bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between the triglyceride to high-density lipoprotein cholesterol ratio and cardiovascular diseases in people living with human immunodeficiency virus: Evidence from a retrospectively cohort study 2005–2022
Authors: Sun Liqin , Luo Yinsong , Jia Xinyun , Wang Hui , Zhao Fang , Zhang Lukun , Ju Bin , Wang Haiyan , Shan Duo , He Yun , Lu Hongzhou , Liu Jiaye
Published: October 2024

Introduction:

The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, a novel biomarker for metabolic syndrome (MetS), has been validated in the general population as being significantly correlated with cardiovascular disease (CVD) risk. However, its capabilities to predict CVD in people living with human immunodeficiency virus (HIV; PLWH) remain underexplored.

Methods:

We conducted a retrospective cohort study of 16,081 PLWH who initiated antiretroviral therapy (ART) at the Third People’s Hospital of Shenzhen (China) from 2005 to 2022. The baseline TG/HDL-C ratio was calculated as TG (mmol/L) divided by HDL-C (mmol/L). We employed a multivariate Cox proportional hazards model to assess the association between the TG/HDL-C ratio and CVD occurrence, using Kaplan–Meier curves and log-rank tests to compare survival distributions. The increase in prediction risk upon the addition of the biomarker to the conventional risk model was examined through the assessment of changes in net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Nonlinear relationships were investigated using a restricted cubic spline plot, complemented by a two-piecewise Cox proportional hazards model to analyze threshold effects.

Results:

At the median follow-up of 70 months, 213 PLWH developed CVD. Kaplan–Meier curves demonstrated a significant association between the increased risk of CVD and a higher TG/HDL-C ratio (log-rank P <0.001). The multivariate-adjusted Cox proportional hazards regression model indicated that the CVD hazard ratios (HR) (95% confidence intervals [95% CIs]) for Q2, Q3, and Q4 versus Q1 of the TG/HDL-C ratio were 2.07 (1.24, 3.45), 2.17 (1.32, 3.57), and 2.20 (1.35, 3.58), respectively (P <0.05). The consideration of the TG/HDL-C ratio in the model, which included all significant factors for CVD incidence, improved the predictive risk, as indicated by the reclassification metrics (NRI 16.43%, 95% CI 3.35%–29.52%, P = 0.014). The restriction cubic spline plot demonstrated an upward trend between the TG/HDL-C ratio and the CVD occurrence (P for non-linear association = 0.027, P for overall significance = 0.009), with the threshold at 1.013. Significantly positive correlations between the TG/HDL-C ratio and CVD were observed below the TG/HDL-C ratio threshold with HR 5.88 (95% CI 1.58–21.88, P = 0.008), but not above the threshold with HR 1.01 (95% CI 0.88–1.15, P = 0.880).

Conclusion:

Our study confirms the effectiveness of the TG/HDL-C ratio as a predictor of CVD risk in PLWH, which demonstrates a significant nonlinear association. These findings indicate the potential of the TG/HDL-C ratio in facilitating early prevention and treatment strategies for CVD among PLWH.
ANALYSIS OF HENLE FIBER LAYER AND OUTER RETINAL LAYERS IN CONE DYSTROPHY
Authors: Kesim Cem , Cansiz Selahattin , Guleser Umit Yasar , Gunduz-Demir Cigdem , Hasanreisoglu Murat
Published: October 2024

Purpose:

To evaluate Henle fiber layer (HFL) thickness and volume parameters in patients with cone photoreceptor atrophy with directional optical coherence tomography.

Methods:

Macular 20°×20° standard and directional optical coherence tomography images were acquired from patients diagnosed with hereditary cone dystrophy with evident foveal ellipsoid zone defect in optical coherence tomography and age-matched healthy controls. Thickness and volume parameters of HFL, outer nuclear layer (ONL), and retinal layers between ellipsoid zone and Bruch membrane complex (EZ–BM) were calculated from manual segmentation through directional optical coherence tomography images, and comparative analysis is performed.

Results:

Twelve eyes of six patients were compared with 12 eyes of six age-matched healthy controls (mean age: 29.5 ± 16.6 and 26.6 ± 3.9 years, respectively; P = 0.162). Patients had lower total HFL volume (0.45 ± 0.03 and 0.85 ± 0.15 mm3; P < 0.001) and mean HFL thickness (16.1 ± 1.1 and 30.1 ± 5.3 µm; P < 0.001) than healthy controls. Central subfield, parafoveal, and perifoveal ETDRS zone HFL parameters in patients were significantly lower than healthy controls. A centrifugal correlation was found between central outer nuclear layer and the corresponding parafoveal HFL (Spearman rho: 0.785; P < 0.001).

Conclusion:

Henle fiber layer assessment might be a useful optical coherence tomography biomarker in patients with cone photoreceptor atrophy. Henle fiber layer thinning is observed in foveal, parafoveal, and perifoveal areas of patients with cone photoreceptor atrophy, while volume reduction in outer nuclear layer and ellipsoid zone and Bruch membrane complex components were limited to central and parafoveal zones.
Improving Access to Community-Based Services for Sexual Assault Survivors
Authors: Brosnan Julie , Shannon Robin , Krueger Shannon , Wolgast Kimberly
Published: October 2024

Background

Emergency department (ED) encounters are often the only healthcare provider encounter for patients seeking care after a reported sexual assault (SA), making the encounter a crucial opportunity to connect patients to support services in the community. An opportunity existed at an urban Level II trauma center to standardize SA discharge planning.

