bluuebunny/crossref_metadata_2025 huggingface dataset:
The risk of major adverse cardiovascular events in patients with systemic sclerosis: a nationwide, population-based cohort study
Authors: Yen Tsai-Hung , Chen Yun-Wen , Hsieh Tsu-Yi , Chen Yi-Ming , Huang Wen-Nan , Chen Yi-Hsing , Chen Hsin-Hua
Published: September 2023

Objective

The objective of this study was to assess the incidence and risk factors of major adverse cardiovascular events (MACEs) in patients with systemic sclerosis (SSc).

Methods

We conducted a nationwide, population-based, cohort study using Taiwan’s National Health Insurance Research Database. We performed propensity score matching (PSM) using a 1:2 ratio, resulting in inclusion of 1379 patients with SSc and 2758 non-SSc individuals in the analysis. We assessed the association between SSc and MACEs, using the multivariable Cox proportional hazard regression model with adjustment of time-dependent covariates, and investigated risk factors for MACEs in patients with SSc, shown as adjusted hazard ratios (aHRs) with 95% CIs.

Results

SSc was not significantly associated with the risk of MACEs (aHR 1.04; 95% CI 0.77–1.42). Nevertheless, SSc was associated with increased risk of myocardial infarction [incidence rate ratio (IRR) 1.76; 95% CI 1.08–2.86] and peripheral arterial occlusion disease (IRR 3.67; 95% CI 2.84–4.74) but not of ischaemic stroke (IRR 0.89; 95% CI 0.61–1.29). Factors independently associated with MACEs in SSc patients included age (aHR 1.02), male gender (aHR 2.01), living in a suburban area (aHR 2.09), living in a rural area (aHR 3.00), valvular heart disease (aHR 4.26), RA (aHR 2.14), use of clopidogrel (aHR 26.65), and use of aspirin (aHR 5.31).

Conclusions

The risk of MACEs was not significantly increased in Taiwanese patients with SSc, and our investigation effectively identified the factors independently associated with MACEs in SSc patients. Additionally, patients with SSc exhibited higher risks of myocardial infarction and peripheral arterial occlusion disease but not of ischaemic stroke.
Fast and Accurate Maximum-Likelihood Estimation of Multi-Type Birth–Death Epidemiological Models from Phylogenetic Trees
Authors: Zhukova Anna , Hecht Frédéric , Maday Yvon , Gascuel Olivier
Published: September 2023

Multi-type birth–death (MTBD) models are phylodynamic analogies of compartmental models in classical epidemiology. They serve to infer such epidemiological parameters as the average number of secondary infections Re and the infectious time from a phylogenetic tree (a genealogy of pathogen sequences). The representatives of this model family focus on various aspects of pathogen epidemics. For instance, the birth–death exposed-infectious (BDEI) model describes the transmission of pathogens featuring an incubation period (when there is a delay between the moment of infection and becoming infectious, as for Ebola and SARS-CoV-2), and permits its estimation along with other parameters. With constantly growing sequencing data, MTBD models should be extremely useful for unravelling information on pathogen epidemics. However, existing implementations of these models in a phylodynamic framework have not yet caught up with the sequencing speed. Computing time and numerical instability issues limit their applicability to medium data sets (≤ 500 samples), while the accuracy of estimations should increase with more data.

We propose a new highly parallelizable formulation of ordinary differential equations for MTBD models. We also extend them to forests to represent situations when a (sub-)epidemic started from several cases (e.g., multiple introductions to a country). We implemented it for the BDEI model in a maximum likelihood framework using a combination of numerical analysis methods for efficient equation resolution. Our implementation estimates epidemiological parameter values and their confidence intervals in two minutes on a phylogenetic tree of 10,000 samples. Comparison to the existing implementations on simulated data shows that it is not only much faster but also more accurate. An application of our tool to the 2014 Ebola epidemic in Sierra-Leone is also convincing, with very fast calculation and precise estimates. As MTBD models are closely related to Cladogenetic State Speciation and Extinction (ClaSSE)-like models, our findings could also be easily transferred to the macroevolution domain.
Do Children With Medicaid Insurance Have Increased Revision Rates 5 Years After Posterior Spinal Fusions?
Authors: Moore Harold G. , Patibandla Sahiti D. , McClung Anna M. , Grauer Jonathan N. , Sucato Daniel J. , Wise Carol A. , Johnson Megan E. , Rathjen Karl E. , McIntosh Amy L. , Ramo Brandon A. , Brooks Jaysson T.
Published: September 2023

Background:

Socioeconomic disparities in musculoskeletal care are increasingly recognized, however, no studies to date have investigated the role of the insurance carrier on outcomes after posterior spinal fusion (PSF) with segmental spinal instrumentation for adolescent idiopathic scoliosis (AIS).

Methods:

A US insurance dataset was queried using the PearlDiver Mariner software for all patients aged 10 to 18 undergoing PSF for a primary diagnosis of AIS between 2010 and 2020. Age, sex, geographic region, number of levels fused, and baseline medical comorbidities were queried. Complications occurring within 90 days of the index surgery were queried using theInternational Classification of Diseases, Ninth Revision(ICD-9) andInternational Classification of Diseases, 10th Revision(ICD-10) codes. Revision surgery was also queried up to 5 years after the index PSF. Categorical variables were compared using the Fisher χ2tests and continuous variables were compared using independentttests. All-cause revision within 5 years was compared using the Kaplan-Meier analysis and a log-rank test. Significance was set atP-value <0.05.

