bluuebunny/crossref_metadata_2025 huggingface dataset:
The Role and Prospect of Emission Trading in the Optimal Allocation of Environmental Resources
Authors: Zhang Haixu , Jiang Chunlai , Huang Jinying , Wang Yaolin , Duan Zhiguo
Published: December 2024

The emission trading system is an important institutional innovation which effectively uses market mechanisms to improve the efficiency of environmental governance, and plays an important role in exploiting the potential of emission reduction for government and enterprise, which would realize the optimal allocation of environmental resources. The study analyses the design mechanism of emission trading system, the crucial parts including verification of emission rights, paid use for resources, emission trading, reserve and control mechanism, as well as management and incentive policies. Thereby, the current problems of emission trading system in China have been found out, including the deficiency of top-level design, ineffective cohesive mechanism between different systems, inactive trading market, and insufficient supporting policy guarantee policy. Based on the development trend of national policies and the practical problems faced by emission trading, the study proposes four prospects for the emission trading efforts. First, the issuance of guidance documents for deepening the emission trading system at the national level is an important foundation for the development of the emission trading system. Second, convergence between the emission rights trading and the emission permit system is the inevitable trend of the development of the system. Third, working on promoting the construction of a trading system dominated by market mechanisms is the focus of the optimal allocation of resources and environment. Last, establishing and improving relevant supporting mechanisms is an important guarantee for the stable development of the emission rights trading market and the efficient allocation of environmental resources.
Coffee's Health Benefits for Human Diet
Authors: Regassa Meseret
Published: December 2024

Coffee is the most popular beverage in the world and the most consumed caffeinated beverage after water and tea. It contains a combination of several chemical components that, with the health benefits, most consumers start the day with at least one cup of coffee after eating and end the working day with coffee. It is considered an important part of modern-day life because it has an alarming effect on the human brain. In contrast, different groups report. They face unequal health risks and are therefore reluctant to drink coffee, suggesting individual differences in coffee intolerance. The purpose of this study was to briefly summarize the health benefits and risks of coffee consumption. Most informative reports suggest that long-term consumption of coffee and decaffeinated coffee can reduce the risk of many diseases. Among them, it is used to improve our physical performance, burn fat, reduce the risk of stroke, liver, prostate and colorectal cancer by 20%, the risk of Parkinson's disease by 25%. the risk of dementia and protect our mind, brighten our mood, help fight depression and minimize the risk of suicide by 50%. In addition, coffee drinkers have a lower risk of heart disease, with highly integrated DNA. It has also been reported that coffee consumption naturally lengthens sleep latency, decreases total sleep duration and efficiency, and worsens putative sleep functions. However, from the positive health perspective of coffee consumption, a recent study reveals that coffee consumption does not always provide protective benefits, since excessive consumption is associated with a negative impact or risk to our health. Some negative effects of coffee consumption on our health: reduces appetite, affects pregnant women, people with cholesterol, causes insomnia and restlessness, breast tissue cysts in women, digestive disorders related to incontinence and risk of headache In addition, it reduces the likelihood of fertility in women and men, causes allergies and abortions, violent heart contractions, anxiety, depression and the need for anti-anxiety drugs, inhibits the production of collagen in human skin, improves the hearing loss. it does not help with prolonged sleep deprivation, it interferes with ossification and may even lead to an increased risk of bone fracture. Finally, more recent studies have reported that the consumption of coffee is beneficial for our health when it is optimal, about four glasses on average. Further research will be crucial to clarify the health benefits and risks of coffee consumption.
An Union Method Combining the Stitching of Normal Images and the Unsupervised Semantic Segmentation of Stitched Image
Authors: Hu Xing , Li Xinjian , Wang Zhengguang , Ren Jie , An Yi , Shao Cheng , Tian Hongsheng , Guo Qingru
Published: December 2024

The union combining the stitching of normal images and unsupervised semantic segmentation of the stitched image is an important region, which is crucial for autonomous driving, intelligent robots, and vehicle detection. This paper designs an union method combining the stitching of normal images and unsupervised semantic segmentation of the stitched image. The normal images are stitched by using the image stitching method designed by Ribeiro D.. The semantic segmentation method for the stitched image uses the method opened in the github. The stitched image contains image distortion. The distortion of the stitched image will make the feature extraction unreasonable. The distortion form of the stitched image is different from the distortion form of the panoramic image combined by line images. Therefore, the DCM proposed by Xing Hu is useless to extract features of the stitched image reasonable. This paper improves the DCM as the improved distortion convolution module (IDCM) by using the deformable convolution, the clamp module, the type transformation module, and the gather module. The IDCM is added before the unsupervised semantic segmentation method opened in the github to extract features reasonable. The IDCM-NUSSM method and the ISM-IDCM-NUSSM method are proposed. The experimental results show the better performance of the designed methods.
Navigating Negative Social Identity: Virtual Identity as a Coping Strategy for Unemployed Youth
Authors: Kitiashvili Anastasia
Published: December 2024

