bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessing the Elasticity of the Flexor Pronator Muscles After Throwing Using Ultrasound Shear Wave Elastography
Authors: Mukohara Shintaro , Mifune Yutaka , Inui Atsuyuki , Nishimoto Hanako , Kurosawa Takashi , Yamaura Kohei , Shinohara Issei , Hoshino Yuichi , Matsushita Takehiko , Matsumoto Tomoyuki , Kuroda Ryosuke
Published: November 2024

Background:

The medial ulnar collateral ligament (UCL) of the elbow joint is the primary restraint to valgus stress during the throwing motion. The flexor pronator muscles (FPMs) also stabilize the elbow joint against valgus forces; however, assessment of FPM stiffness in baseball players has been limited.

Purpose:

To use ultrasound shear wave elastography (USWE) to evaluate the change in tissue elasticity of the FPMs due to pitching.

Study Designs:

Descriptive laboratory study.

Methods:

Included were 14 healthy male amateur baseball players (mean age, 28.0 ± 2.6 years) who had played intermediate-level high school or college baseball. The tissue elasticity of the flexor digitorum superficialis (FDS) in the superficial layer of the FPMs and the flexor digitorum profundus (FDP) in the deep layer of the FPMs were measured using USWE before, immediately after, and 24 hours after a throwing session of 100 pitches. The intra- and interrater reliability of the measurements were evaluated using the Pearson correlation coefficient and intraclass correlation coefficient (ICC). The elasticity of each muscle was analyzed using repeated-measures analysis of variance followed by post hoc analysis.

Results:

Reliability of the USWE measurements was good to excellent (intrarater ICCs, 0.78-0.94; interrater ICCs, 0.85-0.96). The mean tissue elasticity values before, immediately after, and 24 hours after pitching were 22.3 ± 4.4, 41.0 ± 13.8, and 38.3 ± 11.2 kPa, respectively, for the FDS and 27.1 ± 5.8, 48.0 ± 22.3, and 29.6 ± 11.5 kPa, respectively, for the FDP. For both the FDS and FDP, elasticity was significantly higher immediately after pitching than before pitching ( P < .001 and P = .0027, respectively). While the elasticity of the FDS at 24 hours after pitching remained significantly higher compared with before pitching ( P = .0011), the elasticity of the FDP at 24 hours decreased to the same level as before pitching ( P = .91).

Conclusion:

Results using USWE indicated that the elasticity of the FDS did not decrease 24 hours after pitching and remained significantly higher than before pitching, suggesting that it may not be fully functioning as a dynamic stabilizer during this period.

Clinical Relevance:

Pitching in such a condition may result in greater stress on the UCL and increase the risk of UCL injury.
Pathologic differences between systemic sclerosis–associated and idiopathic pulmonary arterial hypertension
Authors: Friedman Samuel H , Harley Russell A , Williams Jacob , Forcucci Jessica A , Ramakrishnan Viswanathan , Strange Charlie , Silver Richard M , Feghali-Bostwick Carol , Argula Rahul G
Published: November 2024

Advances in pulmonary arterial hypertension therapies have led to improvements in the quality of life and survival for patients with idiopathic pulmonary arterial hypertension, but these trends have not uniformly translated to patients with systemic sclerosis–associated pulmonary arterial hypertension. In order to better understand the heterogeneity in treatment response and survival, we aimed to examine the histological and immunophenotypic differences between the systemic sclerosis–associated pulmonary arterial hypertension and idiopathic pulmonary arterial hypertension pulmonary vasculopathies. We performed a semi-quantitative lung morphometry–based analysis comparing sections obtained from systemic sclerosis–associated pulmonary arterial hypertension (n = 24), idiopathic pulmonary arterial hypertension (n = 9), and control (n = 13) bio-banked lung tissue specimens. H&E (Hematoxylin and Eosin) and VVG (Verhoeff-Van Gieson)-stained lung sections were analyzed for interstitial and vascular pathology. Immunohistochemistry was used to stain for an array of inflammatory and fibrosis mediators. Baseline demographic and hemodynamic data for each patient were collected via chart review at the time of lung explantation. Plexiform lesions were present in 5/9 (55%) of idiopathic pulmonary arterial hypertension samples, but absent in all systemic sclerosis–associated pulmonary arterial hypertension samples (0/24). Systemic sclerosis–associated pulmonary arterial hypertension lungs demonstrated significantly worse interstitial fibrosis (p = 0.0001) and interstitial cellularity (p = 0.0002) compared to idiopathic pulmonary arterial hypertension lungs. The degree of smooth muscle hypertrophy and pulmonary artery intimal proliferation were not different between systemic sclerosis–associated pulmonary arterial hypertension and idiopathic pulmonary arterial hypertension lungs. Immunohistochemistry analysis revealed that systemic sclerosis–associated pulmonary arterial hypertension lungs exhibited increased interstitial infiltration of CD3 T-cells (p = 0.009), CD20 B-cells (p = 0.01), and CD163 macrophages (p = 0.048) when compared to idiopathic pulmonary arterial hypertension and control lungs. Systemic sclerosis–associated pulmonary arterial hypertension lungs display a distinct pulmonary vascular pathology as well as significant interstitial fibrosis when compared to idiopathic pulmonary arterial hypertension lungs.
Targeted Multimodality Treatment to Eliminate the Need for Enucleation in Advanced Coats Disease
Authors: González Natalia C. , Villegas Victor M. , Berrocal Audina M. , Gold Aaron S. , Latiff Azeema , Murray Timothy G.
Published: November 2024