Aims

This quality improvement project aimed to improve access to SA support services.

Methods

The Model for Improvement guided two plan–do–study–act (PDSA) cycles. Implementation included (a) creation of a QR-code-accessible SA resource website, (b) ED standardized patient print and electronic medical record after-visit summaries with follow-up guidelines and the QR code, (c) ED staff education, and (d) a community stakeholder survey to assess facilitators and barriers to support services.

Results

During the first PDSA cycle, 19 reported SA survivors were seen in the ED (18 adult, one pediatric) and 14 SA resource website visits. During the second PDSA cycle, 13 reported SA survivors (10 adult, three pediatric) were seen in the ED and 29 website visits. Stakeholder survey data revealed barriers to support services were transportation, overloaded support services, and survivor knowledge of existing services.

Conclusion

The QR code intervention model is a discrete method of improving access to resources and is applicable to other vulnerable populations. The multiagency SA response team will utilize partner survey data to improve access to community resources such as housing and transportation.
Clinical Instructor's Self-reported Modeling of Evidence-Based Practice During Student Clinical Experience
Authors: Dashottar Amit , Haney Jillian , Rourke Matthew O. , Tiwari Devashish
Published: October 2024

Introduction.

Having clinical instructors (CIs) model evidence-based practice (EBP) may enhance physical therapist student engagement in the EBP process and learning. However, the extent of EBP modeling by CIs at present is not known. The purpose of this survey was to assess the modeling of EBP by CIs during physical therapist student clinical education experiences (CEs).

Review of Literature.

The literature focuses on the impact of CIs on the students including the significance of CIs modeling behaviors for students during a CE. Not much is known about if EBP concepts are modeled by the CIs during the CE.

Subjects.

Three hundred and eight CIs affiliated with the Physical Therapist program.

Methods.

A 37-item anonymous e-survey that included CI demographic data, questions about EBP modeling by CI during CEs, and resources and policies surrounding the use of EBP in the clinical setting.

Results.

The results of this survey indicate that CIs' modeling of EBP varies by domain. CIs successfully model EBP by asking relevant clinical questions and acquiring relevant literature. The modeling of critical appraisals and the use of EBP metrices during the diagnostic and intervention planning were not done by most CIs.

Discussion and Conclusion.

It is important that CIs model the use of EBP concepts during a physical therapist student's CE to develop future evidence-based practitioners. However, this modeling may be limited by CIs' familiarity with EBP. The results of this survey indicate an uneven modeling of EBP concepts, with certain domains being modeled more than the others. The findings of the survey may be used to develop refresher/reference materials specifically designed for busy CIs.
Safety and efficacy of simultaneous liver transplantation and sleeve gastrectomy in morbid obese patients with end-stage liver disease: The LT-SG study
Authors: Manzia Tommaso Maria , Sensi Bruno , Gentileschi Paolo , Quaranta Claudia , Toti Luca , Baiocchi Leonardo , Dauri Mario , Angelico Roberta , Tisone Giuseppe
Published: October 2024

In obese patients, metabolic dysfunction–associated steatotic liver disease is becoming a leading etiology of end-stage liver disease and HCC. Simultaneous liver transplantation and sleeve gastrectomy (LT-SG) have been proposed in the United States, but the safety and efficacy of the procedure have not been widely explored in Europe. Between January 2016 and December 2022, morbidly obese patients listed for liver transplantation at Tor Vergata University were enrolled in the LT-SG study. Primary outcomes were (1) safety expressed as 30- and 90-day overall survival and (2) major postoperative complications (Clavien-Dindo >IIIa). The secondary outcome was efficacy expressed as a 3-year %excess body mass index (BMI) loss. Eleven patients were enrolled in the study. The median BMI at transplantation was 42 (IQR 38–48). Indications of LT-SG were HCC (63.6%) and cirrhosis (36.4%). In 54% of cases, donors had high-risk characteristics (eurotransplant donor risk index >1.6). The 30- and 90-day overall survival were 63.6% and 54.5%, respectively. All deaths occurred in patients with P-SOFT >15 or in patients who had at least 3 of the following characteristics: >60 years, BMI >45, metabolic syndrome, MELD >25 or eurotransplant donor risk index >1.6. The 6 months, 1, 2, and 3 years %excess BMI loss was 73%, 60%, 50%, and 43%, respectively. LT-SG is a complex procedure that may carry excess risk in an unselected population. It should be considered only in highly selected patients. Standard donors are recommended, and prioritization of severely obese patients on the waiting list should be considered.
Safety and Efficacy of Endoscopic Submucosal Dissection for Rectal Neoplasms Extending to the Dentate Line
Authors: Gopakumar Harishankar , Dahiya Dushyant Singh , Draganov Peter V. , Othman Mohamed O. , Sharma Neil R.
Published: October 2024

Objective:

Endoscopic submucosal dissection (ESD) is a superior, minimally invasive technique compared with other snare-based endoscopic resection techniques for rectal neoplasms extending to the dentate line (RNDLs). However, performing a successful ESD in the anal canal can be challenging due to vascularity and limited scope stability. In this meta-analysis, we aim to evaluate the safety and efficacy of ESD for RNDLs.

Methods:

We performed a comprehensive electronic database search from January 2005 through January 2024 for studies evaluating outcomes of ESD performed for managing RNDLs. Pooled proportions were calculated using random-effect models. Heterogeneity was evaluated using I
2 and Q statistics.

