bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of previous detoxifications on intelligence, speed, attention, and executive functioning in patients with moderate to severe alcohol use disorder
Authors: Staudt Jeroen , De Haan Hein , Walvoort Serge , Rensen Yvonne , Egger Jos , Dijkstra Boukje
Published: December 2024

Introduction and aims

Repeatedly undergoing supervised, medical, detoxification from chronic alcohol use may contribute to impairments in neurocognitive functioning of patients with an alcohol use disorder (AUD). Unsupervised, non-medical, detoxification, however, may also contribute to neurocognitive impairments, given the absence of first choice prescription medication to counteract severe withdrawal effects. So far, findings from previous studies are inconclusive and specifically effects of non-medical detoxifications are not investigated yet. Using an association modeling approach, this study investigates whether intelligence, speed, attention, and executive functioning are influenced by previous medical and/or non-medical detoxifications.

Methods

A total of 106 participants with AUD underwent a clinical medical supervised detoxification. Basic characteristics of the patient were recorded including the number of previous medical and non-medical detoxifications. Neuropsychological assessment was conducted after 6 weeks of abstinence.

Results

The amount of previous medical detoxifications (F (1, 87) = 4.108, P = .046) and the group of medical detoxifications (F(1, 87) = 4734, P = .032), predicted performance on one out of 14 dependent variables, i.e. the “d2 Number of Signs” task. Though “Age of onset of daily alcohol use” contributed significantly to this relationship, the change of the regression coefficient of the model was ˂10%. The number of non-medical or total amount of previous detoxifications did not predict any of the dependent variables.

Conclusion

The results indicate limited evidence of a linear association between either medical, non-medical, or total amount of previous detoxifications and measures of intelligence, speed, attention, or executive functioning, while controlling for relevant confounders.
Surgical Site Allergic Contact Dermatitis Due to 2-Octyl Cyanoacrylate: A Systematic Review and FDA MAUDE Review
Authors: Fanning James E , Escobar-Domingo Maria J , Montoya Marco , Foppiani Jose , Lee Daniela , Park John B , Rahmani Benjamin , Miller Amitai S , Karinja Sarah J , Boustany Ashley N , Tan Sally Y , Lee Bernard T
Published: December 2024

Skin adhesives containing 2-octyl cyanoacrylate are a common source of allergic contact dermatitis (ACD), a complication of postoperative wound healing. Few studies have described postoperative cutaneous reactions to skin adhesives and their clinical management. The aim of this study was to review the incidence, descriptions, and clinical management of surgical site ACD caused by 2-ocyl cyanoacrylate. A comprehensive systematic literature search was conducted in September 2023 of the PubMed/MEDLINE (National Library of Medicine, Bethesda, MD), Web of Science (Clarivate Analytics, Philadelphia, PA), and Cochrane databases (Cochrane Library, John Wiley & Sons, Ltd., Hoboken, NJ) for studies reporting ACD after skin closure with liquid adhesives containing 2-octyl cyanoacrylate. Additionally, we queried the FDA Manufacturer and User Facility Device Experience (FDA MAUDE, U.S. Food and Drug Administration, Silver Spring, MD) in September 2023 and retrieved clinician-inputted records of ACD caused by liquid adhesives containing 2-octyl cyanoacrylate from 2014 to2023. Nine articles were included for review, with a median of 102 patients exposed to 2-octyl cyanoacrylate for surgical site skin closure. The reported incidence of cutaneous reactions to 2-octyl cyanoacrylate ranged from 0.5% to 14%. The review also included 609 unique FDA MAUDE records reporting surgical site skin reactions to 2-octyl cyanoacrylate. Orthopedic procedures were the most common type of procedure, representing 47% of FDA MAUDE records. Nineteen clinical descriptors of cutaneous reactions were utilized. Topical corticosteroids and oral antihistamines were the most commonly prescribed treatments to manage postoperative cutaneous reactions. Reported incidences of cutaneous reactions to 2-octyl cyanoacrylate vary widely and guidelines for clinical management remain unclear. The FDA MAUDE provides important insights to cutaneous reactions to 2-octyl cyanoacrylate including surgery-type, cutaneous descriptors, and clinical management. Future research is needed to identify patients at risk of 2-octyl cyanoacrylate skin reactions in the preoperative setting.

Level of Evidence: 3 (Therapeutic)
Comprehensive bioinformatics and machine learning analyses for breast cancer staging using TCGA dataset
Authors: Das Saurav Chandra , Tasnim Wahia , Rana Humayan Kabir , Acharjee Uzzal Kumar , Islam Md Manowarul , Khatun Rabea
Published: December 2024

Breast cancer is an alarming global health concern, including a vast and varied set of illnesses with different molecular characteristics. The fusion of sophisticated computational methodologies with extensive biological datasets has emerged as an effective strategy for unravelling complex patterns in cancer oncology. This research delves into breast cancer staging, classification, and diagnosis by leveraging the comprehensive dataset provided by the The Cancer Genome Atlas (TCGA). By integrating advanced machine learning algorithms with bioinformatics analysis, it introduces a cutting-edge methodology for identifying complex molecular signatures associated with different subtypes and stages of breast cancer. This study utilizes TCGA gene expression data to detect and categorize breast cancer through the application of machine learning and systems biology techniques. Researchers identified differentially expressed genes in breast cancer and analyzed them using signaling pathways, protein–protein interactions, and regulatory networks to uncover potential therapeutic targets. The study also highlights the roles of specific proteins (MYH2, MYL1, MYL2, MYH7) and microRNAs (such as hsa-let-7d-5p) that are the potential biomarkers in cancer progression founded on several analyses. In terms of diagnostic accuracy for cancer staging, the random forest method achieved 97.19%, while the XGBoost algorithm attained 95.23%. Bioinformatics and machine learning meet in this study to find potential biomarkers that influence the progression of breast cancer. The combination of sophisticated analytical methods and extensive genomic datasets presents a promising path for expanding our understanding and enhancing clinical outcomes in identifying and categorizing this intricate illness.
Fire metaphors in Plutarch’s Late Republican Lives
Authors: Deriu Morena
Published: December 2024