Results:

A total of 10,794 patients were identified with 9006 (83.4%) patients with private insurance and 1788 (16.6%) patients insured by Medicaid. The mean follow-up in the database was 5.36±3 years for patients with private insurance and 4.78±2.9 years for patients with Medicaid insurance (P<0.001). Children with AIS and Medicaid insurance had a significantly higher prevalence of asthma, hypertension, and obesity. A larger percentage of children with Medicaid insurance (41.3%) underwent a ≥13-level PSF compared with privately insured children (34.5%) (P<0.001). Medicaid patients did not experience higher odds of postoperative complications; in addition, revision surgeries occurred in 1.1% and 1.8% of patients with private insurance and Medicaid insurance, respectively at 5 years postoperatively (P=0.223).

Conclusion:

Despite worse baseline comorbidities and longer fusion constructs, AIS patients insured with Medicaid did not have higher rates of complications or revisions at 5-year follow-up versus privately insured patients.

Level of Evidence:

Level III—retrospective cohort study.
Is There a Benefit to Rigid Fixation in Calcaneal Lengthening Osteotomy in Painful Pediatric Idiopathic Flatfoot Deformity? Comparing Results of Kirschner Wire Versus Plate Fixation
Authors: Tippabhatla Abhishek , Torres-Izquierdo Beltran , William Matthew , Pereira Daniel , Meyer Zachary , Hosseinzadeh Pooya
Published: September 2023

Introduction:

Flexible flatfoot (FF) is a common pediatric condition that is mostly asymptomatic, and surgical intervention is only considered when painful FF is refractory to conservative treatment. Calcaneal lengthening osteotomy (CLO) is one of the most commonly used procedures to address painful FF. Traditionally, Kirschner wires (K-wires) were used for fixation, but there has been a recent increase in the use of plates. We compared the clinical and radiographic outcomes of these 2 fixation methods.

Methods:

This single-center retrospective study included children aged 8 to 18 years with symptomatic FF that received CLO using K-wire or plate fixation. Primary outcomes include weight-bearing radiographic measurements and complications after surgery. Secondary outcomes included patient-reported outcomes. Statistical significance was held at 0.05.

Results:

Among 102 feet (65 patients), 42 feet (41.2%) underwent K-wire and 60 feet (58.8%) underwent plate fixation. No differences in casting duration (P=0.525) and time-to-radiographic healing (P=0.17) were noted. Total complications were higher in the plate cohort (12 vs. 2,P=0.04) due to a higher rate of reoperations (16.7%) for hardware-related pain [10 vs. 0; odds ratio 17.74, 95% CI (1.01, 310.54),P<0.05], and infection rates were similar. Both interventions significantly improved (P≤ 0.001) aneteroposterior (AP) Talo-first metatarsal and calcaneal pitch angles. Irrespective of intervention, CLO significantly improved pain at 6 months and mobility scores at 12 months. Neither modality demonstrated superior pain or mobility scores at final follow-up.

Conclusion:

Both K-wire and plate fixations lead to similar radiographic and functional outcomes after CLO in painful, pediatric flatfeet. Compared with K-wire fixation, plates cause a 17.7-fold increased risk of reoperations for painful hardware, with 16.7% of plated cases requiring reoperation. Noting this, along with the higher costs associated with using plates, our study advocates for K-wire fixation for children undergoing CLO.

Level of Evidence:

Level III
Increasing Cervical Kyphosis Correlates With Cervical Degenerative Disk Disease in Patients With Adolescent Idiopathic Scoliosis
Authors: Lin Adrian , Skaggs David L. , Andras Lindsay M. , Tolo Vernon , Tamrazi Benita , Illingworth Kenneth D.
Published: September 2023

Study Design.

Retrospective review.

Objective.

Our goal was to investigate the incidence of cervical degenerative disk disease (DDD) in patients with adolescent idiopathic scoliosis (AIS), before surgical intervention.

Summary of Background Data.

AIS is often associated with thoracic hypokyphosis and compensatory cervical kyphosis. In adults, cervical kyphosis is associated with DDD. Although cervical kyphosis has been reported in up to 60% AIS patients, the association with cervical DDD has not been reported.

Materials and Methods.

A retrospective review was conducted from January 2014 to December 2019 of all consecutive AIS patients. Inclusion criteria were AIS patients over 10 years of age with cervical magnetic resonance imaging and anterior-posterior and lateral spine radiographs within 1 year of each other. Magnetic resonance imaging were reviewed for evidence of cervical DDD. Severity of cervical changes were graded using the Pfirrmann classification and by a quantitative measure of disk degeneration, the magnetic resonance signal intensity ratio.

Results.

Eighty consecutive patients were included (mean age: 14.1 years, SD=2.5 years). Increasing cervical kyphosis was significantly correlated to decreasing thoracic kyphosis (r=0.49, P<0.01) and increasing major curve magnitude (r=0.22, P=0.04). Forty-five patients (56%) had the presence of DDD (grades 2–4) with a mean cervical kyphosis of 11.1° (SD=9.5°, P<0.01). More cervical kyphosis was associated with more severe cervical DDD as graded by Pfirrmann classification level (P<0.01). Increasing cervical kyphosis was also positively associated with increasing magnetic resonance signal intensity ratio (P<0.01). Nine patients had ventral cord effacement secondary to DDD with a mean cervical kyphosis of 22.8° (SD=8.6°) compared with 2.6° (SD=11.2°) in those who did not (P<0.01).