Results:

Data were extracted from 11 studies comprising 496 patients. The pooled en bloc resection rates were 93.60% (95% CI = 90.70-95.70). The pooled R0 resection rate was 80.60% (95% CI = 70.50-87.80). The pooled recurrence rate was 4.00% (95% CI = 2.40-6.50). There was no evidence of significant heterogeneity calculated using the Q test and I
2 statistic. The main adverse events were anal pain, postprocedural bleeding, and anal stricture with pooled rates of 20.20% (95% CI = 14.80-26.90), 8.20% (95% CI = 4.70-14.0), and 3.50% (95% CI = 2.10-5.70), respectively.

Conclusions:

ESD is a safe and effective option for managing RNDLs with a low recurrence rate. Adverse events such as postprocedural perianal pain, postprocedural bleeding, and anal stenosis seem to be more common compared with colorectal ESD done for more proximal lesions. However, these can typically be managed conservatively or with minimally invasive endoscopic techniques.
Association Between Irritable Bowel Syndrome and Lower Urinary Tract Symptomatology
Authors: Felix-Tellez Francisco A. , Del Rio O´Brien María F. , Ibarra Tapia María E. , Escobar Montes Miriam A. , Peña Barajas Guadalupe J. , Mercado Basoco Salvador A. , González Gómez Firenze G. , Remes-Troche José M. , Velarde-Ruiz-Velasco José A.
Published: October 2024

Goals:

This study aimed to investigate the clinical phenotype of urinary symptoms in patients diagnosed with irritable bowel syndrome, the factors associated with this overlap, and the impact of urinary symptoms on their quality of life.

Background:

Irritable bowel syndrome is a common disorder, affecting up to 3.8% of the population. The overlap with other disorders of the gut-brain interaction, psychiatric disorders, and other somatic disorders is common. Moreover, the association between irritable bowel syndrome and urinary symptoms has been recognized, but the clinical phenotype remains unclear.

Study:

This cross-sectional study involved patients with irritable bowel syndrome according to Rome IV. Lower urinary tract symptoms were classified using the International Continence Society’s classification. Data on demographics, medical history, medication use, anxiety, depression, and quality of life were collected and analyzed using logistic regression analysis.

Results:

The study included 428 subjects, 86 diagnosed with irritable bowel syndrome. Patients exhibited a higher prevalence of lower urinary tract symptoms (60.5%, 95% CI: 50.5-71.9). Multivariate analysis revealed associations between irritable bowel syndrome and lower urinary tract symptoms (OR: 2.49, 95% CI: 1.48-4.18, P=0.001), particularly storage urinary symptoms (OR: 1.94, 95% CI: 1.10-3.40, P=0.021). Patients with urinary symptoms reported significantly lower quality of life compared with those without these symptoms (50.8±17.2 vs. 76.7±21.8, P<0.001).

Conclusions:

Irritable bowel syndrome is associated with lower urinary tract symptoms, contributing to a significant reduction in quality of life. Clinicians should consider referring patients with irritable bowel syndrome and lower urinary tract symptoms to experts in urodynamics to provide targeted management.
Research trends and hotspots of the applications of single-cell RNA sequencing in cardiovascular diseases: a bibliometric and visualized study
Authors: Yu Yue , Ye Juan , Wang Rubing , Wang JingJing , Wang Junnan , Xu Qiumeng , Wang Pei , Wang Bei , Zhang Yufeng
Published: October 2024

Background:

Cardiovascular diseases (CVDs) are the leading causes of death globally. The use of single-cell RNA sequencing (scRNA-seq) in CVDs has gained significant attention in recent years, and there is a growing body of literature on the subject. However, a thorough and impartial analysis of the existing state and trends of scRNA-seq in CVDs is lacking. This study aims to examine the development of scRNA-seq in CVDs using bibliometric and visualized analysis.

Methods:

Global publications on scRNA-seq and CVDs from 2009 to 2023 were extracted from the Web of Science Core Collection (WoSCC) database. The R package “Bibliometrix”, VOSviewer, and CiteSpace were employed to perform a bibliometric study.

Results:

After applying the screening criteria and omitting documents that met exclusive criteria, this bibliometric study included 1170 papers. These were authored by 8595 scholars from 1565 organizations in 57 countries or regions and were published in 369 journals, with 51 073 co-cited references included. Publication volume, citations, and relative research interest index focusing on this field have dramatically increased since 2019. The cooperation network showed that the USA, the Chinese Academy of Medical Sciences, and Qingbo Xu were the most active countries, institutes, and authors in this field, respectively. Circulation Research was the journal with the most publications, which was confirmed to be the top core source by Bradford’s law. The hotspots and emerging direction in the field manifest in (1) three CVDs (atherosclerosis, myocardial infarction, and heart failure) and (2) three cell types (macrophage, fibroblast, and smooth muscle cell).

Conclusions:

Our study provides a systematic visualization of the research literature on scRNA-seq in CVDs and provides guidance and reference for understanding the current research status and discovering new research directions.
Degloving soft tissue injuries of upper limbs and their management in Khartoum – Sudan: a cross-sectional study
Authors: Ali Sara K.A. , Mohamed Momen
Published: October 2024

Background:

Degloving soft-tissue injuries are underreported in Sudan and are potentially devastating. They require early recognition and diagnosis with early and systemic management to reduce the complications that may arise, and to minimize delay for proper intervention by a multidisciplinary team that is usually needed to ensure the effective rehabilitation of these patients and a better outcome.

Objective:

To assess the degloving soft tissue injuries of the upper limb and their management in Khartoum.