In this article, I will investigate how Plutarch uses fire metaphors to conceptualize physical and psychological realities mainly related to the exercise of power in the Lives belonging to the Late Republic and their parallel Lives. I will show how Plutarch uses fire as a source domain to represent the target domains of war and conflict, anger, ambition, and warlike ardour, and erotic desire. I will point out the similarities and differences in such uses to illustrate how these target domains do or do not overlap. My aim is to show how fire metaphors contribute to Plutarch’s evaluation of his heroes, further illuminating the light and shade through which he famously characterizes his protagonists. Since the Lives programmatically provides its readers with models to follow and to avoid, a new understanding of Plutarch’s fire metaphors will also contribute to an improved perception of Plutarch’s protreptic purpose as regards the way his readers should handle the most burning emotions in the system of imperial authority and power. As people hopefully engaged in a long-lasting and noteworthy political career in this system, Plutarch wanted them educated in how to handle and exploit such emotions.
Preliminary urinary profiles of prolactin during gestation and the synergistic effects of embryonic diapause hormones in the giant panda (Ailuropoda melanoleuca)
Authors: Shenfei Wang , Mengshi Zhang , Feiping Li , Xianbiao Hu , Yan Li , Juan Wang , Xiangyu Liu , Rong Hou , Yuliang Liu , Kailai Cai
Published: December 2024

The embryonic diapause of the giant panda (Ailuropoda melanoleuca) has caused great difficulties in monitoring pregnancy in this vulnerable species. The secretion of prolactin (PRL) from anterior pituitary glandular lactotropic cells is an important signal for the termination of embryonic dormancy. Currently, the mechanism by which PRL affects embryonic diapause in giant pandas and methods for detecting PRL in this species is poorly understood. In this study, the first sandwich enzyme immunoassay for detecting PRL in giant panda urine was established by using two antigiant panda PRL antibodies prepared as coating and labeling antibodies, and PRL recombinant proteins prepared via the prokaryotic system as standards. The established method was used to detect the levels of PRL in the urine of giant pandas during pregnancy. At the same time, the changes in PRL levels in giant pandas and the relationship between PRL and progestagen levels were analyzed during the luteal phase. The results showed that in female giant pandas, PRL levels significantly increased before the progestagen peak, and during the luteal phase, the PRL level was significantly greater in giant pandas that gave birth than in those that did not give birth and those in the nonestrus group. To the best of our knowledge, this is the first study to preliminarily explore the mode of action of PRL in the gestation period of giant pandas and lays a foundation for further study of the regulatory mechanisms of endocrine hormones in the giant panda.
Queering Crime Reporting: Representing Anti-queer Violence in LGBTQ News Media
Authors: Mitchell Matthew , O’Neill Tully , Redd Curtis
Published: December 2024

While criminology has studied news media reporting for decades, it has largely overlooked reporting on anti-queer violence and depictions of crime outside mainstream outlets. This article addresses this gap by analysing how anti-queer violence is represented in LGBTQ community media. By analysing 1,295 articles from 11 LGBTQ publications across five Anglophone countries between 2019 and 2021, we examine which forms of anti-queer violence are deemed newsworthy in these outlets. Our analysis reveals that LGBTQ community media emphasize particular types of violence, relationships between victims and perpetrators and contexts of victimization while downplaying or disregarding others. We argue that this selective representation both mirrors and ‘queers’ prevailing norms in mainstream crime news reporting in culturally and criminologically significant ways. In grappling with this tension, we identify and critique several cisheteronormative assumptions embedded in the existing literature on news media representations of crime. Ultimately, our analysis calls for a re-evaluation and revision of the existing discourse within media criminology, urging scholars to engage with a broader range of experiences, communities and narrative practices to understand better how violence is culturally mediated.
Patient preferences for the treatment of Bowen disease
Authors: Ahmady Shima , Mosterd Klara , Jansen Maud H E , Kelleners-Smeets Nicole W J , Essers Brigitte A B
Published: December 2024

Background

Discrete choice experiments (DCEs) are increasingly used to understand and quantify patient preferences for a variety of treatments, services or screening in order to analyse the choices patients make when faced with different alternatives.

Objectives

The aim of this DCE was to examine patient preferences for the treatment of Bowen disease.

Methods

A DCE was conducted alongside a randomized controlled noninferiority trial comparing the effectiveness of surgical excision, methyl aminolaevulinate photodynamic therapy (MAL-PDT) and 5-fluorouracil (5-FU) cream as treatments for Bowen disease. Preferences were elicited by presenting patients with choice tasks between surgical excision, MAL-PDT and 5-FU cream with the following attributes: effectiveness, cosmetic outcome, side-effects, treatment duration and process. A mixed logit model was used to account for the panel nature of the data (repeated choices for each respondent) and heterogeneity in preference.