Purpose: To examine the trends and outcomes in the management of Coats disease and evaluate the effects of a staged therapeutic approach using transpupillary laser vascular ablation, intravitreal (IVT) bevacizumab, and adjunct as-needed posterior sub-Tenon triamcinolone acetonide (used only in cases with a persistent active exudation) on globe retention, anatomic status, and visual acuity (VA). Methods: An evaluation was performed from 2005 to 2023. Previous case series published in the literature were reviewed. In total, the case series comprised 68 patients who were evaluated and treated. In addition, a retrospective consecutive chart review was performed of novel cases of children with advanced Coats disease (stage 3 and 4) who were treated with targeted laser ablation coupled with IVT bevacizumab injection and supplemented with as-needed posterior sub-Tenon triamcinolone acetonide. Results: All patients had total resolution of the retinal detachment, and no patient had evidence of neovascular glaucoma after treatment. At 24 months, 11 (42%) of 26 eyes had better than 20/50 visual acuity (VA), 10 (39%) of 26 eyes had better than 20/400 VA, and 5 (19%) of 26 eyes had better than 5/200 VA. No eye required enucleation or developed endophthalmitis or inflammation after therapy with IVT bevacizumab. In addition, no case required incisional surgery. Conclusions: Treatment trends for advanced Coats disease have evolved, leading to enhanced patient outcomes and improved quality of life. Combined treatment with IVT bevacizumab, transpupillary laser vascular ablation, and as-needed posterior sub-Tenon triamcinolone acetonide results in improved anatomic outcomes.
Clinical use of ACQUIRE Therapy for Children Diagnosed With CASK-Gene Related Disabilities
Authors: Wallace Dory A , Rebekah Trucks Mary , DeLuca Stephanie C
Published: November 2024

Objective:

To report practice based evidence built on clinical findings where an intensive therapeutic approach called ACQUIRE Therapy was used as a rehabilitation/habilitation tool for children diagnosed with CASK mutations. ACQUIRE Therapy delivery is based on principles of learning and guided by a therapeutic framework often used in the delivery of intensive therapy.

Design:

Clinical Cohort.

Setting:

Natural environments (eg, home-like environment).

Participants:

A total of 20 females, 12 to 128 months, mean age = 44.75 (SD = 31.64).

Intervention:

Trained Occupational therapists delivered high-dosage rehabilitation for an average of 64.06 hours (SD = 12.91) across 4 weeks. ACQUIRE Therapy targeted cross-domain intervention targets often associated with executive control and praxis.

Main outcome measures:

Clinical data was examined from the following sources; therapist daily treatment documentation (eg, therapy goals, video recordings, daily therapy logs, and discharge documentation).

Results:

Receptive communication improved in all children. The most common motor skill improvements occurred in trunk control occurring in 33% of children; followed by, gross reaching abilities in 21% of children; fine-motor skills in 19%; head control in 15%; and mobility in 12%. Documentation of cognitive-motor pairing of skills was documented in all children.

Conclusions:

Diagnosis specific intervention targets (eg, attention and cognitive-pairing skills) need to be considered when providing therapeutic services to children with CASK-gene mutations and other forms of Global Developmental Delay. Clinicaltrials.gov registration number is NCT03325946. Date of registration: 1 May 2013. Trial Dates: December 2014 and October 2023. https://clinicaltrials.gov/study/NCT03325946?locStr=Roanoke,%20VA&country=United%20States&state=Virginia&city=Roanoke&cond=Cerebral%20Palsy&intr=Intensive%20therapy&rank=2
Regional metropolization in super mega city regions: Suburbanization and functional specialization in the Pearl River Delta
Authors: Yan Simin , Feng Pengfei , Growe Anna
Published: November 2024

Mega-city regions (MCRs) embody the robust economic growth experienced in Asia in the 21st century. Super MCRs (sMCRs) have developed due to continuous metropolisation extending deep into surrounding hinterlands. This paper examines the suburbanisation and functional specialisation processes in a typical sMCR in China: the Pearl River Delta (PRD). Applying principal component analysis and change importance values, shifting patterns in the socioeconomic structure of the PRD between 2000 and 2020 are analysed and compared using county/district-level occupational data. The nuanced findings show that the suburbanisation process in the PRD during the research period included manufacturing activities and tertiarisation. Sub-central areas have become increasingly important and functionally speciﬁc as the location for knowledge-intensive business services and other emerging occupational activities, such as environmental governance. These changes have contributed to the evolution of the PRD from a development pattern dominated by core cities to a polycentric sMCR with a specialised division of labour and cooperation between cities.
INCA033989: the first shot on goal for MPNs?
Authors: Benlabiod Camelia , Psaila Bethan
Published: November 2024

In this issue of Blood, Reis et al1 identify a monoclonal antibody, INCA033989, that selectively targets mutant calreticulin (mutCALR) in myeloproliferative neoplasms (MPNs), inhibiting its oncogenic activity without affecting normal hematopoiesis.
Prognostic factors after therapeutic bronchoscopy for tracheo- or bronchoesophageal fistulas: Results from the EpiGETIF registry
Authors: Edme Juliette , Fournier Clément , Lepage Benoit , Zea Obando Ep Chateau Claudia , Cellerin Laurent , Wallyn Frederic , Plat Gavin , Héluain Valentin , Lachkar Samy , Egenod Thomas , Gut Gobert Christophe , Perrot Loic , Lorut Christine , Lefebvre Aurélie , Vergnon Jean Michel , Bourinet Valerian , Roy Pascalin , Legodec Julien , Dutau Hervé , Guibert Nicolas
Published: November 2024

Introduction

Treatment of malignant tracheo- or bronchoesophageal fistulas (TEF) using therapeutic bronchoscopy (TB) is not standardized and its outcomes are poorly described. This study aimed to analyze the characteristics of patients treated with TB for a TEF and to identify prognostic factors.