Conclusions.

Cervical kyphosis was significantly associated with increasing severity of cervical DDD in patients with AIS. Patients with evidence of ventral cord effacement had the largest degree of cervical kyphosis with a mean of 22.8±8.6°. This is the first study to evaluate the association between cervical kyphosis in AIS with cervical DDD.
Inhibition of MNK pathway sensitizes nasopharyngeal carcinoma to radiotherapy
Authors: Luo Honglan , Huang Shiyong
Published: September 2023

Improving the clinical management of nasopharyngeal carcinoma (NPC) is an unmet need owing to the high incidence of treatment failure caused by radioresistance. In our study, we observed increased phosphorylation of translation initiation factor 4E (eIF4E), regulated by MAP kinase-interacting kinase (MNK), in NPC cells following irradiation treatment. Using siRNA to deplete MNK, we found that radiation-induced eIF4E phosphorylation was eliminated, NPC cell sensitivity to radiation was enhanced, and radioresistant NPC cell viability was reduced. Furthermore, we tested three pharmacological MNK inhibitors (eFT508, CGP57380, and cercosporamide) and found that they were effective against radioresistant NPC cells and synergized with irradiation. In-vivo experiments confirmed that eFT508, at a tolerable dose, inhibited the growth of radioresistant NPC and synergized with radiation in a radiosensitive NPC xenograft model. Our research highlights the activation of MNK-mediated survival mechanisms in NPC in response to radiotherapy and the potential of combining radiation with MNK inhibitors as a sensitizing strategy. Notably, eFT508 is currently being investigated in clinical trials for cancer treatment, and our findings may prompt the initiation of clinical trials using eFT508 in radioresistant NPC patients.
Research progress of CXCR3 inhibitors
Authors: Yuan Zhuo
Published: September 2023

The human CXCR3 receptor was initially identified and cloned in the mid-1990s. In the process of understanding CXCR3, it gradually found that it plays an important role in the process of a variety of diseases, including inflammation, immune diseases, cancer, cardiovascular diseases, central nervous system diseases, etc., which attracted the attention of many researchers. Subsequently, some small molecule inhibitors targeting CXCR3 receptors were also developed. Unfortunately, no CXCR3 inhibitors have been approved for marketing by FDA. Up to now, only one CXCR3 small molecule inhibitor has entered the clinical trial stage, but it has not achieved ideal results in the end. Therefore, there is still much to think about and explore for the development of CXCR3 inhibitors. This article reviews the important role of CXCR3 in various physiological and pathological processes and some small molecule inhibitors of CXCR3.
Hemodialysis requirement after the first dose of durvalumab following chemoradiation therapy: a case report
Authors: Yamada Chihiro , Kashizaki Fumihiro , Kaneko Mai , Kitaji Daiyu , Kawano Naomi , Kaneko Takeshi
Published: September 2023

Durvalumab is the first immune check point inhibitor that was approved for use following concurrent platinum-based chemoradiation, in patients with unresectable stage III non-small cell lung cancer. The new treatment regimen of durvalumab administered after chemoradiation resulted in higher response rates and required careful immune-related adverse effects management. We experienced a rare case of severe acute kidney injury (AKI) requiring hemodialysis after only the first dose of durvalumab, in a patient who was diagnosed with immune-related AKI by renal biopsy. Although severe (Grade 3 or more) immune-related AKI occurred in 0.9% of patients treated with durvalumab, some drugs and radiation may increase immune-related AKI. Further research is needed to identify the clinical characteristics of patients who tend to develop severe AKI so as to prevent it, by reviewing such rare cases as ours.
High Mechanical Power and Driving Pressures are Associated With Postoperative Respiratory Failure Independent From Patients’ Respiratory System Mechanics*
Authors: Tartler Tim M. , Ahrens Elena , Munoz-Acuna Ricardo , Azizi Basit A. , Chen Guanqing , Suleiman Aiman , Wachtendorf Luca J. , Costa Eduardo L.V. , Talmor Daniel S. , Amato Marcelo B.P. , Baedorf-Kassis Elias N. , Schaefer Maximilian S.
Published: September 2023

OBJECTIVES:

High mechanical power and driving pressure (ΔP) have been associated with postoperative respiratory failure (PRF) and may be important parameters guiding mechanical ventilation. However, it remains unclear whether high mechanical power and ΔP merely reflect patients with poor respiratory system mechanics at risk of PRF. We investigated the effect of mechanical power and ΔP on PRF in cohorts after exact matching by patients’ baseline respiratory system compliance.

DESIGN:

Hospital registry study.

SETTING:

Academic hospital in New England.

PATIENTS:

Adult patients undergoing general anesthesia between 2008 and 2020.

INTERVENTION:

None.