Results

A total of 215 patients completed the DCE. Patients have a clear preference for excision and noninvasive therapies were less valued, as indicated by the large and negative label effect. Both moderate and good-to-excellent cosmetic outcomes were accepted and preferred to poor cosmetic outcomes for all treatments. In addition, none or mild-to-moderate side-effects were considered acceptable and preferred to severe side-effects.

Conclusions

Patients show a clear preference for surgical excision, and of the two noninvasive treatments, 5-FU cream is preferred to MAL-PDT. Treatment choice is also determined by attributes such as effectiveness, cosmetic outcome and side-effects. In the context of shared decision making for Bowen disease, it is important to discuss the elements of treatment that patients value to ensure that an informed decision is made.
Epidemiology and Outcomes of Antibiotic De-escalation in Patients With Suspected Sepsis in US Hospitals
Authors: Kam Kai Qian , Chen Tom , Kadri Sameer S , Lawandi Alexander , Yek Christina , Walker Morgan , Warner Sarah , Fram David , Chen Huai-Chun , Shappell Claire N , DelloStritto Laura , Jin Robert , Klompas Michael , Rhee Chanu
Published: December 2024

Background

Little is known about the frequency, hospital-level variation, predictors, and outcomes of antibiotic de-escalation in suspected sepsis.

Methods

We retrospectively analyzed adults admitted to 236 US hospitals from 2017–2021 with suspected sepsis (defined by blood culture draw, lactate measurement, and intravenous antibiotic administration) who were initially treated with ≥2 days of anti–methicillin-resistant Staphylococcus aureus (MRSA) and anti-pseudomonal antibiotics but had no resistant organisms that required these agents identified through hospital day 4. De-escalation was defined as stopping anti-MRSA and anti-pseudomonal antibiotics or switching to narrower antibiotics by day 4. We created a propensity score for de-escalation using 82 hospital and clinical variables; matched de-escalated to non–de-escalated patients; and assessed associations between de-escalation and outcomes.

Results

Among 124 577 patients, antibiotics were de-escalated in 36 806 (29.5%): narrowing in 27 177 (21.8%), cessation in 9629 (7.7%). De-escalation rates varied between hospitals (median, 29.4%; interquartile range, 21.3%–38.0%). Predictors of de-escalation included less severe disease on day 3–4, positive cultures for nonresistant organisms, and negative/absent MRSA nasal swabs. De-escalation was more common in medium, large, and teaching hospitals in the Northeast and Midwest. De-escalation was associated with lower adjusted risks for acute kidney injury (AKI) (odds ratio [OR], 0.80; 95% confidence interval [CI], .76–.84), intensive-care unit (ICU) admission after day 4 (OR, 0.59; 95% CI, .52–.66), and in-hospital mortality (OR, 0.92; 95% CI, .86–.996).

Conclusions

Antibiotic de-escalation in suspected sepsis is infrequent, variable across hospitals, linked with clinical and microbiologic factors, and associated with lower risk for AKI, ICU admission, and in-hospital mortality.
Association Between the Sequence of β-Lactam and Vancomycin Administration and Mortality in Patients With Suspected Sepsis
Authors: Kondo Yutaka , Klompas Michael , McKenna Caroline S , Pak Theodore R , Shappell Claire N , DelloStritto Laura , Rhee Chanu
Published: December 2024

Background

Timely antibiotic initiation is critical to sepsis management, but there are limited data on the impact of giving β-lactams first versus vancomycin first among patients prescribed both agents.

Methods

We retrospectively analyzed all adults admitted to 5 US hospitals from 2015–2022 with suspected sepsis (blood culture collected, antibiotics administered, and organ dysfunction) treated with vancomycin and a broad-spectrum β-lactam within 24 hours of arrival. We estimated associations between β-lactam- versus vancomycin-first strategies and in-hospital mortality using inverse probability weighting (IPW) to adjust for potential confounders.

Results

Among 25 391 patients with suspected sepsis, 21 449 (84.4%) received β-lactams first and 3942 (15.6%) received vancomycin first. Compared with the β-lactam-first group, patients administered vancomycin first tended to be less severely ill, had more skin/musculoskeletal infections (20.0% vs 7.8%), and received β-lactams a median of 3.5 hours later relative to emergency department arrival. On IPW analysis, the β-lactam-first strategy was associated with lower mortality (adjusted odds ratio [aOR]: .89; 95% CI: .80–.99). Point estimates were directionally similar but nonsignificant in a sensitivity analysis using propensity score matching rather than IPW (aOR: .94; 95% CI: .82–1.07) and in subgroups of patients with positive blood cultures, methicillin-resistant Staphylococcus aureus cultures, and those administered antipseudomonal β-lactams.

Conclusions

Among patients with suspected sepsis prescribed vancomycin and β-lactam therapy, β-lactam administration before vancomycin was associated with a modest reduction in in-hospital mortality. These findings support prioritizing β-lactam therapy in most patients with sepsis but merit confirmation in randomized trials given the risk of residual confounding in observational analyses.
A National Retrospective Cohort Study Comparing the Effects of Cefepime Versus Piperacillin-Tazobactam on the Development of Severe Acute Kidney Injury in Patients With Septic Shock
Authors: Patanwala Asad E , Nix David E , Hills Thomas E , Erstad Brian L
Published: December 2024

Background

Cefepime and piperacillin-tazobactam are commonly used broad-spectrum antibiotics used to treat patients with potential gram-negative bacterial sepsis. Piperacillin-tazobactam has been shown to be associated with acute kidney injury (AKI). However, it has not been compared with cefepime in patients with septic shock. We compared the effects of cefepime and piperacillin-tazobactam on the incidence of severe AKI in patients with septic shock.