Methods

We analyzed data from 96 patients undergoing TB for TEF entered in the EpiGETIF registry between January 2019 and December 2022.

Results

The mean age was 61.4 years. Median survival after TB was 2.40 months (95% CI 1.81–3.32). Histology was mainly represented by esophageal (72%) and lung (23%) cancers and did not influence prognosis (p=0.15), whereas smoking did (2.17versus3.32 months for non-smokers, p=0.04). Patients with poorperformance status(Eastern Cooperative Oncology Group >2) had shorter survival (1.99versus3.02 months, p=0.04). Sixty nine percent of patients had already received oncologic treatment, with no difference in survival (3.02versus2.21 months for treatment-naive patients, p=0.14). Neither the localization (trachea 61.5%, left main bronchus 34.4%, other 4.1%) nor the size of the fistulas (23% <5 mm, 20% 5–10 mm, 54% >10 mm) impacted survival (p=0.91 and p=0.83, respectively). An airway stent (AS) was placed in 92.7% of patients, mainly self-expanding metallic stents (45%). Patients treated with both an esophageal and AS had a better prognosis than patients treated with an AS alone (2.88versus1.77 months, respectively, p=0.02).

Conclusion

Survival of patients treated with TB for a TEF is very poor, and is impacted by smoking, performance status, and the presence of an esophageal stent.
Shorter walk test durations to detect ambulatory oxygen desaturation in interstitial lung disease: an observational cohort study
Authors: Robertson Lucy , Sylvester Karl Peter , Newman Joseph
Published: November 2024

Introduction

6-Minute Walk Test (6MWT) oxygen desaturation is an indication for ambulatory oxygen therapy (AOT) (British Thoracic Society (BTS) SpO2<90%; American Thoracic Society (ATS) SpO2≤ 88%). Shorter walk test durations may be beneficial in remote monitoring or in severe lung disease (ILD), where completing a 6MWT is challenging.

Methods

Retrospective routine clinical 6MWT with minute interval SpO2%, lung function and mortality data were collected from patients with ILD. Median lowest SpO2% at different time periods of the 6MWT were compared statistically and prognostically. Patients were classified by Distance-Oxygen-Gender-Age-Physiology (DO-GAP) index.

Results

274 patient records were analysed. Median SpO2% recorded at 0–1, 1–2, 2–3, 3–4, 4–5 and 5–6 min of the 6MWT were 96%, 93%, 92%, 92%, 91.5% and 91%, respectively (p<0.001). Prognostically, areas under the curve (AUC) for predicting 3-year mortality were significant (p<0.001) and similar for the minimum SpO2% between 0–1, 1–2, 2–3, 3–4, 4–5 and 5–6 min (AUC=0.71, 0.76, 0.77, 0.76, 0.77, 0.76, respectively). 111 patients desaturated to <90% (BTS criteria) during the 6MWT, with the median time to desaturation ranging from 1.5–2.5 min between DO-GAP groups (p=0.01). 94 patients desaturated to ≤88% (ATS criteria) during the 6MWT, with the median time to desaturation ranging from 1.5–2.2 min between DO-GAP groups.

Conclusion

Exertional desaturation manifests during earlier stages of the 6MWT. A 3-minute walk has 87–91% sensitivity in detecting oxygen desaturation requiring AOT, whilst retaining prognostic value. Shorter walk durations can efficiently detect desaturation in ILD, making it more patient-centred and feasible for remote testing.
Early benefit of mepolizumab on small airways in severe asthma: insights from IMPOSE study
Authors: Kotsiou Ourania S. , Kirgou Paraskevi , Siachpazidou Dimitra , Bartziokas Konstantinos , Tourlakopoulos Konstantinos , Malli Foteini , Pinaka Maria , Daniil Zoe , Gourgoulianis Konstantinos I.
Published: November 2024

Background

Severe eosinophilic asthma adversely affects small airway function, but effective therapeutic options are limited. The IMPOSE trial (NCT05147155) assessed the early and sustained effects of mepolizumab on small airways in patients with severe eosinophilic asthma using Impulse Oscillometry (IOS).

Methods

The study included 130 participants: 40 with uncontrolled severe asthma initiating mepolizumab, 40 with well-controlled severe asthma, and 50 healthy controls. Lung function was assessed with IOS, spirometry, and plethysmography at baseline, and at 1-, 3-, and 6-months post-treatment. Clinical outcomes included asthma control, quality of life, and medication adherence.

Results

Small airway function significantly improved within one month of mepolizumab initiation, shown by reductions in Fres, indicating decreased small airway resistance undetectable by spirometry. By six months, sustained improvements in FEF25–75%, TLC%, Fres, AX, and R5–20 were evident, accompanied by better asthma control and quality of life scores. Negative correlations between ΔR5 and ΔR5–20 with ΔACT at six months suggested that decreased small airway resistance and heterogeneity correlated with improved asthma control. These benefits were particularly prominent in patients without fixed airway obstruction. Notably, even patients with irreversible airflow limitations saw improvements in small airway dysfunction (SAD), suggesting that mepolizumab may provide benefits despite irreversible airway changes.