This study explored how unemployed young people create virtual social identities as a coping mechanism for their unfavorable social identities. It hypothesized that as young people without jobs have limited opportunities to interact with others, they might use virtual social identities to redefine their identity. The study used survey research with 200 participants and qualitative interviews with 25 respondents. The results indicated that youth unemployment, compounded by social segregation, negatively affects relationships, social identity, and overall well-being. Findings showed that virtual social identities helped youth develop negative outcomes of their offline social identities, although excessive use of virtual platforms could become a potential source of additional stress. Qualitative data analysis identified key themes including social isolation, stress, humiliation, alienation, and dashed hopes. The importance of the virtual environment in the formation of social identity among unemployed youth was also highlighted, which is the novel contribution to the field. The article also discusses recommendations for social interventions for supporting unemployed youth.
Prickly Pear Cochineal Dactylopius opuntiae, in Morocco: Vigilance and Perspectives
Authors: Bahouq Madiha , Bahouq Hanane , Soulaymani Abdelmajid
Published: December 2024

The appearance in the Province of Sidi Bennour of a pest attacking the prickly pear was announced on 29-07-2015 by the National Office for Food Safety (ONSSA). In case of heavy infestation and in the absence of control measures, the insect can cause plant dieback. Since then, it has caused the death of the prickly pear in all Moroccan regions, resulting in heavy damage for small farmers. This plant is known for its use in animal, industrial, cosmetic, therapeutic and environmental food and whose fruit is appreciated internationally. The development of resistant varieties and new control methods with the establishment of a monitoring system is necessary given the importance of this sector. An inventory of the report, the probable causes and the countermeasures of Morocco and at the level of other regions of the world in the face of this problem, was carried out. The spread of the pest in Morocco has continued to grow since its discovery in 2014. A control and awareness program was launched by ONSSA in cooperation with the Food and Agriculture Organization of the United Nations (FAO). The Ministry of Agriculture has devoted 80 million Dirhams to the operation to fight against the cochineal with the establishment of a vigilance and surveillance committee to manage the plan for uprooting and burying diseased cacti. In addition, a selection program for resistant varieties and treatment products was launched and carried out by the services of the National Institute for Agronomic Research (INRA) in partnership with the various regional administrations of the Ministry of Agriculture. The Tunisian Ministry of Agriculture launched, on August 17, 2021 in social networks, a call for vigilance after the appearance of the insect in northern Algeria with the development of a three-year national strategy of control and to strictly apply agricultural quarantine to limit the spread of the insect.
Collective Action for Seed Producer Cooperatives and Their Role in Improving the Sustainable Seed Supply and Impacts: The Case of Ethiopia
Authors: Bekuma Getu
Published: December 2024

Seed is an essential component in crop production. Using superior seed from improved cultivars can increase yield by as much as fifty per cent per hectare. High-quality seed also encourages using extra agricultural inputs like fertilizers and insecticides. The Ethiopian seed system development strategy recognizes the formal, intermediary, and farmer seed systems. The farmers' system is the primary seed source, with relatively little contribution from the formal system. The public sector primarily controls the formal system's breeding and seed distribution. The formal, farmers', and intermediary systems are comparable to each other. The government encourages Seed Producers Cooperatives (SPCs) to cultivate and supply seeds to the market. Cooperatives (SPCs) supply of high-quality seeds for various crops in response to local and international demand and the needs of farmers. This helps to ensure national seed security. Policymakers and development experts have recognized the significant role of SPCs in Ethiopia's seed industry, and the country's agricultural development initiatives reflect this. It is essential to reform the seed industry to have a positive impact on Ethiopian agriculture's progress. However, the seed industry in Ethiopia faces limitations due to institutional, organizational, technical, and infrastructure challenges, preventing it from meeting the increasing demand from different agro-ecologies and farming systems. Despite this, little research has been conducted to study and document SPCs' involvement in the seed industry and their contributions. Unfortunately, not much work has gone into examining and recording their contributions to increasing seed access and availability as well as their involvement in the seed industry. Concerning improving seed supply and guaranteeing seed security in Ethiopia, this review aimed to evaluate Seed Producers Cooperatives' present standing in the seed industry.
Soybean Bio-fertilizer Technology Promoting Through Cluster Based Demonization in the Mima Learning Watershed from Assosa Western Ethiopia
Authors: Anbessa Bakala , Temene Dessalegn
Published: December 2024

Soil fertility depletion and soil acidity are critical problems for soybean production in western Ethiopia. Therefore, a cluster based biofertilizer technology was demonstrated to improve the depleted soil fertility on Nitisols of Assosa Agricultural Research Centre during 2022 to 2024 cropping season to investigate the response of soybean yield to biofertilizer. The treatment consists of: farmers practice (100 kg NPS ha-1) and biofertilizer plus 100 kg NPS ha-1. Multidisciplinary team had given participatory training from the composed of Soil fertility researcher, soybean breeder and agricultural extension and communication for the selected participates. The training was delivered for different stake holders and farmers on agronomic management of soybean production techniques and management, cluster based bio fertilizer technology demonstration approach. Around 830 packets of bio-fertilizer are distributed for the farmers in last four years cropping season. In order to evaluate the performance share the lesson with different stakeholders’ field day and experience sharing were organized in the fields of beneficiary farmers. In the field day and experience sharing famers, development agents (DAs), experts, heads of agricultural and rural development office, researchers were participated. The cluster based demonstrated biofertilizer technology was compared with farmers practice and the field data recorded and analyzed by descriptive statics. The participant farmers and different stake holders preferred biofertilizer plus NPS fertilizer during the field day and experience sharing. The application of recommended NPS plus inoculation was higher in seed yield of maize by 14% compared to the application of recommended NPS fertilizers alone. The yield advantage relative to NPS alone indicating the depletion of the soil microorganism and its strong response to bio fertilizer application.
Multicellular Dynamics at Spatial Single-Cell Resolution Reveal Early Relapse of Hepatitis B Virus-Associated Follicular Lymphoma
Authors: Deng Yuwei , Zhang Qingyuan , Zhang Huilai , Ma Jianli
Published: December 2024