Material and methods:

A cross-sectional hospital-based study is multicentric (Khartoum North Teaching Hospital, Association Specialized Hospital, East Nile Hospital) in Khartoum – Sudan. A study was conducted on 82 patients with degloving soft tissue injuries of the upper limbs during the period from 2021 to 2022. Patients with different age groups were included whereas patients with close degloving injuries and degloving injuries of fingers were excluded.

Results:

Eighty-two patients were studied. The male-to-female ratio was 4.8:1, with a mean age of 31.5. The common (59.8%) injury site was the dominant upper limb, with 58.5% distal UL injuries. The main etiology of injury was road traffic accidents (52.4%), followed by occupational injuries (20.7%). 51.2% of the injury was a noncircumferential single-plane degloving soft tissue injury. Degloving soft tissue injuries of the upper limbs are associated with deep structure injuries in 61% of patients (bone fracture in 43.9%). Serial debridement before reconstruction as a staged procedure was done in 61% of patients. The most common reconstruction method performed was skin grafts (57.3%), followed by flaps (32.9%). Half (52.4%) of the patients developed complications postoperatively, and the most frequent complication was wound infection (23.1%).

Conclusion:

Upper limb degloving soft tissue injuries are complex life-threatening injuries that, if present late or poorly managed, lead to devastating complications ranging from local infection to major disabilities, amputation, and death.
Becoming a Nurse
Authors: Mellett Chelsea , White Beth Ann , Kustenbauder Paula , Adam Marianne , Nagy Amy , Cruz Laura , Berish Diane
Published: October 2024

Background:

A correlation exists between professional identity (PI), hope, and job satisfaction that warrants interventional measures to reverse nurse turnover. Developing, nurturing, and improving nurses’ PI can positively address nurse turnover.

Purpose:

The purpose of this study was to examine the intersections between career motivation, PI formation, and belongingness in prelicensure nursing students.

Methods:

As part of a larger mixed-methods study, a quantitative survey was disseminated to students.

Results:

Findings suggest significant connections between the depth of perceived PI, motivation to enter the field, and future orientation(s) that are mediated through classroom instruction. PI was shaped by student relationships, confidence, and autonomy.

Conclusions:

Findings underscore the importance of academic intentionality in incorporating PI early in nursing education. Prioritizing quality bedside experiences to develop meaningful relationships while simultaneously increasing confidence and autonomy to assist the nursing student in connecting with their PI is key.
Building a Consortium to Address Graduate Nursing Student Academic Preparedness
Authors: Douglas Kimberly , Pajarillo Edmund J. Y. , Smith Karin , De La Rosa Denise C. , Shank Heidi
Published: October 2024

Background:

The demand for nurses in advanced practice roles is expected to grow by 38% by 2032. The nationwide faculty shortage is also a concern, as it correlates to the nursing shortage. Successful retention strategies for graduate nursing students can strengthen the rising demand of specialized nursing roles.

Problem:

The transition from clinical practice to the graduate student environment can be daunting to some practicing nurses who may struggle with program completion. It is well documented that graduate nursing students lack academic preparation for the rigorous scholarly work.

Approach:

A national onboarding consortium of graduate nursing faculty was formed to meet regularly and utilize a model onboarding program to address graduate nursing students’ academic preparedness.

Conclusions:

Structured onboarding programs show promising results. The programs were easily adopted to support students from various backgrounds and regions within the United States. Benefits of forming a consortium to address a national issue were evident.
Associations Between Nursing Students’ Knowledge, Skills, and Attitudes and Participation in Experiential Learning on Care for People With Disabilities
Authors: Ozkara San Eda , Marx Katherine A. , Robertiello Gina , Nahum Jennifer L. , Hu Jinyu , Pasklinsky Natalya , Latimer Beth
Published: October 2024

Background:

Experiential learning activities on care for people with disabilities (PWD) would help nursing students develop the knowledge, skills, and attitudes (KSAs) needed to provide quality care for PWD.

Purpose:

The purpose of this study was to evaluate the perceived changes in nursing students’ KSAs related to the care for PWD following participation in health assessment and prevention (HAP) experiential learning activities.

Methods:

This was a quasi-experimental, pre- and posttest educational intervention study. Nursing students (n = 160) attended multiple experiential learning activities as a required part of their HAP coursework and completed a pre and posttest survey to assess changes in their KSAs.

Results:

Participation in experiential learning activities on care for PWD was associated with significant increases in perceived knowledge, skills and positive attitudes toward PWD.

Conclusions:

Experiential learning activities aligned with core competencies for health care providers caring for PWDs have the potential to change nursing care and address health inequities for this population.
Pediatric Burn Care for Burn Injury: Outcomes by Timing of Referral Using a U.S. Single-Center Retrospective Cohort, 2005–2019*
Authors: Gale Hannah L. , Staffa Steven J. , DePamphilis Matthew A. , Tsay Sarah , Burns Jeffrey , Sheridan Robert
Published: October 2024

OBJECTIVES:

Burn centers offer specialized care to pediatric patients with burn injuries. However, data about outcome in relation to timing of transfer are limited. We examined these timings and outcomes among burn-injured pediatric patients.

DESIGN:

Single-center, retrospective cohort study of U.S. national and international practice.

SETTING:

Shriners ESO Trauma Burn Registry, 2005–2019.