Conclusions

This study is the first to demonstrate that mepolizumab has a rapid and sustained therapeutic effect on small airways in severe eosinophilic asthma, as shown by IOS. IOS proves to be a valuable tool for monitoring the effects of biologic treatments on small airway function, revealing insights beyond spirometry.
The sustained increase of cardiovascular risk following COPD exacerbations: meta-analyses of the EXACOS-CV studies
Authors: Nordon Clementine , Simons Sami O , Marshall Jonathan , Müllerová Hana , Pollack Michael , Bengtsson Camilla , Hoti Fabian , Lobier Muriel , Salosensaari Aaro , Santos Ana Cristina , Vogelmeier Claus Franz , Rhodes Kirsty
Published: November 2024

Background

TheEXAcerbations of COPD and their OutcomeS on CardioVascular disease(EXACOS-CV) multi-database studies have consistently shown an increased risk of serious cardiovascular event following COPD exacerbations, however with some risk temporality variations. EXACOS-CV results were meta-analysed to increase their generalizability and improve precision.

Methods

Studies conducted in Canada, the United States, Germany, the Netherlands, Spain, Italy, Japan and England were meta-analysed, amounting to 1 030 875 individuals. Generally, each study included individuals aged ≥40 years with COPD diagnosis in 2014–2019; primary outcome was the composite of non-fatal acute coronary syndrome, decompensated heart failure, ischaemic stroke, arrhythmias and all-cause death. Pooled HRs (HRp) of risks in post-exacerbation periods (versusperiods outside exacerbations) were obtained through random effects meta-analysis.

Results

Time periods following an exacerbation (any severity) were associated with increased and sustained risks of the composite outcome: HRp10.22 (95% CI 5.34–19.57) in days 1–7 and HRp1.24 (95% CI 1.09–1.40) in days 181–365. Risks were elevated for 6 months (HRp1.25, 95% CI 1.01–1.55 in days 31–180) and one year (HRp1.48, 95% CI 1.11–1.96 in days 181–365), following a moderate, or a severe exacerbation, respectively. In newly diagnosed individuals, risks were increased until days 31–180: HRp1.66 (95% CI 1.14–2.42) and HRp1.61 (95% CI 1.28–2.02) following the first, and the second post-diagnosis exacerbation, respectively.

Conclusion

Risk of severe cardiovascular events is sustainably increased following an exacerbation of COPD, even early and moderate ones. Cardiopulmonary risk reduction should be a global core target of COPD management.
Allelopathic effects of leaf extracts of Eucalyptus camaldulensis Dehnh. on morphological, physiological, and yield traits of Ethiopian wheat (Triticum durum L.) cultivars
Authors: Andualem Animut Mekuriaw , Aragaw Mersha Wubie , Molla Abiyu Enyew , Tarekegn Zelalem Getnet , Kassa Getinet Masresha
Published: November 2024

Allelochemicals released into the soil from the leaves of eucalyptus species affect the growth and physiology of various crops. This study aimed to evaluate the allelopathic effects of aqueous and methanolic leaf extracts from Eucalyptus camaldulensis on three Ethiopian wheat cultivars (Assasa, Mukiye and Ude) of Triticum durum L. It was conducted as a pot experiment, and it utilized four concentrations of the extracts (Control (0%), 10%, 15%, and 20%) in a completely randomized design with three replicates. Results indicated that both extracts inhibited plant growth, biomass, and yield, with the methanolic extract showing stronger inhibitory effects. For instance, a concentration of 20% methanolic leaf extracts decreased chlorophyll fluorescence in the Assasa, Ude, and Mukiye cultivars by 53.97%, 36.36%, and 36.51%, respectively. The growth of both shoots and roots in Assasa, Ude, and Mukiye was significantly reduced at higher concentrations. Increasing concentrations of the extracts led to greater reductions in seedling traits and overall crop yield, with significant impacts observed (p ≤ 0.05). The findings suggest that eucalyptus should not be planted on agricultural land due to its negative impact on crop productivity.
Procalcitonin-guided antibiotic treatment in patients with cancer: a patient-level meta-analysis from randomized controlled trials
Authors: Gregoriano Claudia , Wirz Yannick , Heinsalo Ashley , Annane Djilali , Reinhart Konrad , Bouadma Lila , Christ-Crain Mirjam , Kristoffersen Kristina B. , Damas Pierre , Nobre Vandack , Oliveira Carolina F. , Shehabi Yahya , Stolz Daiana , Verduri Alessia , Mueller Beat , Schuetz Philipp
Published: November 2024

Background

Use of serum procalcitonin (PCT), an inflammatory biomarker for bacterial infections, has shown promising results for early stopping antibiotic treatment among patients with respiratory infections and sepsis. There is need for additional data regarding effectiveness and safety of this concept among patients with cancer.

Methods

Individual data of patients with a documented diagnosis of cancer and proven or suspected respiratory infection and/or sepsis were extracted from previous trials where adult patients were randomized to receive antibiotic treatment based on a PCT protocol or usual care (control group). The primary efficacy and safety endpoints were antibiotic exposure and 28-day all-cause mortality.

Results

This individual-patient data meta-analysis included 777 patients with a diagnosis of cancer from 15 randomized-controlled trials. Regarding efficacy, there was a 18% reduction in antibiotic exposure in patients randomized to PCT-guided care compared to usual care ([days] 8.2 ± 6.6 vs. 9.8 ± 7.3; adjusted difference, − 1.77 [95% CI, − 2.74 to − 0.80]; p < 0.001). Regarding safety, there were 72 deaths in 379 patients in the PCT-guided group (19.0%) compared to 91 deaths in 398 participants in the usual care group (22.9%) resulting in an adjusted OR of 0.78 (95% CI, 0.60 to 1.02). A subgroup analysis showed a significant reduction in mortality in patients younger than 70 years (adjusted OR, 0.58 [95% CI, 0.40 to 0.86]).