Methods

This was a retrospective, multicenter, inverse probability-of-treatment weighted cohort study conducted in 220 geographically diverse community and teaching hospitals across the United States. Adult patients were included if they had septic shock on hospital admission and received cefepime or piperacillin-tazobactam. The proportions of patients in whom stage 3 AKI occurred during hospitalization were compared between groups.

Results

Of the 8427 patients included in the final cohort, 4569 received cefepime and 3858 received piperacillin-tazobactam. Patients had a mean (SD) age of 66.2 (15.2) years, and 45.3% were female; the mean (SD) estimated glomerular filtration rate was 48 (24) mL/min/1.73 m2 on the day of admission. In the weighted cohort, stage 3 AKI occurred in 9.9% receiving cefepime and 9.8% receiving piperacillin-tazobactam (odds ratio, 0.98 [95% confidence interval, .84–1.15]; P = .82). In terms of secondary outcomes, there was no significant difference between cefepime and piperacillin-tazobactam with regard to renal replacement therapy, in-hospital death, major adverse kidney events, stage 1 AKI, stage 2 AKI, maximum recorded serum creatinine, or hospital length of stay

Conclusions

Among hospitalized patients with septic shock, there was no difference between cefepime and piperacillin-tazobactam in the occurrence of severe AKI.
Community-Acquired Respiratory Virus Infections: A Threat to Long-Term Survivors After Allogeneic Stem Cell Transplant?
Authors: Piñana José Luis , Carbonell-Asins Juan A , Gómez Dolores , Montoro Juan , Pérez Ariadna , Hernani Rafael , Chorão Pedro , Hernández-Boluda Juan Carlos , Navarro David , Solano Carlos
Published: December 2024

Background

Studies on late community-acquired respiratory virus (CARV) infections in long-term allogeneic hematopoietic stem cell transplantation (allo-HCT) survivors are scarce, creating knowledge gaps on the epidemiology, risk of progression to lower respiratory tract disease (LRTD), and conditions linked to poor outcomes.

Methods

We included consecutive CARV infection episodes occurring up to 6 months after allo-HCT registered in our database from December 2013 to June 2023 at 2 Spanish transplant centers.

Results

Among 426 allo-HCT recipients, 1070 CARV episodes were recorded, 791 (74%) with only upper respiratory tract disease (URTD) and 279 (15%) progressing to LRTD, at a median of 18.6 months post-transplant. The most common CARVs were rhinovirus, respiratory syncytial virus (RSV), and influenza. The LRTD progression rate was 26%, with a 4.9% all-cause mortality rate at 100 days post-CARV detection. Risk factors for LRTD progression included graft-versus-host disease prophylaxis (odds ratio [OR] 3.08), corticosteroid use (0.1 to <30 mg/day: OR 2.44; ≥30 mg/day: OR 5.19), absolute lymphocyte count (ALC) <1 × 10^9/L (OR 1.60), fever at CARV screening (OR 4.27), RSV (OR 2.46), and human metapneumovirus (HMPV) (OR 2.76). Risk factors for 100-day all-cause mortality included human leukocyte antigen (HLA) mismatch (hazard ratio [HR] 2.49); corticosteroid use (0.1 to <30 mg/day: HR 3.87; ≥30 mg/day: HR 5.77); ALC <1 × 10^9/L (HR 2.44); neutropenia <0.5 × 10^9/L (HR 6.74), and age ≥40 years (HR 4.85).

Conclusions

Recipients with profound and prolonged immunosuppression remain at risk for severe CARV infection outcomes late after allo-HCT, necessitating intensive clinical monitoring for respiratory symptoms.
Urine complement-related proteins in IgA nephropathy and IgA vasculitis nephritis, possible biomarkers of disease activity
Authors: Nurmi Mazdak Sanaei , Pérez-Alós Laura , Garred Peter , Fellström Bengt , Gabrysch Katja , Lundberg Sigrid
Published: December 2024

Introduction

The activation of the complement system plays an important role in the pathogenesis of IgA nephropathy (IgAN). Our primary aim was to evaluate a range of complement-related proteins, including pentraxin-3 (PTX-3), in blood and urine at diagnosis and their association with disease activity in the kidney biopsy, eGFR, albuminuria, and outcome. Our secondary aim was to compare the same biomarkers between patients with IgAN and IgA vasculitis with renal involvement (IgAVN).

Methods

In a longitudinal Swedish cohort of 96 patients with IgAN (n = 65) or IgAVN (n = 31), with a median follow-up time of 10.8 years, we analysed mainly lectin-pathway-related proteins and PTX-3 in plasma and urine (u) samples stored at the time of kidney biopsy. Outcome was defined by the GFR slope or by the combined outcome of 50% loss of eGFR or end-stage kidney disease (ESKD).