PATIENTS:

Patients 0–17 years old admitted to a pediatric burn center with 10–80% total body surface area (TBSA) burn between 2005 and 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The cohort of 761 patients was subcategorized according to timing of referral: early presentation (EP) (0–7 d), delayed presentation (DP) (8–60 d), and very delayed presentation (VDP) (> 60 d). Primary outcomes included hospital length of stay (LOS), ICU LOS, percent TBSA (%TBSA)/LOS ratio, mortality, and disposition. Dichotomous outcomes were analyzed using logistic regression and continuous outcomes were compared using median regression, both utilizing multivariable analysis adjusting for a priori confounders and presented as adjusted coefficients (ACs) with 95% CI. Delayed referral (DP and VDP) was associated with higher %TBSA burn and with fewer referrals from high-income countries. Compared with EP, VDP was associated with higher LOS/%TBSA (AC, 0.2 [0.01–0.4]). On univariate analysis, in comparison with EP, DP and VDP were associated with higher ICU (DP 16 [6–29]; VDP 8 [0–18]) and hospital LOS (DP 34 [21–55]; VDP 32 [18–58]). Overall, ten of 761 patients died (1.3%), and we found no association between timing of referral and mortality. Also, in 751 survivors, 635 patients (84.6%) were discharged home without home health, and we found no association with timing of referral on multivariable analysis.

CONCLUSIONS:

In this report, we have reviewed our single-center, international burn-injured pediatric cohort, operating in the United States (2005–2019). We find that referral with VDP as opposed to EP was associated with increased LOS/%TBSA.
Unveiling the Gaps: Analyzing Family Physicians’ Perspectives on Infectious Disease Notification in Türkiye
Authors: Uzun Süleyman Utku , Usturali Mut Ayşe Nur , Mut Hakan
Published: October 2024

Objective:

This study aimed to assess the opinions, attitudes, and behaviors of family physicians in Türkiye regarding mandatory communicable disease notification.

Design:

Cross-sectional study.

Setting:

A national online survey in Türkiye.

Participants:

This study was conducted among 397 family physicians from different geographical regions in Türkiye.

Main Outcome Measure(s):

Family physicians’ opinions, attitudes, and behaviors regarding infectious disease notification.

Results:

The majority of family physicians (69.3%) felt inadequate in terms of knowledge about the notification system and 70.3% desired post-graduation training on communicable disease reporting. About one-third of the participants were dissatisfied with the current notification system. Reasons for under-reporting included lack of time, lack of feedback, and uncertainty about post-notification procedures. Factors significantly associated with higher infectious disease notification attitude scores (IDNAS) were receiving training on communicable disease reporting, feeling competent about reporting, and being satisfied with the reporting system (P < .001). However, physicians who admitted choosing a different ICD code to avoid filling out an infectious disease notification form had lower IDNAS scores (P < .001).

Conclusion:

This study highlights knowledge gaps and negative attitudes among family physicians in Türkiye regarding infectious disease reporting. Addressing these challenges requires continuous education and training programs. Feedback mechanisms should be improved to enhance physicians’ engagement in the notification process. Reducing the workload of family physicians and simplifying the reporting process may also contribute to higher compliance with mandatory communicable disease reporting.
Impact of switching from efavirenz/emtricitabine/tenofovir disoproxil fumarate to bictegravir/emtricitabine/tenofovir alafenamide on psychiatric symptoms and neurocognition
Authors: Vergori Alessandra , Del Duca Giulia , Lorenzini Patrizia , Brita Anna Clelia , Mastrorosa Ilaria , Fusto Marisa , Camici Marta , Ottou Sandrine , Gagliardini Roberta , Paulicelli Jessica , De Zottis Federico , Grilli Elisabetta , Esvan Rozenn , Plazzi Maria Maddalena , Mazzotta Valentina , Bellagamba Rita , Antinori Andrea , Pinnetti Carmela
Published: October 2024

Objectives:

The aim was to investigate whether switching from efavirenz/emtricitabine/tenofovir disoproxil fumarate (EFV/F/TDF) to bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) may improve neuropsychiatric symptoms and neurocognition.

Design:

Pilot, single-arm, prospective study of persons with HIV (PWH) on the efficacy and safety of switching from EFV/F/TDF to BIC/F/TAF.

Methods:

Participants underwent neuropsychological assessment (NPA) at switch (T0) and after 48 weeks (T1). NPA was carried out through a standardized battery of 12 tests. Neurocognitive impairment (NCI) was defined by a score of at least 1 standard deviation (SD) below the normal mean on at least two tests or ≥2 SD below on one test. Individual z scores were determined, NPZ-12 was calculated as the average of 12 test z scores and change of NPZ-12 was the outcome. HIV-associated neurocognitive disorder (HAND) was classified by Frascati's criteria. Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI-II), and Pittsburgh Sleep Quality Index (PSQI) were administered. Paired-Wilcoxon and McNemar tests were used for comparisons, and logistic regression for associations with NCI changes.

Results:

Out of 126 participants, BAI, BDI-II, and PSQI questionnaires revealed an improvement at T1. NPA revealed NCI in 40.5% of persons at T0 and 42.1% at T1 (P = 0.746). Specifically, at T0, among participants with NCI, 35% improved; among those without, 26% worsened at T1; NPZ-12 score worsened at T1. 5.6% of ANI was observed at T0 and 7.9% at T1. No factor associated with these changes was found.