MEASUREMENTS AND MAIN RESULTS:

The primary exposure was high (≥ 6.7 J/min, cohort median) versus low mechanical power and the key-secondary exposure was high (≥ 15.0 cm H2O) versus low ΔP. The primary endpoint was PRF (reintubation or unplanned noninvasive ventilation within seven days). Among 97,555 included patients, 4,030 (4.1%) developed PRF. In adjusted analyses, high intraoperative mechanical power and ΔP were associated with higher odds of PRF (adjusted odds ratio [aOR] 1.37 [95% CI, 1.25–1.50]; p < 0.001 and aOR 1.45 [95% CI, 1.31–1.60]; p < 0.001, respectively). There was large variability in applied ventilatory parameters, dependent on the anesthesia provider. This facilitated matching of 63,612 (mechanical power cohort) and 53,260 (ΔP cohort) patients, yielding identical baseline standardized respiratory system compliance (standardized difference [SDiff] = 0.00) with distinctly different mechanical power (9.4 [2.4] vs 4.9 [1.3] J/min; SDiff = –2.33) and ΔP (19.3 [4.1] vs 11.9 [2.1] cm H2O; SDiff = –2.27). After matching, high mechanical power and ΔP remained associated with higher risk of PRF (aOR 1.30 [95% CI, 1.17–1.45]; p < 0.001 and aOR 1.28 [95% CI, 1.12–1.46]; p < 0.001, respectively).

CONCLUSIONS:

High mechanical power and ΔP are associated with PRF independent of patient’s baseline respiratory system compliance. Our findings support utilization of these parameters for titrating mechanical ventilation in the operating room and ICU.
A genetic variant in the immune-related gene ERAP1 affects colorectal cancer prognosis
Authors: Zou Danyi , Cai Yimin , Jin Meng , Zhang Ming , Liu Yizhuo , Chen Shuoni , Yang Shuhui , Zhang Heng , Zhu Xu , Huang Chaoqun , Zhu Ying , Miao Xiaoping , Wei Yongchang , Yang Xiaojun , Tian Jianbo
Published: September 2023

Background:

Findings on the association of genetic factors and colorectal cancer (CRC) survival are limited and inconsistent, and revealing the mechanism underlying their prognostic roles is of great importance. This study aimed to explore the relationship between functional genetic variations and the prognosis of CRC and further reveal the possible mechanism.

Methods:

We first systematically performed expression quantitative trait locus (eQTL) analysis using The Cancer Genome Atlas (TCGA) dataset. Then, the Kaplan–Meier analysis was used to filter out the survival-related eQTL target genes of CRC patients in two public datasets (TCGA and GSE39582 dataset from the Gene Expression Omnibus database). The seven most potentially functional eQTL single nucleotide polymorphisms (SNPs) associated with six survival-related eQTL target genes were genotyped in 907 Chinese CRC patients with clinical prognosis data. The regulatory mechanism of the survival-related SNP was further confirmed by functional experiments.

Results:

The rs71630754 regulating the expression of endoplasmic reticulum aminopeptidase 1 (ERAP1) was significantly associated with the prognosis of CRC (additive model, hazard ratio [HR]: 1.43, 95% confidence interval [CI]: 1.08–1.88, P = 0.012). The results of dual-luciferase reporter assay and electrophoretic mobility shift assay showed that the A allele of the rs71630754 could increase the binding of transcription factor 3 (TCF3) and subsequently reduce the expression of ERAP1. The results of bioinformatic analysis showed that lower expression of ERAP1 could affect the tumor immune microenvironment and was significantly associated with severe survival outcomes.

Conclusion:

The rs71630754 could influence the prognosis of CRC patients by regulating the expression of the immune-related gene ERAP1.

Trial Registration:

No. NCT00454519 (https://clinicaltrials.gov/)
18F-prostate specific membrane antigen positron emission tomography/computerized tomography for lymph node staging in medium/high risk prostate cancer: A systematic review and meta-analysis
Authors: Lv Zhengtong , Song Liuqi , Wang Miao , Hou Huimin , Li Haodong , Wang Xuan , Wang Jianye , Wang Jianlong , Liu Ming
Published: September 2023

Background:

Lymph node staging of prostate cancer (PCa) is important for planning and monitoring of treatment. 18F-prostate specific membrane antigen positron emission tomography/computerized tomography (18F-PSMA PET/CT) has several advantages over 68Ga-PSMA PET/CT, but its diagnostic value requires further investigation. This meta-analysis focused on establishing the diagnostic utility of 18F-PSMA PET/CT for lymph node staging in medium/high-risk PCa.

Methods:

We searched the EMBASE, PubMed, Cochrane library, and Web of Science databases from inception to October 1, 2022. Prostate cancer, 18F, lymph node, PSMA, and PET/CT were used as search terms and the language was limited to English. We additionally performed a manual search using the reference lists of key articles. Patients and study characteristics were extracted and the QUADAS-2 tool was employed to evaluate the quality of included studies. Sensitivity, specificity, the positive and negative likelihood ratio (PLR and NLR), diagnostic odds ratio (DOR), area under the curve (AUC), and 95% confidence interval (CI) were used to evaluate the diagnostic value of 18F-PSMA PET/CT. Stata 17 software was employed for calculation and statistical analyses.

Results:

A total of eight diagnostic tests including 734 individual samples and 6346 lymph nodes were included in this meta-analysis. At the patient level, the results of each consolidated summary were as follows: sensitivity of 0.57 (95% CI 0.39–0.73), specificity of 0.95 (95% CI 0.92–0.97), PLR of 11.2 (95% CI 6.6–19.0), NLR of 0.46 (95% CI 0.31–0.68), DOR of 25 (95% CI 11–54), and AUC of 0.94 (95% CI 0.92–0.96). At the lesion level, the results of each consolidated summary were as follows: sensitivity of 0.40 (95% CI 0.21–0.62), specificity of 0.99 (95% CI 0.95–1.00), PLR of 40.0 (95% CI 9.1–176.3), NLR of 0.61 (95% CI 0.42–0.87), DOR of 66 (95% CI 14–311), and AUC of 0.86 (95% CI 0.83–0.89).