Results

Patients with detectable vs undetectable u-PTX-3 and u-mannose-binding lectin (MBL) more frequently had mesangial hypercellularity, endocapillary proliferation, and crescents in their kidney biopsy. u-C4c levels were higher in patients with advanced tubulointerstitial fibrosis, and u-C4c was also an independent predictor of a more severe eGFR slope. There were no differences in the levels of biomarkers between patients with IgAN and IgAVN.

Conclusion

u-PTX-3 and u-MBL might be biomarkers of an active proliferative stage of the disease, while higher u-C4c levels indicate more chronic lesions in both IgAN and IgAVN. These results must, however, be confirmed in larger and multiethnic cohorts.
Performance of higher-order networks in reconstructing sequential paths: from micro to macro scale
Authors: Teo Kevin , Arnold Naomi , Hone Andrew , Kiss István Zoltán
Published: December 2024

Activities such as the movement of passengers and goods, the transfer of physical or digital assets, web navigation and even successive passes in football, result in timestamped paths through a physical or virtual network. The need to analyse such paths has produced a new modelling paradigm in the form of higher-order networks which are able to capture temporal and topological characteristics of sequential data. This has been complemented by sequence mining approaches, a key example being sequential motifs measuring the prevalence of recurrent subsequences. Previous work on higher-order networks has focused on how to identify the optimal order for a path dataset, where the order can be thought of as the number of steps of memory encoded in the model. In this article, we build on these approaches to consider which orders are necessary to reproduce different path characteristics, from path lengths to counts of sequential motifs, viewing paths generated from different higher-order models as null models which capture features of the data up to a certain order, and randomize otherwise. Furthermore, we provide an important extension to motif counting, whereby cases with self-loops, starting nodes and ending nodes of paths are taken into consideration. Conducting a thorough analysis using path lengths and sequential motifs on a diverse range of path datasets, we show that our approach can shed light on precisely where models of different order overperform or underperform, and what this may imply about the original path data.
Demographic analysis of survival trends in squamous cell carcinoma of the upper 1/3 of the esophagus: a population-based study
Authors: Travis Dylan , Nnawuba Kingsley , Vellanki Sruthi , Robinson Samantha , Jensen Hanna , Trikannad Anup Kumar
Published: December 2024

Esophageal malignancies, constituting 3% of global cancers, pose significant health challenges with poor survival rates. Squamous Cell Carcinoma (SCC) and Adenocarcinoma (AC) are predominant subtypes, with shifting incidences globally. This analysis will focus primarily on the demographics of survival trends for Squamous cell carcinoma of esophagus (SCCE). This retrospective study, utilizing the SEER database, examined demographic factors influencing survival trends in SCC of the upper esophagus. Variables included age, sex, race, income, and rurality. Statistical analyses included chi-square tests and multivariable models, specifically logistic regression and conditional inference tree models. A total of 2821 patients were included in this study. Demographic disparities were evident with race (p < 0.001), age (p = 0.002), and sex (p = 0.048) significantly impacting survival when holding other variables constant, with Non-Hispanic Black individuals exhibiting the greatest odds of mortality compared to other racial groups. Median household income (p = 0.344) and Rural-Urban Continuum (p = 0.100) were not significantly associated with improved survival rates when controlling for other demographics. Our findings align with previous research on sex-based survival disparities and racial variations in SCCE incidence and outcomes. Socioeconomic and biological factors contribute to these disparities, highlighting the need for tailored interventions and equitable healthcare access. Understanding demographic determinants in SCCE survival is crucial for personalized treatment and policy reforms to address disparities. Future research should focus on prospective, diverse cohorts to further elucidate these complex interactions and improve esophageal SCCE management and outcomes.
Diverse Phenotypes, Consistent Treatment: A Study of 30 997 South Asian and White Inflammatory Bowel Disease Patients Using the UK Inflammatory Bowel Disease BioResource
Authors: Balarajah Sharmili , Martinez-Gili Laura , Alexander James Leslie , Mullish Benjamin Harvey , Perry Robert William , Li Jia V , Marchesi Julian Roberto , Parkes Miles , Orchard Timothy Robin , Hicks Lucy Charlotte , Williams Horace Richard Timothy
Published: December 2024

Background

Studies in the UK and North America have suggested a distinct disease profile in South Asians compared to that of White populations. Disparities in the medical and surgical management of IBD in minority ethnic groups (including Black Americans and Asians) in the US have been shown, while data from Europe, including the UK, have been lacking. This study sought to evaluate South Asian (SA) and White (WH) inflammatory bowel disease (IBD) phenotypes, and to explore treatment approach variations between these cohorts in the UK using the IBD BioResource database.

Design

Differences between WH and SA IBD patients were analysed using demographic, phenotypic and outcome data. Drug utilisation patterns and surgical outcomes were assessed in propensity score-matched (PSM) cohorts with multivariable logistic regression, Cox regression and Kaplan-Meier analysis.

Results

30,997 eligible patients were included. UC was the predominant disease subtype in SA (p<0.001). SA were younger at diagnosis (p<0.001), had a male preponderance (p<0.001), and were less likely to have a smoking history at diagnosis. The SA CD phenotype differed from WH, with less ileal (SA 30.3%, WH 38.4%, p=0.008) and stricturing (SA 16.9%, WH 25.6%, p<0.001) disease, but more perianal disease (SA 38.5%, WH 32.2%, p=0.009). More SA UC patients had extensive disease (SA 41.7%, WH 34.1%, p<0.001). In PSM cohorts, comparing treatments, there were no differences in 5-aminosalicylate, corticosteroid, thiopurine, anti-TNF or vedolizumab use. Survival analysis in matched cohorts showed no difference in time to surgery (CD) or colectomy (UC), and SA ethnicity was not associated with a difference in risk of surgery/colectomy.