Hepatitis B virus (HBV) infection increases the risk for B-cell lymphomas including follicular lymphoma (FL). HBV-positive patients have a higher incidence of disease progression with 24 months (POD24) and precisely identifying those patients with potential POD24 remains a challenge. Therefore, we reconstructed the spatial molecular crosstalk in HBV-associated tumors with POD24 after immunochemotherapy using spatial transcriptomics at single-cell resolution. The tumors from patients with dynamic HBV states and distinct virus carrying times were characterized by refined four malignant cell subsets and four follicular dendritic cell (FDC) subsets, including a newly identified memory B cell-like malignant cells (MBLM) subset that was traced as atypical malignant cells with latent indolence, prominently occurred in HBV-high tumors and increased following POD24 occurrence. The newly-identified virus protein transport-related FDC differed significantly in tumors with dynamic HBV states and was negatively correlated with MBLM. Stratified by dynamic HBV states, specific immunosuppressive cell cohorts colocalized with certain malignant cells may interpret the POD24 occurrence which was associated with virus-induced immune exhaustion. Our spatial molecular classifications and multicellular stratifications revealed an intratumoral crosstalk between dominant malignant cells subsets and immune cells which may promote POD24 occurrence in HBV-related FL tumors, and provided therapeutic targeting of specific cellular molecules.
Adding Eltrombopag to Intensive Immunosuppressive Therapy Helps Adult Patients Catch up Pediatric Patients in Severe Aplastic Anemia
Authors: Yang Bixi , Wang Leyu , Fu Lingling , Wu Runhui , Ma Jie , Chen Miao , Han Bing
Published: December 2024

Aim: To evaluate the differences of efficacy and survival between adults and children patients with severe aplastic anemia receiving intensive immunosuppressive therapy (IST) ± eltrombopag.

Methods: The clinical data of patients with SEVERE APLASTIC ANEMIA receiving IST ± eltrombopag between 2013 and 2022 were analyzed retrospectively. Baseline characteristics, hematological response, overall survival (OS), event-free survival (EFS), relapse, and clonal evolution in those treated with IST alone or IST+ eltrombopag were compared between adult (aged >18 years) and pediatric (aged ≤18 years) patients.

Results: A total of 366 patients were included, including 141 adults and 225 children. For IST alone, adult patients had a similar overall response rate (ORR, 76% vs.75%, P=1.000) but a lower complete response rate (CRR, 31% vs. 48%, P=0.048) than pediatric patients at 12 months. Adult patients had lower OS (84.9±3.9% vs. 96.9±2.2%, P=0.007) and EFS (66.4±5.1% vs. 79.7±5.3%, P=0.047) than pediatric patients. After adding eltrombopag, the ORR was higher in adult patients than pediatric patients (89% vs. 73%, P=0.027) and the CRR was similar in two groups (54% vs. 50%, P=0.614). The OS and EFS in adults improved significantly and were similar to those in pediatric patients (91.4±4.2% vs. 96.7±1.8%, P=0.081 and 75.1±6.3% vs. 72.3±4.7%, P=0.834, respectively). Adults had similar relapse rates as children, either with or without eltrombopag (P>0.05). Adult patients had significant higher clonal evolution rates than pediatric patients, either in IST alone group (9.2% vs. 1.4%, P=0.040) or in IST+ eltrombopag group (5.5% vs. 0%, P=0.017).

Conclusions: Adding eltrombopag to intensive IST improved the ORR, CRR, OS and EFS in adults more than it did in children. Adults had greater clonal evolution, regardless of the addition of eltrombopag.
Asparaginase Premedication with Hydrocortisone Decreases Hypersensitivity Reactions
Authors: Wegter Megan , Guerrettaz Ryan , Pan Amy , McCabe Kalen , Volmy Rebecca , Burke Michael J.
Published: December 2024

Background:

Asparaginase is an integral component of leukemia and lymphoma treatment. However, hypersensitivity reaction (HSR) remains a common adverse event associated with administration of pegylated-asparaginase products. Previous clinical trials have demonstrated rates of HSR to pegylated E coli asparaginase (PEG) anywhere from 0.5% to 25%. At our institution, despite premedication with antihistamine medications such as diphenhydramine and famotidine, we have observed up to 30% of patients develop treatment-limiting HSR to PEG. Additionally, these reactions often overlap with nonallergic infusion reactions (IR), making it difficult to identify true HSR. There are now reports of universal premedication (UPM) adding hydrocortisone to the premedication regimen, however data to support this recommendation is lacking.