Conclusions:

18F-PSMA PET/CT showed moderate sensitivity but high specificity in lymph node staging of medium/high-risk PCa. The diagnostic efficacy was almost equivalent to that reported for 68Ga-PSMA PET/CT.

Registration:

International Prospective Register of Systematic Reviews (PROSPERO), No. CRD42023391101.
Applications of Participatory System Dynamics Methods to Public Health
Authors: Decker Hallie , Wendel Monica
Published: September 2023

System dynamics, and specifically qualitative participatory applications of system dynamics, have potential to benefit public health research, scholarship, and practice. A systematic review was conducted to examine the existing applications of participatory system dynamics (PSD) to public health research. Three databases were searched using unique search terms related to PSD and methodological applications in public health research. A total of 57 unique articles met inclusion criteria and were included for review. The studies included for review were conducted globally and represent a wide breadth of public health issues. The review identified several advantages to adopting PSD methods in public health scholarship and practice. The PSD methods provide innovative frameworks for conceptualizing complex and nuanced public health problems. The participatory nature of PSD allows for increased community engagement and empowerment to address public health problems, as well as to mitigate existing power dynamics between research institutions and marginalized communities that are disproportionately impacted by social and health inequities. Finally, causal loop diagrams developed using PSD methods have unique potential to convey complex concepts to policy makers and interventionists. This systematic review reports evidence for PSD's potential to advance equity in public health research and practice.
The Effectiveness of Using CO2 Fractional Laser and Mebo Burn Ointment Together in Treating Scars on the Face after Surgery
Authors: Zhang Jiaqi , Ge Jun , Chen Chen , Shi Fen , Wang Yongzhen , Zhang Jinming , Liang Weiqiang
Published: September 2023

Background:

This study aimed to investigate the efficacy and safety of CO2 fractional laser combined with Mebo burn ointment in treating facial postoperative scars.

Methods:

Sixty patients with facial postoperative scars in the department of plastic surgery of Sun Yat-sen Memorial Hospital from January 2020 to June 2022 were divided into a control group (30 cases) and a study group (30 cases). Both groups received CO2 fractional laser treatment, but the study group also received Mebo burn ointment application.

Results:

The study found that both methods resulted in a significant decrease in Sawada score and a significant increase in Investigator Global Assessment score after treatment (P < 0.05), with the study group showing a more significant improvement and higher patient satisfaction (P < 0.05). All patients experienced varying degrees of bleeding, swelling, and erythema immediately after treatment, with two cases of pigmentation and two cases of persistent erythema in the control group, and one case of pigmentation and one case of persistent erythema in the study group. Adverse reactions were minimal, with the study group showing better tolerance.

Conclusions:

The study suggests that CO2 fractional laser combined with Mebo burn ointment is an effective and safe treatment for facial postoperative scars.
Bioimpedance analysis predicts the etiology of cirrhosis in a prospective cohort study
Authors: El-Serag Hashem B. , Akhdar Ghida , Thrift Aaron P. , Luster Michelle , Khaderi Saira , Alsarraj Abeer , Duong Hao , Kanwal Fasiha
Published: September 2023

Background:

Obesity is associated with an increased risk of developing cirrhosis. However, body mass index (BMI) and waist-to-hip ratio (WHR) may not be indicative of body composition parameters that predispose to cirrhosis. Bioimpedance analysis (BIA) is a noninvasive cost-efficient method for more detailed estimation of body composition.

Methods:

We examined patients with cirrhosis who underwent BIA as part of enrollment into a prospective cohort study. We examined the correlation between BIA variables, BMI, and WHR. We performed sex-adjusted and race-adjusted and race-specific multivariable logistic regression analyses to examine the association between anthropometric variables and risk factors [NAFLD, alcohol-associated liver disease (ALD), and HCV].

Results:

We analyzed data from 348 cirrhosis patients; 23.3% were women; 48.3% were non-Hispanic White; 19.3% were Hispanic; and 30.7% were African American. The cirrhosis etiology was 21.8% NAFLD, 56.9% HCV mostly cured, and 11.5% ALD. Several BIA variables correlated well with BMI, and others showed modest correlations, but none correlated well with WHR. Higher body fat mass and basal metabolic rate were positively associated, while higher lean body mass, dry lean mass, total body water, or skeletal muscle mass were negatively associated with NAFLD. Associations between these BIA parameters and ALD-related cirrhosis were in the opposite direction. These associations of BIA variables were seen only in Hispanic and non-Hispanic White patients but not non-Hispanic Blacks. BIA variables were more predictive of cirrhosis etiology than BMI or WHR.