Conclusion

Result of this individual patient meta-analysis from 15 previous trials suggests that among patients with cancer and suspected or proven respiratory infection or sepsis, use of PCT to guide antibiotic treatment decisions results in reduced antibiotic exposure with a possible reduction in mortality, particularly among younger patients.
Comparison between community-acquired pneumonia and post-obstructive pneumonia associated with endobronchial tumors
Authors: Yu Wenwen , Shi Yubo , Zheng Qingsong , Chen Jianwu , Zhang Xie , Chen Ali , Yu Zhiyang , Zhou Weilong , Lin Li , Zheng Legui , Ye Hua , Li Yunlei
Published: November 2024

Background

Endobronchial tumors can infiltrate the bronchial wall or protrude into the bronchial lumen, causing post-obstructive pneumonia (POP). Differentiating between POP and community-acquired pneumonia (CAP) is challenging due to similar clinical, laboratory, and imaging findings, which can delay the diagnosis and treatment of endobronchial tumors.

Methods

We compared general demographic information, laboratory test results, lung CT images, bronchoscopic observations, pathological findings between the POP group and the CAP group.

Results

(1) The POP group consisted mainly of older individuals (mean age 69 vs. 56 years; P < 0.05), males (93.4% vs. 47.1%; P < 0.05), and smokers (67.2% vs. 14.7%; P < 0.05). Clinical symptoms varied, with chest pain (23.0% vs. 11.8%; P < 0.05) and hemoptysis (26.2% vs. 10.8%; P < 0.05) more prevalent in the POP group. MSCT showed that bronchial wall thickening, bronchial stenosis, occlusion, obstructive emphysema, mucoid impaction, and endobronchial shadows occurred more frequently in POP, while consolidation and exudation shadows were predominant in CAP (P < 0.05). (2) In the POP group, neoplasms were the most frequent bronchoscopic findings (57 cases, 93.44%), especially in the upper lungs. Squamous cell carcinoma was the primary pathological type (52 cases, 85.25%). The average delay in diagnosing endobronchial tumors was 214.8 days. In the POP group, 34 cases (55.74%) had abnormal CT images in the past and did not undergo bronchoscopy, resulting in delayed diagnosis. (3) Factors such as gender, age, bronchial occlusion, stenosis, mucus embolism, and intraluminal shadow were determined to be independent risk factors for endobronchial tumors (P < 0.05 and OR > 1).

Conclusions

Endobronchial tumors combined with POP are easily misdiagnosed as CAP in the early stage. Factors like bronchial occlusion, stenosis, mucus embolism, and intraluminal shadows on MSCT are significant independent risk factors for these tumors, indicating the need for early bronchoscopy.
Exploring the breadth of medicine: 8-year outcomes of a brief clinical summer immersion for premedical students
Authors: Weinlander Eva , Sams Elizabeth , Khemani Sarita , Jamal Armaan , Srinivasan Malathi
Published: November 2024

Background

Exposure to the breadth of healthcare opportunities is crucial to high-school and college students considering a career in medicine. Most programs revolve around research or subspecialties, limiting exposure to the richness within medicine.

Objective

We conducted a program evaluation of the Stanford Clinical Summer Internship (CSI) 2-week program, to understand learner viewpoints around CSI program utility, and to assess long term impact. We assess viewpoints by learner level (high school versus college) and participation mode (in-person versus virtual).

Methods

In 2016 we launched a two-week premedical internship, incorporating AAMC core competencies. In 2022 and 2023, we surveyed past participants, collecting demographic data and evaluating/comparing CSI’s impact on educational and career paths, future preferences in healthcare careers, and influential factors of matriculation for high-school and college participants.

Results

Of 411 past participants, 42% responded (n = 173). We found minimal significant differences between high school and college students. The primary reason for joining was exploring a career in health professions. Notably, 82% acknowledged Stanford-CSI broadened their medical perspectives, 79% gained clarity on healthcare professionals' daily life, 79% heightened their interest in healthcare careers, 71% enhanced their resumes, and 72% learned valuable clinical skills. In-person participants reported developing more friendships (agree/strongly agree: 60% vs 35%, unpaired t-test: p = 0.01), while virtual participants reported having more interest in research careers (40% vs 68%, p = 0.01). Amongst high school matriculants (n = 133), 46% are now in college and 4% in medical or nursing school. Amongst collegiate matriculants (n = 40), 89% have graduated and 11% are now in graduate or medical school. All respondents believed Stanford-CSI was a worthwhile investment of time and resources, with nearly all reporting subsequent increased interest in medicine.

Conclusions

Stanford-CSI's summer internship gives premedical students real-world medical profession exposure and fosters meaningful connections. Our findings and teaching framework can guide similar program developments, supporting future medical education initiatives.
Large language models improve clinical decision making of medical students through patient simulation and structured feedback: a randomized controlled trial
Authors: Brügge Emilia , Ricchizzi Sarah , Arenbeck Malin , Keller Marius Niklas , Schur Lina , Stummer Walter , Holling Markus , Lu Max Hao , Darici Dogus
Published: November 2024

Background

Clinical decision-making (CDM) refers to physicians’ ability to gather, evaluate, and interpret relevant diagnostic information. An integral component of CDM is the medical history conversation, traditionally practiced on real or simulated patients. In this study, we explored the potential of using Large Language Models (LLM) to simulate patient-doctor interactions and provide structured feedback.