Methods:

We conducted a retrospective analysis evaluating the benefits of adding hydrocortisone to a two-drug premedication regimen of famotidine and diphenhydramine. Data was gathered via chart audit comparing pre-intervention with a two-drug regimen (diphenhydramine and famotidine) to post-intervention with a three-drug regimen of diphenhydramine, famotidine, and hydrocortisone. Analysis included patients with acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LL) treated with a frontline PEG-containing treatment regimen. A one-year time interval was used to collect data for the pre- and post-intervention groups. All patients who received pegaspargase were reviewed. HSRs or IRs were reviewed independently to confirm and grade the reactions using Common Terminology Criteria for Adverse Events (CTCAE), v5 of allergic reactions. Hypersensitivity reactions observed included urticaria or any respiratory symptoms, such as sneezing, cough, tachypnea, bronchospasm, and/or oxygen desaturations. Other symptoms were considered consistent with IRs. Grade 2 reactions included the use of intravenous diphenhydramine, while grade ≥3 reactions included intramuscular epinephrine.

Results:

In 86 patients analyzed over a 2-year period, 48 were in the pre-intervention group given a two-drug regimen of diphenhydramine and famotidine prior to PEG or calaspargase. The rate of HSR in the pre-intervention group was 33% with an additional 12.5% experiencing IRs. The post-intervention group contained 38 patients who received a three-drug regimen with diphenhydramine, famotidine, and hydrocortisone. The incidence of HSR and IR were 16% and 13% respectively. Based on this data, rates of IR remained unchanged, while rates of HSR decreased significantly by approximately 50% (p-value 0.0411) with the addition of hydrocortisone to the pre-medication regimen.

Conclusions:

Universal premedication with the inclusion of hydrocortisone can significantly decrease HSR rates and serves as a useful strategy in the treatment of ALL/LL.
Effect of Pre- and Peri-Transplant Measurable Residual Disease Clearance in Patients with Myelodysplastic Neoplasm; A Referral Center Experience
Authors: Yodsuwan Ratdanai , Mott Sarah L , Vegel Andrew , Ravindra Aditya , Dhakal Prajwal , Sutamtewagul Grerk , Magalhaes-Silverman Margarida , Poonsombudlert Kittika
Published: December 2024

Introduction

Measurable residual disease (MRD) has emerged as a potential prognostic marker for allogeneic stem cell transplant (HSCT) outcomes in various hematologic malignancies. However, the MRD status in myelodysplastic neoplasm (MDS) or myelodysplastic/myeloproliferative neoplasm (MDS/MPN), can be difficult to interpret due to heterogenous disease biology and unique limitations in each MRD measuring techniques. In comparison to B-cell acute lymphoblastic leukemia whose clearance of pre-HSCT MRD is considered essential, the data in MDS or MDS/MPN is less clear. As post-HSCT disease surveillance becomes more standardized, we also evaluated the effect of peri-HSCT MRD status on relapse-free and overall survival (RFS and OS) outcomes.

Methods

We reviewed records of adult patients who underwent HSCT for MDS or MDS/MPN at our institution between 2012-2023 and report the outcomes of patients between those who had undetectable MRD (MRD-) vs detectable MRD (MRD+) pre-HSCT and conducted a conditional analysis of outcomes based on MRD status at day+90 post-HSCT.

Results

We identified 38 and 55 patients in MRD- and MRD+ cohorts respectively. Baseline patient characteristics were similar between the cohorts, including age, Revised and Molecular International Prognostic Scores (IPSS-R & IPSS-M), and HSCT-related factors. The MRD+ cohort had inferior RFS (HR: 1.84, 95% CI: 1.09-3.12, p=0.02) but a statistically significant difference in OS was not evidenced (HR: 1.52, 95% CI: 0.88-2.61, p=0.14). After adjusting for % blasts at diagnosis, and conditioning intensity, MRD+ patients were found to be at 1.92 times increased risk of relapse or death (95% CI: 1.12-3.28, p=0.02). Additionally, increasing IPSS-M score was associated with poorer RFS (HR: 1.27, 95% CI: 1.01-1.59, p=0.04) and OS (HR: 1.52, 95% CI: 1.20-1.91, p<0.01). On a conditional analysis of patients who were alive and in remission until day +90 post-HSCT, the pre-HSCT MRD status did not confer a statistically significant difference in RFS and OS if patients were able to achieve an MRD- status by day +90 post-HSCT.

Conclusion:

Pre- and peri-HSCT MRD testing may offer valuable survival prognostic information in patients with MDS and MDS/MPN and should be considered part of routine disease surveillance.
Concurrent Coronary Artery Disease and Immune Thrombocytopenia: A Systematic Review
Authors: Rozi Waail , Rahhal Alaa , Provan Drew , Shunnar Khaled , Najim Mostafa , Ahmed Ashraf , Al-Khabori Murtadha , Marashi Mahmoud , Alrasheed Mona , Osman Hani Yousif , Yassin Mohamed A
Published: December 2024

Introduction

Coronary artery disease (CAD) management in the setting of immune thrombocytopenia (ITP) remains very challenging to clinicians as a reasonable balance between bleeding and thrombosis risks needs to be achieved, and the evidence guiding such management is scarce.

Methods

We conducted a systematic review following the PRISMA guidelines to summarize the available literature on the management and outcomes of CAD coexisting with ITP. We searched PubMed and Embase for studies published in English exploring CAD and ITP management until 05 October 2022. Two independent reviewers screened and assessed the articles for inclusion. Patients' characteristics, CAD treatment modalities, ITP treatment, and complications were reported.