Conclusions:

Among patients with cirrhosis, several BIA-derived measurements indicative of body fat and muscle are associated with NAFLD and ALD etiology. BIA variables show stronger associations, as well as race/ethnicity-specific associations, with cirrhosis etiology than those of BMI or WHR.
Fetoplacental vascular effects of maternal adrenergic antihypertensive and cardioprotective medications in pregnancy
Authors: Tropea Teresa , Mavichak Weerawaroon , Evangelinos Angelos , Brennan-Richardson Charlotte , Cottrell Elizabeth C. , Myers Jenny E. , Johnstone Edward D. , Brownbill Paul
Published: September 2023

Maternal cardiovascular diseases, including hypertension and cardiac conditions, are associated with poor fetal outcomes. A range of adrenergic antihypertensive and cardioprotective medications are often prescribed to pregnant women to reduce major maternal complications during pregnancy. Although these treatments are not considered teratogenic, they may have detrimental effects on fetal growth and development, as they cross the fetoplacental barrier, and may contribute to placental vascular dysregulation. Medication risk assessment sheets do not include specific advice to clinicians and women regarding the safety of these therapies for use in pregnancy and the potential off-target effects of adrenergic medications on fetal growth have not been rigorously conducted. Little is known of their effects on the fetoplacental vasculature. There is also a dearth of knowledge on adrenergic receptor activation and signalling within the endothelium and vascular smooth muscle cells of the human placenta, a vital organ in the maintenance of adequate blood flow to satisfy fetal growth and development. The fetoplacental circulation, absent of sympathetic innervation, and unique in its reliance on endocrine, paracrine and autocrine influence in the regulation of vascular tone, appears vulnerable to dysregulation by adrenergic antihypertensive and cardioprotective medications compared with the adult peripheral circulation. This semi-systematic review focuses on fetoplacental vascular expression of adrenergic receptors, associated cell signalling mechanisms and predictive consequences of receptor activation/deactivation by antihypertensive and cardioprotective medications.
In-Hospital Receipt of Ivermectin Is Associated With No Benefit in Mortality, Disease Progression, or Length of Stay for Patients With Mild to Moderate COVID-19
Authors: Hasse Adam , Korwek Kimberly , Poland Russell E.
Published: September 2023

Background

Use of the antiparasitic agent ivermectin as a potential treatment for early coronavirus disease 2019 (COVID-19) is not recommended, yet inpatient administration continues to be seen.

Methods

This was a retrospective analysis of more than 100,000 patients admitted to a large health system of community hospitals for COVID-19 to assess the association of ivermectin administration, either early in disease course or at higher severity, with mortality and disease progression (intensive care unit admission or use of mechanical ventilation). Propensity match analysis was used to account for covariates.

Results

Of the 122,002 patients hospitalized with COVID-19 included in this analysis, 1.1% (1380) received ivermectin while at mild to moderate severity (on room air or nasal cannula), and 0.2% (n = 293) received the drug while severe (noninvasive or mechanical ventilation). Among those who received it with mild to moderate severity, there was no effect on relative risk (RR) of mortality (RR, 1.01; 95% confidence interval [CI], 0.802–1.27), intensive care unit admission (RR, 0.984; 95% CI, 0.865–1.12), or use of mechanical ventilation (RR, 0.976; 95% CI, 0.777–1.23), but an increase in average length of stay (mean days, 8.0 vs 7.5; P < 0.001). Of those who received their first dose of ivermectin with more severe COVID-19, there was an increase in the RR of mortality (RR, 1.63; 95% CI, 1.34–1.99; P < 0.001).

Conclusion

Among hospitalized patients admitted with mild to moderate COVID-19, in-hospital administration of ivermectin provides no benefit in mortality or disease progression when administered early in the disease course, and may contribute to excess mortality when administered to patients at more severe disease states.
Facial Palsy After Multisystem Inflammatory Syndrome in Children
Authors: Mandelia Yamini , Moravec Katherine , Bryant Kathleen Kinney , Dalzell William A.B.
Published: September 2023

COVID-19 pandemic has affected the pediatric and adult populations in different ways. Although adults experience more respiratory disease, pediatric population has been struck by multisystem inflammatory syndrome in children. There have been multiple case reports of Bell’s palsy associated with acute COVID-19 infection. We present the first known case of unilateral facial palsy after multisystem inflammatory syndrome in children in a pediatric patient.
Nurses' Attitudes Toward Patients Who Use Cannabis
Authors: McCall Darci , Rapoza Sarah , Liverman Wendi , Carter Jeremy
Published: September 2023

Background

Cannabis has been cited as the most frequently used drug in this country, and intolerance toward substance use is a recognized concern in nursing. The twofold purpose of this descriptive study was to determine (a) what, if any, were the differences between nurses' attitudes of patient cannabis use in states in which cannabis was legal versus illegal and (b) how do nurses working in diverse care settings differ in their attitudes regarding patient cannabis use.

Methods

A sample of 809 registered nurses from across the United States were recruited to take part in this study in October 2018. A previously validated 20-question survey was used to collect participants' perceptions of and attitudes toward patient cannabis use. Demographic information collected included age, gender, educational level, years in practice, primary area of practice, and legal status of cannabis in state of practice. An independent t test and analysis of variance were used to analyze group differences.

Findings

Findings from this study indicated that there was no significant difference in attitudes of nurses in states in which cannabis use was legal (M = 28.76, SD = 7.83) and states in which it was illegal (M = 29.43, SD = 7.65), t(807) = 1.202, p = .230. In addition, no significant differences were found in attitudes across six areas of practice, F(5) = 1.531, p = .178. Furthermore, nursing attitudes were largely positive toward patient cannabis use (M = 29.04, SD = 7.762; range: 20–100).