Methods

We developed AI prompts to simulate patients with different symptoms, engaging in realistic medical history conversations. In our double-blind randomized design, the control group participated in simulated medical history conversations with AI patients (control group), while the intervention group, in addition to simulated conversations, also received AI-generated feedback on their performances (feedback group). We examined the influence of feedback based on their CDM performance, which was evaluated by two raters (ICC = 0.924) using the Clinical Reasoning Indicator – History Taking Inventory (CRI-HTI). The data was analyzed using an ANOVA for repeated measures.

Results

Our final sample included 21 medical students (agemean = 22.10 years, semestermean = 4, 14 females). At baseline, the feedback group (mean = 3.28 ± 0.09 [standard deviation]) and the control group (3.21 ± 0.08) achieved similar CRI-HTI scores, indicating successful randomization. After only four training sessions, the feedback group (3.60 ± 0.13) outperformed the control group (3.02 ± 0.12), F (1,18) = 4.44, p = .049 with a strong effect size, partial η2 = 0.198. Specifically, the feedback group showed improvements in the subdomains of CDM of creating context (p = .046) and securing information (p = .018), while their ability to focus questions did not improve significantly (p = .265).

Conclusion

The results suggest that AI-simulated medical history conversations can support CDM training, especially when combined with structured feedback. Such training format may serve as a cost-effective supplement to existing training methods, better preparing students for real medical history conversations.
Exploring the educational journey: perspectives of ethnic minority GP-trainees in Dutch GP-specialty training - a qualitative interview study
Authors: van Moppes N.M , Nasori M. , Jorissen A.C. , van Es J.M. , Bont J. , Visser M.R.M. , van den Muijsenbergh M.E.T.C.
Published: November 2024

Background

Previous research highlights persistent differential attainment by ethnicity in medical education, wherein the perceived inclusiveness significantly influences ethnic minority students’ and trainees’ outcomes. Biased organizational practices and microaggressions exacerbate the challenges faced by ethnic minorities, leading to lower academic performance and higher dropout rates. Consequently, understanding ethnic minority GP-trainees’ experiences and perspectives regarding relevant educational aspects is crucial for addressing these disparities and cultivating a more inclusive environment within medical education.

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Research question

We aimed to investigate the experiences of minority GP-trainees throughout their educational journey in Dutch GP-specialty training, emphasizing their challenges, sources of support, and suggestions for enhancing their learning environment.

Method

We conducted semi-structured, in-depth interviews with minority GP trainees, employing purposive convenience sampling to ensure diversity across multiple dimensions. These included gender, age, ethnicity, social background, migration generation, educational stage, encountered challenges, sources of support, and the GP training institute attended. The analysis involved iterative, open and axial coding, followed by generating, reviewing, and defining themes. For a structured analysis of encountered microaggressions, we adopted Sue's Taxonomy of Microaggressions.

Results

All fourteen ethnic minority interviewees had faced educational barriers stemming from misunderstandings and stereotyping in a predominantly 'white' organization. These barriers impacted various aspects of their education, including professional identity formation, application, admission, assessment procedures, social networks, course content, and expert guidance. Microaggressions permeated throughout their educational journey, hindering their full expression and potential. Their ideal GP-specialty training emphasized uniqueness of all trainees, comprehensive staff engagement in inclusivity, robust diversity, equity, and inclusion (DEI)-policies, individual mentorship, transparent standards, concise language usage in test questions, and bias elimination through mandatory DEI staff training.

Conclusion

Ethnic minority GP-trainees in the Netherlands face significant challenges like biased assessment and admission, stereotyped course content, inadequate support networks, and microaggressions, putting them at risk for underperformance outcomes. They emphasize the need for inclusive training with robust DEI-policies to eliminate bias.
Enhancing patient-centred chiropractic care in Canada: identifying barriers, enablers, and strategies through a qualitative needs assessment
Authors: To Daphne , Southerst Danielle , Atkinson-Graham Melissa , Yu Hainan , Connell Gaelan , Draper Crystal , Cancelliere Carol
Published: November 2024

Background

The Canadian Chiropractic Association (CCA) initiated a quality improvement project to develop best practices aimed at enhancing the patient experience.

Objectives

(1) Identify and prioritise the key moments in the new patient experience that could be improved by providing chiropractors with focused support and resources; (2) explore views, barriers, and enablers to implementing these best practices; and (3) develop recommendations to facilitate the adoption of these practices.

Methods

We conducted a qualitative needs assessment using a human-centred design approach, focused on understanding the needs and experiences of end-users to create tailored solutions. The Theoretical Domains Framework (TDF) was employed to explore chiropractors’ knowledge use and behaviour change, and TDF domains were mapped to Behaviour Change Techniques (BCTs) to develop targeted strategies for addressing identified barriers and enablers. Thirteen chiropractors from across Canada participated in semi-structured interviews and related activities.

Results

The key moments where participants felt they needed the most support were “treatment”, “report of findings”, “informed consent”, “physical examination”, and “before the appointment”. All participants agreed with the best practices seed statements. Key barriers included gaps in knowledge, communication skills, and resource availability, particularly in rural areas. Enablers included collaboration with other health professionals, mentorship, and access to practice tools. Recommendations include enhanced training in communication and treatment planning, increased access to resources in rural areas, and fostering collaborative relationships among health professionals.

Conclusion

Understanding the barriers and enablers to implementing best practices can inform targeted strategies to improve patient-centred care in chiropractic practice across Canada.
Genetic-by-age interaction analyses on complex traits in UK Biobank and their potential to identify effects on longitudinal trait change
Authors: Winkler Thomas W. , Wiegrebe Simon , Herold Janina M. , Stark Klaus J. , Küchenhoff Helmut , Heid Iris M.
Published: November 2024

Background

Genome-wide association studies (GWAS) have identified thousands of loci for disease-related human traits in cross-sectional data. However, the impact of age on genetic effects is underacknowledged. Also, identifying genetic effects on longitudinal trait change has been hampered by small sample sizes for longitudinal data. Such effects on deteriorating trait levels over time or disease progression can be clinically relevant.