Results

We identified 32 CAD cases, among which 18 cases were revascularized with percutaneous coronary intervention (PCI), 12 cases underwent coronary artery bypass graft surgery (CABG), and two cases were managed conservatively. More than 50% were men, with a mean age of 61 ± 13 years and a mean baseline platelet count of 52 ± 59 × 109/L. Irrespective of the revascularization modality, most patients were treated with either corticosteroids alone, intravenous immunoglobulins (IVIG) alone, or in combination. Among those who underwent PCI, two patients had bleeding events, and one patient died. Similarly, among those with CABG, one patient developed bleeding, and one patient died.

Conclusion

We found that revascularization with either PCI or CABG with the concurrent use of corticosteroids and/or IVIG for ITP was feasible, with an existing non-negligible risk of bleeding and mortality.
Improving Quality Outcomes through a Medicine Hospitalist-Driven Malignant Hematology Service
Authors: Lee Grace , Benyahia Steven , Syed Misbahuddin , Thakkar Hardik , Reich Richard R , Lochner James , Isenalumhe Leidy Lismeris , Hembree Timothy , Abdallah Enas , Verma Neha
Published: December 2024

Background: In recent oncology care, the hospitalist model has emerged to reduce hospital stays, enhance inpatient capacity and alleviate burnout among oncologists, all while maintaining high quality inpatient care (Morris JC, et al. J Hosp Med. 2023;18(5):391-397). Oncology hospitalists-typically internal medicine physicians caring for acutely ill cancer patients-are shown to reduce hospital stays and improve inpatient capacity by enhancing communication, managing oncologic emergencies, and managing palliative care symptoms (Atlas KR, et al. Oncologist. 2020;25(12):e2006-e2009).

To our knowledge, Moffitt Cancer Center pioneers one of the first long-term, consistent and comprehensive studies into the hospitalist model for inpatient care, focusing on individuals with malignant hematology conditions and addressing their acute medical issues. The Heme Hospitalist service structure includes a hospitalist, a malignant hematology-trained advanced practice provider, and a malignant hematology-trained pharmacist to emphasize a comprehensive approach to drive high quality patient-centered care.

Objective: Evaluate the oncology hospitalist model on key quality outcomes within an inpatient malignant hematology setting through a single-center retrospective cohort study at Moffitt Cancer Center.

Methods: Electronic records were queried for patients >18 years of age that were admitted to inpatient services in Heme A and B (traditional) or the co-managed Heme C and M service (hospitalist model implemented in Oct 2022). Three time periods of 13-month duration: Traditional (Aug 2020-Aug 2021), Transition (Sept 2021-Sept 2022), Hospitalist Model Intervention (Oct 2022-Oct 2023) were compared for admissions, discharges, Average Length of Stay (ALOS), Inpatient (IP) Bed Days Used, and 30-day unplanned readmission rate. ANOVAs compared LOS, case mix index, mortality risk, and severity of illness. We excluded patients that were transferred between services.

Results: 4,813 admissions occurred during the Aug 2020-Oct 2023 study period. ALOS decreased significantly amongst all services, as did the gap between Vizient expected LOS versus actual LOS. Although total IP Bed Days Used increased during the same time period, if there was no decrease in ALOS, 1,688 additional IP Bed Days would have been needed (as based on volume of discharges in the Hospitalist Model Intervention period). Severity of illness, age and risk of mortality increased significantly. There was no significant difference in unplanned readmission rate (Table 1).

Conclusion: Significant ALOS reduction despite increased severity, age, and risk of mortality, and no change in unplanned readmission rates highlight the success of the co-managed Heme C and M hospitalist service in addressing acute medical problems and shaping future developments in inpatient malignant hematology programs.
Location, Location(s), Location(s+): Moving from Acute to Chronic Pain in SCD Pain in School-Age Children
Authors: Murphy Bridget N , Hood Anna M , Hildenbrand Aimee K. , Shook Lisa M , Quinn Charles T. , Smoot Erin , Sil Soumitri , Crosby Lori E.
Published: December 2024

Introduction: Sickle cell disease (SCD) pain significantly impairs quality of life for children and adolescents. It is unclear when pain in SCD evolves from acute, episodic pain to chronic pain. Understanding predictors of transition from acute to chronic pain among individuals with SCD is essential to inform prevention efforts for chronic pain. Research indicates that for older adolescents and adults (16+ years), SCD pain location changes with age (localized vs. widespread) and that pain intensity varies based on location. Less is known about differences in pain experiences for those younger than 16. This study aimed to examine the relationship between pain location, pain intensity, and age in a sample of children and adolescents (<16 years) with SCD presenting to the emergency department (ED).

Methods: Data were collected as a part of a larger study examining ED visits for patients living with SCD. Data were extracted from the medical records of patients with SCD ages 8-16 who were seen in the ED at a children's hospital in the Midwest between June 2010 and June 2018. Only patients with data for pain sites and pain intensity documented in the ED notes were included in current analyses (N = 102 patients with N = 313 unique ED visits). Pain location and intensity (0 = no pain, 10 = worst pain) were reported during the ED visit, and we used the first recorded documented location and intensity. We used independent samples t-tests to assess group differences in age and pain intensity between patients who reported one pain site and patients who reported two or more pain sites.