Conclusion:

Our results suggest switching from EFV/F/TDF to B/F/TAF significantly improves psychiatric symptoms and sleep quality. Neurocognitive performance remained stable, although a decline in NPZ-12 and in specific domains was observed.
Real-world clinical and economic outcomes from rapid start antiretroviral therapy in HIV: systematic review and meta-analysis
Authors: Duong Khanh N.C. , Schmutz Howard Weston , Ben-Umeh Kenechukwu C. , Duru Emeka E. , Rose Natalie , Trom Cassidy , Chaiyakunapruk Nathorn , Willis Connor
Published: October 2024

Objective:

We aimed to synthesize clinical and economic outcomes of rapid start versus nonrapid antiretroviral therapy (ART) in people with HIV (PWH) in real-world settings.

Methods:

A search was conducted in PubMed, Embase, Web of Science, and ProQuest from January 2017 to January 2023, supplementing a previous search by Ford et al. in 2018. Observational studies investigating clinical or economic outcomes of rapid start ART versus nonrapid ART in PWH were included. Clinical outcomes were mortality, loss-to-follow-up (LTFU), and viral suppression. Economic outcomes were incremental cost-effectiveness ratio (ICER) values and per patient per month (PPPM) costs. Meta-analyses using random-effects models were performed for clinical outcomes, whereas qualitative syntheses were conducted for economic outcomes. The quality of clinical and economic studies was assessed.

Results:

Sixty-two studies were included. The pooled adjusted risk ratio (aRR) for mortality demonstrated a significant reduction in risk of mortality among participants who received rapid start ART compared with nonrapid ART [0.80, 95% confidence interval (CI), 0.65–0.98]. For LTFU at 6 and 12 months, the pooled aRR showed increased LTFU for rapid start ART (1.33, 95% CI, 1.15–1.55 and 1.18, 95% CI, 0.74–1.89 respectively). All cost-effectiveness studies reported cost-saving or cost-effective findings. The PPPM costs of rapid start ART across the first 36 months of treatment were consistently lower than nonrapid ART.

Conclusion:

Rapid ART is associated with reduced mortality and is cost-effective compared with nonrapid ART in real-world settings. Clinicians and policymakers should consider these findings to facilitate rapid start of ART in PWH. Further research on LTFU in PWH is needed.
Genetic Risk Scores for the Clinical Rheumatologist
Authors: Wheeler Austin M. , Riley Thomas R. , Merriman Tony R.
Published: October 2024

Background/Historical Perspective

The advent of genome-wide sequencing and large-scale genetic epidemiological studies has led to numerous opportunities for the application of genetics in clinical medicine. Leveraging this information toward the formation of clinically useful tools has been an ongoing research goal in this area. A genetic risk score (GRS) is a measure that attempts to estimate the cumulative contribution of established genetic risk factors toward an outcome of interest, taking into account the cumulative risk that each of these individual genetic risk factors conveys. The purpose of this perspective is to provide a systematic framework to evaluate a GRS for clinical application.

Summary of Current Literature

Since the initial polygenic risk score methodology in 2007, there has been increasing GRS application across the medical literature. In rheumatology, this has included application to rheumatoid arthritis, gout, spondyloarthritis, lupus, and inflammatory arthritis.

Major Conclusions

GRSs are particularly relevant to rheumatology, where common diseases have many complex genetic factors contributing to risk. Despite this, there is no widely accepted method for the critical application of a GRS, which can be a particular challenge for the clinical rheumatologist seeking to clinically apply GRSs. This review provides a framework by which the clinician may systematically evaluate a GRS.

Future Research Directions

As genotyping becomes more accessible and cost-effective, it will become increasingly important to recognize the clinical applicability of GRSs and identify those of the highest utility for patient care. This framework for the evaluation of a GRS will also help ensure reliability among GRS research in rheumatology, thereby helping to advance the field.
Treatment of Comminuted Mandibular Angle Fractures Using Champy Technique
Authors: Zhang Difei , Lin Yuxin , Lv Kun
Published: October 2024

Objective:

Isolated and noncomminuted mandibular angle fractures are commonly fixed with a single miniplate on the superior border (Champy technique) through an intraoral approach. However, the use of this technique for comminuted mandibular angle fractures has not been reported yet. This article verified that the Champy technique can also be used to treat comminuted mandibular angle fractures.

Methods:

The authors compared the therapeutic effects of using the Champy technique for intraoral fixation of comminuted mandibular angle fractures with or without alveolar bone defect. The dislocated teeth were removed. Iodoform gauze was used in a patient with alveolar bone defects and incomplete closure of soft tissue.

Results:

A patient with comminuted mandibular angle fractures without alveolar bone defect experienced primary wound healing and good occlusion after surgery. A patient with comminuted mandibular angle fractures accompanied by alveolar bone defect and incomplete closure of soft tissue has an intraoral fistula and bone resorption until 2 months postoperatively. At 6 months postoperatively, the occlusion remained stable and callus healing had been completed.

Conclusion:

The Champy technique for intraoral single plate fixation is feasible for comminuted mandibular angle fractures. Incomplete closure of soft tissue leads to exposure of the bone marrow cavity, resulting in delayed fracture healing.
PROTECTION OF MICE AGAINST CECAL LIGATION AND PUNCTURE-INDUCED POLYMICROBIAL SEPSIS BY A FASCIOLA HEPATICA HELMINTH DEFENSE MOLECULE
Authors: Fazekas Barbara , Hamon Siobhán , De Marco Verissimo Carolina , Cwiklinski Krystyna , López Corrales Jesús , Gaughan Siobhán , Ryan Sinéad , Taggart Clifford C. , Weldon Sinéad , Griffin Matthew D. , Dalton John P. , Lalor Richard
Published: October 2024