Results

Under certain assumptions, we demonstrate analytically that genetic-by-age interaction observed in cross-sectional data can be indicative of genetic association on longitudinal trait change. We propose a 2-stage approach with genome-wide pre-screening for genetic-by-age interaction in cross-sectional data and testing identified variants for longitudinal change in independent longitudinal data. Within UK Biobank cross-sectional data, we analyze 8 complex traits (up to 370,000 individuals). We identify 44 genetic-by-age interactions (7 loci for obesity traits, 26 for pulse pressure, few to none for lipids). Our cross-trait view reveals trait-specificity regarding the proportion of loci with age-modulated effects, which is particularly high for pulse pressure. Testing the 44 variants in longitudinal data (up to 50,000 individuals), we observe significant effects on change for obesity traits (near APOE, TMEM18, TFAP2B) and pulse pressure (near FBN1, IGFBP3; known for implication in arterial stiffness processes).

Conclusions

We provide analytical and empirical evidence that cross-sectional genetic-by-age interaction can help pinpoint longitudinal-change effects, when cross-sectional data surpasses longitudinal sample size. Our findings shed light on the distinction between traits that are impacted by age-dependent genetic effects and those that are not.
Multi-omics landscape of childhood simple obesity: novel insights into pathogenesis and biomarkers discovery
Authors: Ren Yi , Huang Peng , Zhang Lu , Tang Yufen , He Siyi , Li HaiDan , Huang XiaoYan , Ding Yan , Liu Lingjuan , Liu Liqun , He Xiaojie
Published: November 2024

Background

The increasing incidence of childhood obesity annually has led to a surge in physical and mental health risks, making it a significant global public health concern. This study aimed to discover novel biomarkers of childhood simple obesity through integrative multi-omics analysis, uncovering their potential connections and providing fresh research directions for the complex pathogenesis and treatment strategies.

Methods

Transcriptome, untargeted metabolome, and 16 S rDNA sequencing were conducted on subjects to examine transcripts, metabolites in blood, and gut microflora in stool.

Results

Transcriptomic analysis identified 599 differentially expressed genes (DEGs), of which 25 were immune-related genes, and participated in immune pathways such as antimicrobial peptides, neutrophil degranulation, and interferons. The optimal random forest model based on these genes exhibited an AUC of 0.844. The metabolomic analysis examined 71 differentially expressed metabolites (DEMs), including 12 immune-related metabolites. Notably, lauric acid showed an extremely strong positive correlation with BMI and showed a good discriminative power for obesity (AUC = 0.82). DEMs were found to be significantly enriched in four metabolic pathways, namely “Aminoacyl-tRNA biosynthesis”, “Valine leucine and isoleucine biosynthesis, and Glycine”, “Serine and threonine metabolism”, and “Biosynthesis of unsaturated fatty acids”. Microbiome analysis revealed 12 differential gut microbiotas (DGMs) at the phylum and genus levels, with p_Firmicutes dominating in the obese group and g_Escherichia-Shigella in the normal group. Subsequently, a Random Forest model was developed based on the DEMs, immune-related DEGs, and metabolites with an AUC value of 0.912. The 14 indicators identified by this model could potentially serve as a set of biomarkers for obesity. The analysis of the inter-omics correlation network found 233 pairs of significant correlations. DEGs BPIFA1, BPI, and SAA1, DEMs Dimethy(tetradecyl)amine, Deoxycholic acid, Pathalic anhydride, and DL-Alanine, and DGMs g_Intestinimonas and g_Turicibacter showed strong connectivity within the network, constituting a large proportion of interactions.

Conclusion

This study presents the first comprehensive description of the multi-omics characteristics of childhood simple obesity, recognizing promising biomarkers. Immune-related markers offer a new perspective for researching the immunological mechanisms underlying obesity and its associated complications. The revealed interactions among these biomarkers contribute to a deeper understanding the intricate biological regulatory networks associated with obesity.
Aggregation of cardiovascular risk factors in a cohort of 40-year-olds participating in a population-based health screening program in Sweden
Authors: Borgström Bolmsjö Beata , Stenman Emelie , Grundberg Anton , Sundquist Kristina
Published: November 2024

Background

It is important to identify and evaluate cardiovascular risk factors at an early stage to address them accordingly. Among the younger population, the metabolic syndrome is less common than in older ages. However, each separate metabolic risk factor still has an additive effect on cardiovascular risk factor burden. Non-metabolic risk factors that occur in the younger population include family history, smoking, psychological distress and socioeconomic vulnerability. In 2021 a voluntary health intervention program was introduced in an urban area in Sweden where a cohort of 40-year-olds was invited for cardiovascular risk identification. The aim of this study was to identify how cardiovascular risk factors tend to aggregate in individuals participating in a voluntary health screening program and how the metabolic risk factors associate with non-metabolic cardiovascular risk factors.

Methods

This was a cross-sectional study with 1831 participants. Data from questionnaires and baseline measurements were used to calculate the prevalence of metabolic- (blood pressure, lipids, fasting plasma glucose, BMI, waist-hip ratio) and non-metabolic risk factors (family history of CVD, smoking, psychological distress, socioeconomic vulnerability) for CVD. SCORE2 was calculated according to the algorithm provided by the SCORE2 working group and ESC (European Society of Cardiology) Cardiovascular Risk Collaboration. Associations among each of the metabolic risk factors and non-metabolic risk factors were estimated using logistic regression and presented as odds ratios (ORs) with 95% confidence intervals (CIs).