Results: The number of ED visits per patient ranged from one to 22 (M = 3.02, SD = 3.36), with most patients having one (48%), two (17%), or three (10%) ED visits. Average age at first ED visit was 12.06 (SD = 2.65), and Average age at the last ED visit was 13.36 (SD = 2.75). Pain sites ranged from 1 to 4 (M = 1.40, SD = 0.67), with the mode being 1 (69.3%). Patients who reported 2 or more pain sites were significantly older (t(311) = -2.843, p = .005) and had significantly higher pain intensity than those who reported one pain site (t(311) = -2.264, p = .024).

Discussion: Similar to prior research, our findings suggest that the presentation of SCD pain changes with age; this study extends those findings to late childhood and early adolescence. Monitoring the emergence of increasingly multifocal or widespread pain among youth with SCD could facilitate preventive or early intervention for chronic pain, including use of interdisciplinary pain management strategies. Additional research is needed to understand pain trajectories over this developmental period as well as the best ways to support patients through changes to pain presentation.
Community-Engaged Research in Psychological Interventions for Pediatric Sickle Cell Disease: A Scoping Review
Authors: Murphy Bridget N , Durkin Kristine , Williford Desireé N , Blakey Ariel , Musa Chloe , Hood Anna M , Muhammad Malika , Crosby Lori E.
Published: December 2024

Introduction: Involving those with lived experience in the design and implementation of interventions improves the quality of life and health outcomes and is imperative, as engagement can improve the relevance, reach and effectiveness of interventions. Although there has been a growing call to enhance the use of community-engaged research (CEnR) methods, it remains uncertain how extensively these methods are being adopted and what the quality of the resulting research is.

The aim of this scoping review was to identify and describe the CEnR methods used in the development and evaluation of self-management interventions for pediatric SCD.

Methods: We conducted a systematic search of three databases (PubMed, Scopus, and PsychInfo). All titles, abstracts, and full texts for papers that met criteria were independently reviewed by two members of the research team. Data were extracted from articles that met inclusion criteria: (1) psychological intervention for (2) infants, children, adolescents, and youth adults (3) living with SCD (4) that used CEnR methods.

Results: The search yielded 236 original articles, of which eight met the inclusion criteria. These articles showed varying levels of involvement of community collaborators (patients, families, and community-based organizations) across research phases. Notable gaps in the literature were: 1) few studies reported utilizing CEnR methods, 2) a lack of consensus in language/terms used to describe CEnR methods, 3) limited demographic data about community collaborators, and 4) a lack of description of CEnR frameworks guiding intervention development and evaluation.

Conclusions: This scoping review found that most self-management intervention studies for youth with SCD failed to describe CEnR methods in a way that would facilitate reproducibility or evaluation of the quality of the research. Given the increased focus on the use of CEnR methods it will be important to develop reporting standards (e.g., for demographic information, frameworks, steps of CEnR methods) and use common terms/keywords to increase clarity and translatability. By adhering to these recommendations for improving the use and reporting of CEnR methods, we can enhance the effectiveness of patient self-management interventions, ultimately leading to better health outcomes for youth living with SCD.
Characterization of Complement and Immunoglobulin Deposition in Bone Marrow Trephine Biopsies of Patients with Cytopenias
Authors: Fidanza Cecilia Anna , Bortolotti Marta , Croci Giorgio Alberto , Barcellini Wilma , Fattizzo Bruno
Published: December 2024

Cytopenias can be categorized in “peripheral”, such as autoimmune hemolytic anemias (AIHA), immune thrombocytopenic purpura (ITP), and chronic idiopathic/autoimmune neutropenia (CIN/AIN), and “central”, including disorders such as aplastic anemia (AA) and myelodysplastic neoplasms (MDS). Several overlaps exist between the two forms, with a clear role of the humoral and complement immune response in the former, that is however less known in the latter.

We assessed complement fractions C3 and C4, IgM and IgG deposits by immunohistochemistry on bone marrow biopsies from 162 cytopenic patients diagnosed between 2016 and 2023 at a tertiary hematologic center, reference for immune cytopenias, in Milan, Italy. Deposits were expressed using a semiquantitative scale from 0 to +3 by an expert hemopathologist. The topographical distribution was then evaluated and categorized as serous versus precursors pattern. We collected laboratory data at diagnosis to evaluate a correlation with the immunohistochemical data.

Overall, 28 AIHA, 15 ITP, 58 CIN/AIN, 12 AA, and 49 lower-risk MDS were accrued. A significantly greater deposition of C3 and C4 (≥2+) was found in AA and MDS versus peripheral cytopenias (42% and 33% in AA, 49% and 41% in MDS versus 21% and 14% in all peripheral cytopenias, p=0.004 and p=0.002, respectively). Ig deposition was significantly greater (≥ 3+) in MDS and AA (63% and 42% for IgM and 49% and 33% for IgG, respectively) versus peripheral cytopenias (39% for IgM and 11% for IgG, respectively, p < 0.05); notably, IgM deposition was particularly evident in AIHA, ≥ 3+ in 50% of cases. Topographically, most of C3 and C4 deposition showed a serous pattern, while deposition on precursors was observed in 25% of MDS cases (mainly C3) and 42% of AIHA (mainly C4). IgG/M deposits were equally distributed on serum and precursors in all disease category. Hb and reticulocytes values were negatively correlated with C4 deposits in MDS patients (r= -0.031, p=0.01 for Hb and r= -0.29, p=0.02 for reticulocytes). Bone marrow cellularity negatively correlated with IgM deposits in AA (r= -0.72, p=0.004). Finally, platelet counts negatively correlated with IgM deposits in ITP (r=-0.5, p=0.02).