Conclusions

Findings from this study indicate that cannabis use may not carry the same perceived stigma as other illicit substances for nurses and unbiased care may be provided regardless of personal beliefs.
Interplay of Depression, Smoking Intention, and Smoking Behavior in Chinese Dai Adolescents
Authors: Zhao Xiang , Davey Gareth , Wan Xiangxing
Published: September 2023

Tobacco smoking and depression are important contributors to the burden of disease in China, and their onset typically occurs in adolescence. However, there is no consensus on the nature and underlying mechanisms of their interplay, and related studies on Chinese adolescents and ethnic minorities are limited. This study tested the mediation role of depression in the link between smoking intention and behavior in relation to sex. A secondary analysis was conducted on data from a survey of 1,322 Chinese Dai middle school students aged 15–19 years (M = 17.02 years; 773 female students and 542 male students) in Xishuangbanna, China. We found that the mediation role of depression between smoking intention and smoking behavior was nonsignificant, although smoking intention and depression both had significant associations with smoking behavior. Therefore, depression might be better theorized as an underlying predictor of smoking intention or that other volitional factors may link smoking intention and smoking behavior more closely. Nevertheless, depression was a significant independent variable for smoking behavior even when smoking intention was adjusted. Women perceived more depression than men with similar smoking intention levels, yet the relationship between smoking intention and smoking behavior was stronger in men. Although it seems that men were abler to translate their smoking intention into actual smoking, the high level of depression among young women who reported higher levels of smoking intention is noteworthy. Tobacco control for Chinese adolescents could incorporate sex-specific psychological therapies for negative emotions and for the internalization of problems by children.
Risk and Protective Factors for the Use of Illicit Drugs
Authors: Ventura Carla Aparecida Arena , Moll Marciana Fernandes , Zanardo Ana Beatriz Rizzo , Ferreira Paulo Sergio , Eugenio Samira Janis , de Ávila Domingos Stefany Guimarães
Published: September 2023

This article aimed to describe the perspective of people who make harmful use of illicit substances on the contributions of risk and protective factors to the development of problems related to drug use. One hundred eleven participants were recruited from a health service for drug users in a city in the interior of the state of São Paulo through posters with information, distribution of brochures, and snowball sampling technique. The sample consists of 51.9% men and 48.1% women, with 81.3% single and 10.3% married. Among them, 54.2% of participants completed high school, 64.1% were Catholic, and 34% rarely practiced their religion. The results on risk factors were classified into three domains, namely, “personal characteristics and behaviors,” “family circumstances,” and “other social pressures,” and those on protective factors were also classified into three domains, namely, “personal characteristics and behaviors,” “family circumstances,” and “circumstances in the community.” The data make it possible to guide the incorporation of multiple strategies to protect the consumption of illicit drugs in human biopsychosocial development, especially among children and adolescents.
Transcranial Direct Current Stimulation in Nicotine Use
Authors: Gwon Seok Hyun , Lee Han-Joo , Brian Ahn Hyochol
Published: September 2023

Tobacco use is a leading cause of cancer, cardiovascular and respiratory disease, and preventable death in the United States. The brains of individuals with nicotine dependence are characterized by damaged mesolimbic pathways in the medial portion of the limbic and frontal lobes, creating positive reinforcing mechanisms. Transcranial direct current stimulation (tDCS) targets this neuroadaptation to improve smokers' nicotine-related outcomes, such as craving and smoking behavior, by depolarizing or hyperpolarizing the neurons of the brain. Recent literature reported promising outcomes in smokers after tDCS treatment interventions. tDCS has great potential for clinical nursing research for tobacco control given its multiple methodological advantages and few disadvantages. Nurse researchers can consider individualized and home-based tDCS interventions for community-based tobacco control research and may need to consider objective outcome measures (e.g., cotinine in urine) and addiction-related cognitive variables (e.g., self-regulation). Users of electronic nicotine delivery systems also need to be considered as participants in tDCS interventions. Additional considerations for nursing research are discussed.
The Intersection of Nurses With Substance Use Disorder and Peer Support
Authors: Scholler Brooke , Waite-Labott Kristin , DeMark Misty
Published: September 2023

Support within the nursing community for those coping with substance misuse has been lacking for over a hundred years. A review of the history of substance use disorders in nursing reveals that nurses still encounter similar risks, stigma, and punishments today. Kristin, a nurse for over 30 years, tells her story of trials, tribulations, and triumphs with substance use. She shares how having to face early recovery on her own sparked the development of the Wisconsin Peer Alliance for Nurses (WisPAN). WisPAN offers a community for nurses in recovery to provide peer support to those taking their first steps on the journey toward recovery.
Multilineage differentiation potential in the infant adipose- and umbilical cord-derived mesenchymal stem cells
Authors: Huang Hui-Kuang , Hsueh Kuang-Kai , Liao Yu-Ting , Wu Szu-Hsien , Chou Po-Hsin , Yeh Shih-Han , Wang Jung-Pan
Published: September 2023

Background:

This study aims to compare the biological properties of infant adipose-derived mesenchymal stem cells (infant ADSCs) from excised polydactyly fat tissue and umbilical cord-derived mesenchymal stem cells (UCSCs) in terms of proliferation and differentiation capabilities. The proliferation of infant ADSCs and UCSCs was analyzed by determining the fold changes of cell numbers and doubling time periods.

Methods:

The state of senescence and replicative stress was compared by analyzing the expression of age-related genes, senescence-associated β-galactosidase (SA-β-gal) staining, and phosphorylated histone variant H2AX (γH2AX) immunofluorescence staining. The expression levels of superoxide dismutase (SODs) and genes related to multilineage differentiation were analyzed using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Differentiation levels were determined using histochemical staining, immunohistochemical staining, and immunofluorescence staining.