Conclusion

Demographic and phenotypic differences exist between UK SA and WH IBD patients, highlighting distinct ethnicity-related variance, and the need for a research focus on under-represented populations. In comparing matched SA and WH patients, no disparity in medical and surgical IBD therapy in UK healthcare has been demonstrated: treatment is consistent regardless of ethnicity.
Non-invasive myocardial work in severe aortic regurgitation: implications for post-operative left ventricular dysfunction
Authors: Tan Yu-Ting , Wang Yao-Ling , Abulipizi Abudukadier , Ji Xiang , Zhang Rui-Ze , Zhao Ruo-Han , Hou Quan-Fei , Liu Tian-Shu , He Shu-Kun , Shi Jia-Wei , Li Yu-Man , Fang Ling-Yun , Zhang Li , Qiu Li , Zhang Jing , Xie Ming-Xing , Wang Jing
Published: December 2024

Aims

Non-invasive myocardial work offers a promising echocardiographic method to evaluate left ventricular (LV) function as it integrates myocardial deformation and afterload. The study sought to investigate the association of myocardial work indices with post-operative LV dysfunction in patients with chronic severe aortic regurgitation (AR).

Methods and results

Pre-operative LV ejection fraction (LVEF), LV global work index (LV GWI), LV global constructive work (LV GCW), LV global wasted work (LV GWW), and LV global work efficiency (LV GWE) were measured. Post-operative LV dysfunction was defined as LVEF < 50% at 12 months after surgery. One hundred and forty-one patients with chronic severe AR and preserved LVEF (52 (42–58) years; 74.5% men) who underwent aortic valve surgery were studied. Twenty-six patients (18%) developed post-operative LV dysfunction. Patients with post-operative LV dysfunction had lower LV GWI, LV GCW, and LV GWE compared with those without (all P < 0.05). In multivariate analysis, LV GWI (adjusted odds ratio (OR): 0.99; 95% CI: 0.98–1.00; P < 0.001), and LV GCW (adjusted OR: 0.99; 95% CI: 0.99–1.00; P < 0.001) were associated with post-operative LV dysfunction. Moreover, a multivariate logistic regression model with LV GWI (Akaike information criterion = 108.023, Bayesian information criterion = 119.818, C-statistics = 0.836) showed the best capability in predicting post-operative LV dysfunction. The comparative analysis of C-statistics across the three models—LV GWI, LV GCW, and LV GLS—did not reveal statistically significant differences (all P > 0.05).

Conclusion

In patients with chronic severe AR and preserved LVEF, impaired myocardial work indices are associated with post-operative LV dysfunction. Myocardial work has potential value for risk stratification and surgical decision-making in such a population.
Estimating inflammatory risk in atherosclerotic cardiovascular disease: plaque over plasma?
Authors: Annink Maxim E , Kraaijenhof Jordan M , Beverloo Cheyenne Y Y , Oostveen Reindert F , Verberne Hein J , Stroes Erik S G , Nurmohamed Nick S
Published: December 2024

Inflammation is an important driver of disease in the context of atherosclerosis, and several landmark trials have shown that targeting inflammatory pathways can reduce cardiovascular event rates. However, the high cost and potentially serious adverse effects of anti-inflammatory therapies necessitate more precise patient selection. Traditional biomarkers of inflammation, such as high-sensitivity C-reactive protein, show an association with cardiovascular risk on a population level but do not have specificity for local plaque inflammation. Nowadays, advancements in non-invasive imaging of the vasculature enable direct assessment of vascular inflammation. Positron emission tomography (PET) tracers such as 18F-fluorodeoxyglucose enable detection of metabolic activity of inflammatory cells but are limited by low specificity and myocardial spillover effects. 18F-sodium fluoride is a tracer that identifies active micro-calcification in plaques, indicating vulnerable plaques. Gallium-68 DOTATATE targets pro-inflammatory macrophages by binding to somatostatin receptors, which enhances specificity for plaque inflammation. Coronary computed tomography angiography (CCTA) provides high-resolution images of coronary arteries, identifying high-risk plaque features. Measuring pericoronary adipose tissue attenuation on CCTA represents a novel marker of vascular inflammation. This review examines both established and emerging methods for assessing atherosclerosis-related inflammation, emphasizing the role of advanced imaging in refining risk stratification and guiding personalized therapies. Integrating these imaging modalities with measurements of systemic and molecular biomarkers could shift atherosclerotic cardiovascular disease management towards a more personalized approach.
Surgical valve replacement in adults late after total cavo-pulmonary connection/Fontan procedure
Authors: Lisignoli Veronica , Iannaccone Giulia , Murphy Michael , Kacar Polona , Moscatelli Sara , Li Wei , Shore Darryl , Gatzoulis Michael A , Montanaro Claudia
Published: December 2024

OBJECTIVES

There is dearth of data on long-term outcomes of systemic semilunar (SS) or atrioventricular (AV) valve operation in adult patients with a Fontan circulation. We describe a single-centre experience of adults who underwent valve surgery late after a Fontan procedure.