In conclusion, our data demonstrated a significant deposition of complement and Ig in bone marrow of patients with “peripheral” and “central” cytopenias, more marked in the latter. The correlation with hematological parameters hints for a role of the immune attack against bone marrow precursors in all these conditions and might foster innovative therapeutic approaches.
Comparative Effectiveness of Chatgpt 4.0 and Gemini Advanced in Diagnosing Challenging Hematologic Cases
Authors: Khamees Ibrahim , Wu Xiangni , Qasim Hana , Al-sadi Anas , Abumuhfouz Ma'in , Yacoub Abdulraheem , Li Haoran
Published: December 2024

Background: In the rapidly evolving field of artificial intelligence (AI), ChatGPT 4.0 and Gemini Advanced have emerged as significant tools with diverse applications, including healthcare. This study evaluates their efficacy in diagnosing hematologic diseases using pathology images, highlighting the potential of AI to augment medical diagnostics.

Methods: We utilized reference cases from the American Society of Hematology (ASH) Image Bank, which includes peer-reviewed hematologic images and texts for educational purposes. To accommodate AI constraints on image processing, we merged the images for each case into a single file. We replicated all the cases from the ASH reference cases, excluding those with insufficient clinical details, which made it difficult to approach them in two steps. Each case was run in separate chat sessions to prevent the model from applying any “learning” to subsequent cases. We pasted them along with our prompts into the Chat GPT 4.0 and Gemini Advanced models. Initially, a minimal clinical description was provided; if inaccurately diagnosed, a more comprehensive description was used. For each step, we asked the models to give a diagnosis and a list of differential diagnoses based on probability. The aim was to assess and compare the diagnostic accuracy of the two models under varying information conditions.

Results: Of 134 evaluated cases, 29 were excluded due to insufficient data. With case images and limited clinical information (step 1), ChatGPT 4.0 accurately identified the correct diagnosis in 38.1% of cases, compared to 26.6% provided by Gemini Advanced. When provided with detailed clinical information (step 2), ChatGPT 4.0's accuracy improved to 46.1%, compared to 32.4% for Gemini Advanced. ChatGPT 4.0 also demonstrated superior performance in differential diagnosis, correctly including the right diagnosis 82.8% of the time, versus 64.7% for Gemini Advanced. When the correct diagnosis was provided in the differential diagnoses list but not as the top diagnosis, the average rank of the correct diagnosis in step 1 was 3.6 for ChatGPT 4.0 and 2.5 for Gemini Advanced. In contrast, in step 2, it was 2.7 for ChatGPT 4.0 and 2 for Gemini Advanced.

Conclusion: ChatGPT 4.0 outperformed Gemini Advanced in diagnosing complex hematologic cases, both as a primary and differential diagnosis tool. While both models show promise in supporting hematologic diagnostics, their reliability for clinical application requires further investigation and refinement.
Altered Quantity and Function of Follicular T Helper Cell Subsets in Multiple Myeloma and MGUS
Authors: Wang Jinuo , Zhao Duoduo , Zhai Xingyuan , Wu Wenjun , Cai Zhen
Published: December 2024

Introduction

Almost all Multiple myeloma (MM) cases were progressed from a premalignant condition called monoclonal gammopathy of undetermined significance (MGUS). So far, the pathogenesis of myeloma is not yet clear. The immune cells, especially T cells in the tumor microenvironment, play an important role in myelomagenesis. Follicular helper T cells (Tfh) primarily assist in plasma cell activation and antibody secretion, potentially contributing to abnormal plasma cell generation. Previous studies showed a significant increase in circulating Tfh cell numbers in MM patients. However, the specific changes in quantity and function, as well as their correlation with disease status, remain unclear. In this study, we performed a comprehensive analysis of Tfh cell subsets in untreated MM patients and individuals with MGUS, which might help further elucidate mechanisms of immune dysfunction during myelomagenesis.

Methods

Our study included 20 MGUS patients and 45 newly diagnosed MM (NDMM) patients. Flow cytometry was applied to determine the proportion of Tfh cell subsets in PB. Flow sorting technology was used to separate Tfh cells and follicular regulatory T cells (Tfr) in MGUS and MM patients. The immune function was indirectly calculated by detecting proliferation rate of plasmablasts differentiated from B cells which were cocultured with Tfh cells. Concentration of IL-10, IL-21 from the culture supernatants of proliferation assay was measured using ELISA.

Results

The proportion of Tfh (CD4+CXCR5+PD-1+) in CD4+ T cells was significantly higher in NDMM patients than healthy controls (P<0.001); there was no difference in the proportion of Tfh between MGUS and healthy adults (P=0.37). The proportion of Tfh1 subset (CD3+CD4+CXCR5+PD-1+CXCR3+CCR6−) in Tfh cells was gradually increased in MGUS, NDMM patients than healthy controls (P=0.012, P<0.001); while the number of Tfh2 subset (CD3+CD4+CXCR5+PD-1+CXCR3-CCR6−) in Tfh cells showed a trend of decrease in MGUS, NDMM patients than healthy controls. The proportions of Tfr cells in CD4+ T cells in MGUS and NDMM patients were no difference from healthy adults.