Results

More than half of the study population had at least one metabolic risk factor, and more than 1/3 was considered to be suffering from psychological distress. Furthermore, obesity or central obesity demonstrated individual associations with all of the non-metabolic risk factors in the study; smoking (1.49; 1.32–2.63), family history of CVD (1.41; 1.14–1.73), socioeconomic vulnerability (1.60; 1.24–2.07), and psychological distress (1.40; 1.14–1.72). According to SCORE2 25% of the men were at moderate risk (2.5–7.5%) of developing a cardiovascular event within 5–10 years, but only 2% of the women.

Conclusions

Obesity/central obesity should be a prioritized target in health screening programs. The non-metabolic risk factors, socioeconomic vulnerability, and psychological distress should not be ignored and addressed with adequate guidance to create health equity.
Reconstructive surgical treatment of peri-implantitis with use of a chitosan brush for decontamination- case series with 1-year follow-up
Authors: İnce Kuka Gizem , Gürsoy Hare
Published: November 2024

Introduction and aim

There is a need for studies assessing the efficacy of different therapeutic approaches in the reconstructive surgical treatment of peri-implantitis. The aim of this case series is to evaluate the clinical outcomes and radiographic bone fill of reconstructive surgical treatment using the oscilating chitosan brush for implant surface decontamination.

Materials and methods

Nine patients with 11 Class I and III peri-implantitis defects were included. Following implant surface decontamination performed with a chitosan brush, guided bone regeneration (GBR) was performed by means of a bovine derived cancellous bone graft and collagen membrane. Clinical parameters such as full mouth plaque score (FMPS), probing depth (PD), bleeding on probing (BoP), recession, and radiographic bone level (RBL) were recorded at baseline and 1 year following treatment.

Results

All evaluated parameters, including PD, BoP, recession, RBL, and full mouth plaque scores, revealed significant improvements at 1 year follow-up compared to baseline (p < 0.05). The mean PD values reduced from 7.30 ± 1.29 to 3.78 ± 0.65 (p = 0.000). RBL was detected 5.50 ± 1.31 and 1.38 ± 0.74 at baseline and 1-year, respectively (p = 0.010).

Conclusion

Reconstructive surgical treatment of Class I and III peri-implantitis defects with GBR may be an effective treatment protocol when an oscilitating chitosan brush is used for surface decontamination.

Clinical trial number

Not applicable.
Serous endometrial carcinoma metastatic to the sigmoid colon masquerading as a primary colon cancer detected by bowel obstruction
Authors: Shimura Taiga , Fukushima Naoko , Tsuboi Kazuto , Suzuki Toshimasa , Kajimoto Tetsuya
Published: November 2024

Background

The majority of colorectal malignancies are primary tumors. Secondary tumors are rare, and colorectal metastasis from endometrial carcinoma is exceptionally uncommon. We report a case of serous endometrial carcinoma that metastasized to the sigmoid colon, initially presenting as a primary colon carcinoma due to bowel obstruction.

Case presentation

A 79-year-old woman presented with abdominal distention and constipation. Five years earlier, she had undergone an open total hysterectomy with bilateral salpingo-oophorectomy for endometrial serous carcinoma. A colonoscopy revealed stenosis encircling the entire sigmoid colon. Abdominal computed tomography demonstrated irregular wall thickening in the sigmoid colon with enhanced regional lymph node enlargement and upstream bowel dilatation. Peritoneal dissemination in the pelvis was also noted. To relieve the obstruction, two self-expanding metal stents were inserted. Subsequently, due to the presumed diagnosis of sigmoid colon carcinoma with peritoneal dissemination, an open left hemicolectomy with resection of the peritoneal dissemination was performed. Histopathological examination identified the colon tumor and peritoneal dissemination as metastatic serous endometrial carcinoma. Immunohistochemical studies showed the tumor cells were negative for CK7, CK20, and CDX2. No chemotherapy was administered, and 6 months post-operation, no recurrence was observed.

Conclusions

Metastasis of endometrial carcinoma to the colon is extremely rare. Diagnosing a colon tumor as a metastasis from endometrial carcinoma is challenging during preoperative examinations. Therefore, in patients with a history of endometrial carcinoma, the possibility that the primary site might be the uterus should be considered.
Effective use of a supraglottic airway (i-gel™) during emergence from anesthesia in a patient with multiple giant bullae
Authors: Arime Hayato , Asai Takashi , Fujishiro Asuka , Saito Tomoyuki
Published: November 2024

Background

Anesthetic management of a patient with multiple giant bullae is generally difficult due to an increased risk of respiratory complications, and there is no consensus regarding safe extubation methods. We report a case of an effective use of a supraglottic airway (i-gel™) during emergence from anesthesia in a patient with multiple giant bullae, in whom a double-lumen bronchial tube was being used during anesthesia.

Case presentation

A 52-year-old man with multiple giant bullae underwent video-assisted pulmonary resections, while the ventilation was controlled via a double-lumen bronchial tube. After successful thoracoscopic surgery, an i-gel™ was inserted while the double-lumen tube was still in place, and the double-lumen tube was subsequently removed under deep anesthesia. The i-gel™ was removed without complications after the patient had become able to respond to verbal command.

Conclusion

We believe that this method would minimize the risk of trauma to the respiratory system during emergence from anesthesia in patients with multiple giant bullae.