METHODS

We retrospectively reviewed all patients with a Fontan circulation who had a reoperation for severe valve disease during adulthood in our centre. Demographic, anatomical, clinical and periprocedural data and long-term outcome were retrospectively retrieved from our dedicated electronic hospital database and examined.

RESULTS

Out of 233 adults with a Fontan operation, 8 (7 males [88%]) had valve surgery during the study period. Indication for surgery was severe symptomatic valve regurgitation in all patients (of the SS valve in seven cases and of the left AV valve in 1). Mechanical prosthesis was implanted in all cases. At a median follow-up of 10 years (interquartile range 5–20), one patient died due to hepatitis C virus infection. All the remaining 7 patients experienced a significant improvement of the New York Heart Association class compared to the pre-operative state (P = 0.015); echocardiography showed stable systemic ventricle ejection fraction in absence of volume overload (50.1 ± 7.9% vs 51.6 ± 8.7%, P = 0.399) and well-functioning prostheses. No patient needed further operation nor heart transplantation.

CONCLUSIONS

Surgical SS valve replacement late after a Fontan operation in highly selected adult patients with valvular regurgitation performed in a tertiary dedicated centre resulted to be safe in our population and conveyed clinical benefit. Close monitoring of all Fontan patients developing valvular dysfunction is warranted, whereas future prospective research may refine selection criteria, optimal timing and outcomes.
Overall survival, cause of death and time interval between diagnosis and death after Stanford type B acute aortic dissection (TBAAD)
Authors: Becker Daniel , Slongo Alexander , Yildiz Murat , Mosbahi Selim , Bosiers Michel Joseph , Jungi Silvan , Schoenhoff Florian , Kotelis Drosos , Makaloski Vladimir
Published: December 2024

OBJECTIVES

This study aimed to assess survival rates and the causes of both early and late mortality in patients with Stanford type B acute aortic dissection (TBAAD)

METHODS

A retrospective analysis was conducted on all consecutive patients presenting with TBAAD from 2000 to 2018 at a single tertiary care centre. The primary end-point was early (<3 months) and late (>3 months) survival following TBAAD, with causes of both early and late mortality evaluated.

RESULTS

A total of 274 patients, with a mean age of 64 ± 13 years, were included. Among these, 155 patients (57%) presented with uncomplicated TBAAD, including 52 (19%) identified as high-risk, and 119 patients (43%) had complicated TBAAD. Early aorta-related mortality occurred in 9 patients (3.3%), all within the complicated TBAAD group. The median follow-up period for the entire cohort was 8.5 years [95% confidence interval (CI) 7.6–11.2]. Long-term survival was significantly higher in patients with uncomplicated TBAAD compared to those with complicated TBAAD (P < 0.001). Both complicated and high-risk uncomplicated TBAAD cases required significantly more interventions in the chronic phase (>3 months) compared to uncomplicated TBAAD cases [hazard ratio (HR) 9.8, 95% CI 6.4–15.4, P < 0.001; HR 3.3, 95% CI 2.1–5.1, P < 0.001).

CONCLUSIONS

Complicated TBAAD presents the greatest risk for aorta-related mortality and interventions. Patients with high-risk uncomplicated TBAAD are also notable for an increased rate of aorta-related mortality and interventions. Thorough evaluation of clinical and anatomical characteristics is essential for determining the optimal therapeutic approach.
Palatal rugae change shape following orthodontic treatment: a comparison between extraction and non-extraction borderline cases using fractal analysis and 3D superimposition
Authors: Makrygiannakis Miltiadis A , Konstantonis Dimitrios , Vastardis Heleni , Athanasiou Athanasios E , Halazonetis Demetrios J
Published: December 2024

Introduction

Palatal rugae are used as anatomical landmarks on the hard palate, in various clinical applications; in forensics, for insertion of mini-screws, and for superimposition. There is ambiguous evidence on whether they change during orthodontic treatment and to what extent. Therefore, we investigated changes in the shape, complexity, and area occupied by palatal rugae following orthodontic treatment with and without extractions.

Materials and methods

Pre- and post-treatment plaster models of maxillae of 28 cases involving first premolar extractions (17 females and 11 males) and 33 non-extraction cases (19 females and 14 males) were scanned and analysed. All participants were selected from a parent sample via discriminant analysis and represent borderline cases. We applied mesh cropping, ball pivoting, distance mapping, contour cropping of rugae, best-fit superimposition, fractal dimension (FD) analysis, and creation of rugae’s convex hull area with Viewbox 4 software. The average distance between the closest points of the outlines of pre- and post-treatment palatal rugae (indicating shape change in the set of rugae), disparity in their pre- and post-treatment FDs (reflecting the complexity of their shapes), area occupied by rugae, arch depth, and size of palatal surface were then computed.

Results

The medians of the average distance between pre- and post-treatment outlines after best-fit superimposition were 0.39 mm (interquartile range [IQR]: 0.34–0.51) and 0.27 mm (IQR: 0.22–0.34) mm for the extraction and non-extraction groups, respectively (P < 0.001). The median pre-treatment FDs were 1.497 (IQR: 1.481–1.521) for the extraction group and 1.481 (IQR: 1.456–1.509) for the non-extraction group, whereas their median post-treatment FDs were 1.502 (IQR: 1.472–1.532) and 1.489 (IQR: 1.469–1.501), respectively. The differences between pre- and post-treatment fractal dimensions were not found to be significant, neither within each group, nor across the groups. On the other hand, the surface area occupied by rugae showed a median increase of 14.7 mm2 (IQR: 0.0–46.5) (P = 0.003) following non-extraction treatment only.