The immune function of Tfh cells was also altered in MGUS and NDMM patients. The ability of induced differentiation from B cells into plasmablasts (CD19+CD27+CD38hiIgD−) was significantly enhanced in MGUS and NDMM patients compared with healthy controls (P=0.047, P=0.011). The levels of IL-10 and IL-21 secreted by Tfh cells in untreated MM patients was notably higher than that of healthy adults (P<0.001, P=0.001).

Conclusions

There were significant changes in the frequencies of Tfh cell subsets in MGUS and MM patients, suggesting that immunomodulatory abnormality has existed in patients at premalignant stage. The induced differentiation and cytokine secretory functions of Tfh cells in MGUS and NDMM patients were also impaired to promote myeloma cell proliferation and disease progression.
Assessment of Annual Rate Changes of Intraarticular Tissue Measurements in Hemophilic Joints Experiencing Acute Bleeding Using the Joint Activity Damage Exam (JADE) Ultrasound Protocol
Authors: Sheth Parthiv V , Glenzer Michael , Nwi-Mozu Isaac , Aguero Peter , Steiner, DPT, RMSK Bruno U.K. , Bailey Cindy , Quon Doris V. , Kruse-Jarres Rebecca , von Drygalski Annette
Published: December 2024

Background: The Joint Activity and Damage Exam (JADE) ultrasound protocol has been validated to measure key joint tissues (cartilage thickness, osteochondral alterations, and soft tissue expansion) at sentinel positions in patients with hemophilia. The effect of an acute joint bleed on longitudinal rate changes in these tissues has not been established.

Aims: Determine the effect of acute joint bleeding on annual rate changes of JADE measurements.

Methods: We prospectively evaluated 44 adult patients with hemophilia (A or B) of any severity at three Hemophilia Treatment Centers in the United States. Inclusion criteria required at least one arthropathic joint with Hemophilia Joint Health Score (HJHS) >3. JADE measurements and HJHSs were captured at 3 times points (study entry, ≈12-18 months, and ≈24-36 months). We calculated rates of change in JADE measurements in these joints. Rates of change of joint tissue that experienced an acute bleed confirmed by musculoskeletal ultrasound during the study period were compared to those that did not experience an acute bleed.

Results: Most patients in the cohort had severe hemophilia A and were on regular Factor VIII prophylaxis. The median age was36 [IQR 28,49] years. A total of 264 joints were evaluated longitudinally. Of these joints, 248 (94%) experienced no acute joint bleeds over the study period. While the annual bleed rate was low (<1), 16 joints (4 elbows, 8 ankles, and 4 knees) experienced at least one acute joint bleed. HJHSs remained stable and there was no difference in rate changes of JADE measurements in bleeding joints when compared to non-bleeding joints.

Conclusions: These data suggest that rare joint bleeds may not affect the trajectory of joint health in adult patients who are otherwise well controlled on prophylaxis.
KLF4/MLL3 Compass Complex Regulates NRBP2 to Eliminate Acute Myeloid Leukemia Cells
Authors: Yang Meng , Chen Cong , Lu Ting , Yang Shangda , Cheng Hui , Cheng Tao
Published: December 2024

Acute myeloid leukemia (AML) is recognized as a complex disease involving hematopoietic stem cell disorders. Despite advanced in therapy, the prognosis for AML patients remains poor. Previous studies by our group and others have demonstrated that krüppel-like factor 4 (KLF4), a transcription factor, inhibited AML through microRNA networks or p57 signaling pathway. In our previous studies, we found that overexpression of the YAMANAK factor (OSKM) in AML cells induced apoptosis, with KLF4 playing a significant role. However, the mechanisms through which KLF4 regulates gene transcription and histone modifications in AML remain elusive and require further investigation. In this study, we demonstrated that the overexpression of KLF4 inhibited AML proliferation, induced cell apoptosis, and prolonged the survival of AML mice. Co-inmmunoprecipitation (Co-IP) and mass spectrometry analysis verified that KLF4 interacted with the MLL3 CAMPASS complex, including MLL3/4, WDR5, RBBP5 and others. To investigate the mechanisms, we generated different truncated forms of KLF4 and showed that the zinc finger (ZnF) and TRD domains of KLF4 were crucial for the elimination of AML cells, as evidenced by cell viability experiments. In addition, we conducted RNA-seq, ATAC-seq and ChIP-seq in KLF4 overexpressing THP-1 cells. The results indicated that KLF4 regulated the transcription of NRBP2. Interestingly, downregulation of MLL3 led to a decrease in the luciferase activity of NRBP2. Furthermore, the increased cell apoptosis and impaired cell proliferation induced by overexpression of KLF4 could be rescued by knocking down NRBP2. Consequently, KLF4 promoted AML pathogenesis by interacting with the MLL3 CAMPASS complex and facilitating the transcription of NRBP2. These findings indicate that the KLF4-MLL3 CAMPASS-NRBP2 axis plays a crucial role in AML cells and suggests a potential therapeutic target for the disease.