Sepsis results from a dysregulated host immune response to infection and is responsible for ~11 million deaths each year. In the laboratory, many aspects of sepsis can be replicated using a cecal ligation and puncture model, which is considered the most clinically relevant rodent model of sepsis. In the present study, histological and biomarker multiplex analyses revealed that the cecal ligation and puncture model initiated a large-scale inflammatory response in mice by 24 h, with evidence of acute organ damage by 48–72 h. While many typical proinflammatory cytokine/chemokines were systemically elevated, a specific array including IL-10, eotaxin, MIP-1α, MIP-1β, MCP-1, and RANTES noticeably increased just prior to animals reaching the humane endpoint. Treatment of mice with 10 μg of a synthetic 68-amino acid peptide derived from an immunomodulatory molecule secreted by a parasitic worm of humans and livestock, F. hepatica, termed F. hepatica helminth defense molecule, potently suppressed the systemic inflammatory profile, protected mice against acute kidney injury, and improved survival between 48 and 72 h after procedure. These results suggest that the anti-inflammatory parasite-derived F. hepatica helminth defense molecule peptide has potential as a biotherapeutic treatment for sepsis.
EFFECTS OF LOCAL HYPOTHERMIA ON LIMB VIABILITY IN A SWINE MODEL OF ACUTE LIMB ISCHEMIA DURING PROLONGED DAMAGE-CONTROL RESUSCITATION
Authors: Kao Emily , Patel Sahil , Wang Xu , Ringgold Kristyn , Snyder Jessica M. , Stern Susan , Bulger Eileen , White Nathan , Aarabi Shahram
Published: October 2024

Background: New strategies are needed to mitigate further tissue injury during traumatic limb ischemia in cases requiring damage control resuscitation (DCR). Little is known about the pathophysiology and injury course in acute limb ischemia (ALI) with DCR in polytraumatized casualties. We therefore investigated the effects of therapeutic limb hypothermia in a swine model of ALI and DCR. Methods: Fifteen swine underwent a published 6-h DCR protocol of hemorrhage and then resuscitation. After hemorrhage, animals were randomized to 5°C or 15°C cooling of one hindlimb; the contralateral limb serving as an uncooled control. Physiologic variables, limb temperature, and limb tissue metabolites (glucose, lactate, and pyruvate) were measured throughout the DCR protocol. Muscle and nerve biopsies were obtained after the 6-h protocol. Results: Lactate and pyruvate levels were significantly lower in the cooled limbs than in the uncooled control limbs but did not differ between the 5°C and 15°C groups. Tissue glucose levels did not differ between the 5°C group, the 15°C group, and controls. Mean histologic muscle score was significantly higher in the 5°C group than in controls (P = 0.03). Mean nerve histology scores did not differ between the 5°C and paired control limbs, or between the mean muscle and nerve histology scores of the 15°C and paired control limbs. Conclusion: Cooling to 15°C significantly reduced local tissue metabolites compared to paired controls, while producing no significant increase in histologic damage, whereas cooling to 5°C increased histologic muscle damage. These results suggest an approach to prevention of ischemic injury through local hypothermia but warrant further functional testing.
PARTIAL OCCLUSION, LESS AKI: AN AORTA REGISTRY ANALYSIS OF PREBOA-PRO
Authors: Vassy William Matthew , Beckett Andrew , Dennis Bradley , Duchesne Juan , Kundi Rishi , Nguyen Jonathan , Spalding M. Chance , Moore Ernest E. ,   On behalf of AAST Multi-Institutional Trials Committee
Published: October 2024

Background: Noncompressible torso hemorrhage remains a leading cause of potentially preventable deaths. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) has emerged as an adjunct temporizing hemorrhage control. The complete occlusion strategy with the ER-REBOA catheter can cause distal ischemia when used for longer than 30 min. To specifically address this limitation, the pREBOA-PRO catheter was developed. The objective of the current study is to investigate the impact of longer, partial occlusion times provided by pREBOA-PRO on acute kidney injury and mortality. Methods: This is a retrospective analysis of the Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery registry as of August 2023. Patients in the pREBOA-PRO group (n = 110) receiving partial occlusion in Zone 1 were contrasted to patients in the ER-REBOA group (n = 752) treated with complete occlusion in Zone 1. Between-group comparisons included demographics, clinical presentation, aortic occlusion strategy, clinical complications, and mortality. Results: Demographics, clinical presentation, and mortality were indistinguishable between groups, except for age which was higher in the ER-REBOA group (44 vs. 38, P < 0.002). The partial aortic occlusion strategy was employed more often in the pREBOA-PRO group (87% vs. 33%, P < 0.05) and for longer periods (59 min vs. 50 min, P < 0.003). In contrast, AKI occurred less frequently in the pREBOA-PRO group (19% vs. 33%, P < 0.05). Conclusions: The more frequently partial and longer occlusion times in Zone 1 with the use of pREBOA-PRO resulted in lower AKI incidence suggesting that this newer device is a safer extended bridge to hemorrhage control.
Atmospheric footnotes: Ada Lovelace on climate
Authors: Ferlier Louisiane
Published: October 2024