Conclusion

Palatal rugae change shape during orthodontic treatment, but their shape complexity, as measured by fractal dimensions, remains unaltered. Extraction treatment exerts a more pronounced effect in shape change compared to treatment without extractions. Nevertheless, non-extraction orthodontic treatment increases the surface on which rugae lie, as measured by means of the convex hull. Although the alterations may appear minor, it is necessary to exercise caution and prudence when employing rugae for superimposition and forensic dentistry purposes.
Is racism a barrier to HIV care continuum engagement among Black People in the United States? A scoping review to assess the state of the science and inform a research agenda
Authors: Ford Chandra L , Cook Mekeila C , Cross Rebecca Israel
Published: December 2024

People living with HIV can achieve viral suppression through timely HIV care continuum (HCC) engagement (ie, diagnosis, linkage to HIV care, retention in care, and adherence to prescribed treatment regimens). Black populations have poorer viral suppression, suboptimal HCC engagement, and higher levels of racism-related mistrust. The state of the evidence linking suboptimal HCC engagement to racism among US Black populations is assessed in this article. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, 6 English language databases were searched using 3 sets of key terms related to HCC engagement (eg, HIV diagnosis), racism (eg, discrimination), and the population (eg, Black people). To exclude articles, 3 rounds of reviews were conducted and results assessed for interrater reliability (κ = 99.00%; P < 0.00). From 2027 articles initially retrieved, the final set of analyses (n = 32) included clinical and nonclinical samples of people living with or at risk for HIV. Overall, the evidence was conceptually robust but methodologically simple. Studies primarily targeted intrapersonal and interpersonal racism and the late stage of HCC engagement: adherence. Sample-specific prevalence of racism ranged considerably; for example, 20% to 90% of sample members in clinical settings perceived or experienced interpersonal forms of racism. To date, the evidence suggests the relationship between racism and HCC engagement is mixed. Racism is salient among Black people living with or at risk for HIV. It appears not to impede HIV testing, though it may limit retention in HIV care, especially among men who have sex with men.
“I consider myself to be a leader”: a qualitative exploration of early career women family physicians’ intentions to assume a leadership role
Authors: Koempel Annie , Filippi Melissa K , Byrd Madeline , Siddiqi Anam , Bazemore Andrew , Jabbarpour Yalda
Published: December 2024

Background

Despite the increasing presence of women in US medical schools over the past 25 years, gender equity in medical leadership remains elusive. This qualitative study delves deeper into definitions of institutional leadership roles, who they are designed for, and how women currently contribute in unrecognized and uncompensated leadership positions.

Methods

We recruited family physicians who responded to the American Board of Family Medicine 2022 or 2023 graduate survey. We developed a semistructured interview guide following a modified life history approach to uncover women’s experiences through the stages from residency to workforce. A qualitative researcher used Zoom to interview 25 geographically and racially diverse early career women physicians. Interviews were transcribed verbatim and analyzed utilizing NVivo software following an Inductive Content Analysis approach.

Results

Three themes emerged from the data. First, the nature of institutionally recognized leadership positions was largely perceived as bureaucratic and disciplinary, which did not appeal to most participants. Second, women engaged in leadership roles that increased practice efficiency, improved working conditions, and added to their emotional labor—without remuneration. Third, women experienced a tension between work and family, but this did not impact their long-term career goals—which remained focused on patient care or lower-level leadership positions.

Conclusion

Increasing the number of women in leadership positions can be achieved through innovative leadership models that prioritize collaboration, flexibility, and work–life balance. Organizations must revise definitions of leadership to expand it to include the valuable, unrewarded work women undertake that advance their goals and overall patient health.
Excitation of filamentous growth in Dekkera spp. by quorum sensing aromatic alcohols 2-phenylethanol and tryptophol
Authors: Britton Scott J , Dingemans Thijs , Rogers Lisa J , White Jane S , Maskell Dawn L
Published: December 2024

Fungi from the genus Dekkera, also known as Brettanomyces, are significant contaminants in commercial beer and wine production, and when present unintentionally, these non-domesticated yeasts result in the development of undesirable sensorial characteristics, in part due to the production of volatile phenols and acetate esters. The persistence of Dekkera spp. in industrial manufacturing environments can be attributed to its strong bioadhesive properties, allowing it to attach to various surfaces and form biofilms, which often contribute to recurrent contaminations. In other fungi, the yeast-to-filamentous transition is pivotal in enhancing bioadhesive properties, a process tightly regulated by density-dependent quorum-sensing mechanisms. However, there is no documented evidence regarding the influence of fungal quorum-sensing compounds on the yeast-to-filamentous transition in Dekkera, nor is there any evidence of existing quorum-sensing circuits in this genus. In this investigation, two Dekkera spp. were cultivated on a modified nitrogen-limiting synthetic low-ammonium dextrose medium supplemented with exogenous concentrations of quorum-sensing molecules 2-phenylethanol and tryptophol. Following cultivation, whole colonies were imaged and analyzed with a whole colony filamentation algorithm to quantify their filamentation. Our results demonstrate that the quorum-sensing compounds 2-phenylethanol and tryptophol significantly promote the yeast-to-filamentous transition in Dekkera spp., underscoring the broader presence of quorum-regulated social behaviors within this genus.