1% showed normal cell anemia). Compared with the anemia (n = 39) group, the non-anemic group (n = 64) had longer fever duration and increased respiratory rate (P < 0.05). In logistic regression analysis, anemia was associated with lower levels of Alb and higher levels of WBC, CRP, LDH, and ESR (P < 0.05). Spearman correlations analysis showed a significant negative correlation between hemoglobin (Hb) levels and inflammatory markers. After one month of antitubercular therapy (ATT), the Hb levels of 76.9% children returned to normal.

Conclusions

Anemia is common among children with TB at diagnosis. The majority of children with TB-related anemia are mild to moderate microcytic hypochromic anemia. There is a strong correlation between the severity of anemia and the inflammation induced by TB. This suggests that anemia is a biomarker of the severity of TB in clinical practice among children.