This article brings to light correspondence between Augusta Ada King, Countess of Lovelace (1815–1852) and Sir John Frederick William Herschel (1792–1871) from the Royal Society archives. The 1848 letters reveal the extent of her contribution to an article authored by her husband, William King, Lord Lovelace (1805–1893), on the role of climate on crop growth. This involvement uncovers little-known facets of her scientific pursuits: her interest in the application of photography to meteorological instrumentation, her budding study of astronomy, and her development of mathematical treatments to model the environmental conditions required for plants to grow. The exchange situates Ada Lovelace in the larger context of Victorian science and reflects more widely on the complicated access of women to institutional science.
DIVERSITY AND CLINICAL CORRELATIONS OF SARS-CoV-2 VARIANT DURING THE INTRODUCTION OF THE DELTA VARIANT IN GUATEMALA
Authors: Carranza Claudia , Ortiz Lucia , Castellanos Maria Eugenia , Gonzalez-Reiche Ana Silvia , Mendizabal-Cabrera Renata , Khalil Zain , van DeGuchte Adriana , Farrugia Keith , Herrera Mariana , Mena Ernesto , Cordon-Rosales Celia , van Bakel Harm , Perez Daniel R.
Published: October 2024

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomic surveillance is crucial for understanding viral evolution and guiding public health responses. However, many countries, particularly in Central America, have limited sequencing capacity, resulting in scarce and delayed data. This study addresses this gap by analyzing 320 SARS-CoV-2 genomes sequenced from a major diagnostic center in Guatemala City, Guatemala, between April and August 2021. Clade 21J (Delta) was predominant (46.2%), followed by 19B (29.4%) and 20J (Gamma, 6.6%). The most reported symptoms were cough, headache, malaise, and myalgia/arthralgia. Among patients infected with the Delta variant, 39.9% reported being contacts from a confirmed case, less than reported by the patients infected with non-Delta variants (53.2%, p= 0.017). The proportion of signs and symptoms was similar among these two groups, except for the history of fever which was increased ~2-fold in the Delta group. This research contributes valuable genomic and epidemiological data to elucidate SARS-CoV-2 variant dynamics in Central America and emphasizes the importance of global genomic surveillance for pandemic preparedness and response.
Iridescent structural coloration in a crested Cretaceous enantiornithine bird from Jehol Biota
Authors: Li Zhiheng , Hu Jinsheng , Stidham Thomas A. , Ye Mao , Wang Min , Pan Yanhong , Zhao Tao , Li Jingshu , Zhou Zhonghe , Clarke Julia A.
Published: October 2024

A combination of sectioning and microscopy techniques, along with the application of finite-difference-time-domain modeling on a fossil feather, results in the novel estimation of the range of iridescent colors from the fossilized melanosome type and organization preserved in the elongate head crest feathers of a new Cretaceous enantiornithine bird. The densely packed rod-like melanosomes are estimated to have yielded from red to deep blue iridescent coloration of the head feathers. The shape and density of these melanosomes also may have further increased the feather’s structural strength. This occurrence on a likely male individual is highly suggestive of both a signaling function of the iridescent crest, and a potential behavioral role in adjusting the angle of light incidence to control the display of this iridescent structural coloration.
Global test of the enemy release hypothesis reveals similar patterns of herbivory across native and non-native plants
Authors: Galmán Andrea , Hahn Philip G. , Inouye Brian D. , Underwood Nora , Liu Yanjie , Whitehead Susan R. , Wetzel William C.
Published: October 2024

The Enemy Release Hypothesis (ERH) proposes that non-native plants escape their co-evolved herbivores and benefit from reduced herbivory in their introduced ranges. Numerous studies have tested this hypothesis, with conflicting results, but previous studies focus on average levels of herbivory and overlook the substantial within-population variability in herbivory, which may provide unique insights into the ERH. We tested differences in mean herbivory and added a novel approach to the ERH by comparing within-population variability in herbivory between native and non-native plant populations. We include several covariates that might mask an effect of enemy release, including latitude, regional plant richness, plant growth form and plant cover. We use leaf herbivory data collected by the Herbivory Variability Network for 788 plant populations (616 native range populations and 172 introduced range populations) of 503 different native and non-native species distributed worldwide. We found no overall differences in mean herbivory or herbivory variability between native and non-native plant populations. Taken together, our results indicate no evidence of enemy release for non-native plants, suggesting that enemy release is not a generalized mechanism favoring the success of non-native species.

OPEN RESEARCH STATEMENT

Data published and available for peer review athttps://doi.org/10.5061/dryad.44j0zpckm
Extending the IICR to complex non-stationary structured models
Authors: Jouniaux Alexane , Arredondo Armando , Boitard Simon , Chikhi Lounès , Mazet Olivier
Published: October 2024

Population genetic studies use genetic data to understand aspects of the evolutionary history of species, particularly to infer their demography. Here, we extend the non-stationary structured coalescent framework to complex models where the parameters of the model, and thus the state space, change between stationary periods. To do this, we introduce glue matrices that allow us to map one state space to another, hence enabling the computation of the Inverse Instantaneous Coalescence Rate (IICR) using Q-matrices of different dimensions. This approach allows us to study models where the number of demes changes due to extinction or foundation. Our analysis confirms that interpreting IICR curves as indicators of population size changes can be misleading. However, we also show that there are cases where new deme foundations can generate an increase in the IICR (forward in time). We explore the impact of changes in migration rates, timing of deme creation or deletion, and sampling strategies on the IICR, identifying several counter-intuitive results. For instance, we find that the IICR starts to decrease several generations before any change in the number of demes, as if the population “knew” something was about to happen. It is particularly unexpected when a deme is founded and the population is only increasing. Our results underscore the need for careful interpretation of PSMC and similar curves, which are often used and interpreted as population size changes. By presenting examples of IICRs for various transitions and sampling scenarios, we emphasize the importance of nuanced approaches in population genetic studies.