Results:

Infant ADSCs exhibited higher proliferation rates and expression levels of SOD1, SOD2, and SOD3 at passages 3–5 compared with UCSCs. Senescence related genes (p16, p21, and p53), SA-β-gal staining, and replicative stress analysis were reduced in infant ADSCs. The expression levels of chondrogenic genes (COL2 and COL10), osteogenic genes (RUNX2 and ALP), adipogenic genes (LPL), and hepatogenic genes (ALB and TAT) in infant ADSC-differentiated cells were significantly higher than those in UCSCs. Histochemical and immunofluorescence staining confirmed these results. Only the expression levels of tenogenic genes (MMP3, DCN, and COL3) in infant ADSC-differentiated cells were lower than those in UCSCs.

Conclusion:

Infant ADSCs exhibit higher proliferation rates, reduced cellular senescence and replicative stress, better antioxidative activity, and higher differentiation potential toward chondrogenic, osteogenic, adipogenic and hepatogenic lineages than UCSCs.
Approaches of laparoscopic anatomical liver resection of segment 8 for hepatocellular carcinoma: A retrospective cohort study of short-term results at multiple centers in China
Authors: Wang Xingru , Li Jianwei , Cao Jun , Zhang Qifan , Wei Yonggang , Cheng Wei , Liang Xiao , Tian Feng , Wang Xin , Xu Hongwei , Chen Jie , Zhou Ning , Yang Zaibo , Tao Changcheng , Wang Hongguang
Published: September 2023

Background:

Laparoscopic anatomical liver resection of segment 8 (LALR-S8) remains a challenge for anatomical laparoscopic segmentectomy. Most current reports on LALR-S8 are case series using one surgical approach, and there is a lack of multicenter data on identifying intersegmental planes using different approaches. In this study, we aimed to elucidate the short-term results of three different approaches for LALR-S8 for hepatocellular carcinoma (HCC), focusing on intersegmental plane determination, and to reflect on current practice regarding different approaches at multiple centers in China.

Materials and methods:

The clinical cohort data of 122 patients who underwent LALR-S8 for HCC at seven leading centers in China were retrospectively analyzed. The surgical procedures of all approaches were summarized and standardized according to the method of the Glissonean pedicle of segment 8 identification. The postoperative short-term outcomes and oncological results of the three approaches were evaluated and compared.

Results:

Three approaches were used: laparoscopic ultrasonography-guided indocyanine green (ICG) fluorescent positive staining approach (11/122, 9.02%), hepatic vein-guided approach (99/122, 81.15%), and Glissonean ICG fluorescent negative staining approach (12/122, 9.83%). Seven (5.73%) patients experienced complications according to the Clavien–Dindo (CD) classification, and the rate of grade ≥IIIa complications was 2.46%. The R0 resection rates among the groups (margin >1 mm) and the margin width showed no statistical difference.

Conclusion:

LALR-S8 is safe and feasible for treating HCC under standardized surgical techniques and appropriate surgical approaches. The three reported approaches had comparable short-term oncological outcomes, while the hepatic vein-guided approach was most commonly used.
Evolving nutritional needs, obesity, and overweight status in cystic fibrosis
Authors: Szentpetery Sylvia E.
Published: September 2023

Purpose of review

The nutritional landscape in cystic fibrosis has shifted dramatically in the era of CFTR modulator therapy. In this review, we will critically examine the literature on overweight and obesity in CF, current nutritional care unknowns and opportunities for further investigation or adaptation in clinical care.

Recent findings

Results of clinical trial and real-world data reflect marked improvement in nutritional status and quality of life. Clinical outcomes including CF related diabetes and CF related liver disease appear positively impacted. Secondary impacts on cardiometabolic disease have been noted, especially in association with excessive weight gain.

The prior approaches to optimizing nutrition in cystic fibrosis with caloric excess can likely be safely retired for many. As modulator access expands across the lifespan, a longitudinal focus on health maintenance should be considered.
Sensitivity and specificity of diagnostic modalities in pouchitis: a systematic review and meta-analysis
Authors: Nieto Luis Miguel , Iqbal Afia , Vinci Danilo , Sriranganathan Danujan , Pellino Gianluca , Segal Jonathan P.
Published: September 2023

Restorative proctocolectomy (RPC) is the most common surgical procedure to restore gastrointestinal continuity after surgical resection of the colon and rectum. Pouchitis is a common complication with several different modalities that can be used to aid diagnosis. This systematic review and meta-analysis aimed at exploring the sensitivity and specificity these diagnostic modalities. The medical literature was searched using MEDLINE, EMBASE and EMBASE classic and PubMed from 1978 to June 2022. We calculated descriptive statistics using sensitivity, specificity, and false-positive rate of the primary studies and also their positive and negative likelihood ratios, and their diagnostic odds ratios. The screen found 5477 records with 13 studies being included. Faecal lactoferrin was found to have the highest pooled sensitivity and specificity of 98% and 88% respectively with imaging modalities coming in second and faecal calprotectin third with pooled sensitivities and specificities of 87% and 79% and 74% and 81% respectively. Faecal biomarkers particularly lactoferrin and imaging modalities may have an important role to play in diagnosing pouchitis. Importantly due to delays in availability of pouchoscopy, our data supports early ordering of these tests to help delineate from other causes. Further studies are required with larger cohort sizes to further validate these tests.