bluuebunny/crossref_metadata_2025 huggingface dataset:
Mesenchymal Stem Cells-Derived Exosomes Alleviate Acute Lung Injury by Inhibiting Alveolar Macrophage Pyroptosis
Authors: Liu Peipei , Yang Shengnan , Shao Xuecheng , Li Chen , Wang Zai , Dai Huaping , Wang Chen
Published: February 2024

Acute lung injury (ALI) is an important pathological process of acute respiratory distress syndrome, yet there are limited therapies for its treatment. Mesenchymal stem cells-derived exosomes (MSCs-Exo) have been shown to be effective in suppressing inflammation. However, the effects of MSCs-Exo on ALI and the underlying mechanisms have not been well elucidated. Our data showed that MSCs-Exo, but not exosomes derived from MRC-5 cells (MRC-5-Exo), which are human fetal lung fibroblast cells, significantly improved chest imaging, histological observations, alveolocapillary membrane permeability, and reduced inflammatory response in ALI mice model. According to miRNA sequencing and proteomic analysis of MSCs-Exo and MRC-5-Exo, MSCs-Exo may inhibit pyroptosis by miRNAs targeting caspase-1-mediated pathway, and by proteins with immunoregulation functions. Taken together, our study demonstrated that MSCs-Exo were effective in treating ALI by inhibiting the pyroptosis of alveolar macrophages and reducing inflammation response. Its mechanism may be through pyroptosis-targeting miRNAs and immunoregulating proteins delivered by MSCs-Exo. Therefore, MSCs-Exo may be a new treatment option in the early stage of ALI.
A Comparison of Newer and Traditional Approaches to Diagnosing Vaginal Infections
Authors: Powell Anna , Goje Oluwatosin , Nyirjesy Paul
Published: February 2024

Molecular diagnostic testing (eg, polymerase chain reaction [PCR]–based vaginitis testing) is widely used in clinical practice, although vaginitis experts have reservations about its use for vaginitis diagnosis. As with any new technology, cost to the health system is a large concern. Although clinical evaluation of signs and symptoms along with wet mount microscopy is traditionally used for vaginitis diagnosis, it is less accurate compared with molecular diagnostic testing. Here we review the benefits of adopting newer molecular diagnostics into routine gynecologic practice with some guidance from vaginitis experts that favor both traditional and more modern approaches. We argue that instead of trying to resist the oncoming tide of molecular diagnostics, we can embrace them and put them to appropriate use to effect rapid, accurate, and more flexible diagnosis of vaginitis conditions for our patients.
Clinical and genetic determinants of vitamin D receptor expression in cutaneous melanoma patients
Authors: De Smedt Julie , Aura Claudia , Van Kelst Sofie , Janssen Laudine , Marasigan Vivien , Boecxstaens Veerle , Stas Marguerite , Bogaerts Kris , Belmans Ann , Cleynen Isabelle , Vanderschueren Dirk , Vandenberghe Katleen , Bechter Oliver , Nikkels Arjen , Strobbe Tinne , Emri Gabriella , Lambrechts Dieter , Garmyn Marjan
Published: February 2024

Decrease of vitamin D receptor (VDR) expression is observed in melanocytic naevi and melanoma compared to normal skin. Little is known about factors influencing VDR expression in cutaneous melanoma (CM). We investigated the correlation of VDR expression in CM with 25-hydroxy vitamin D (25OHD) levels, demographic/clinical parameters, genetic variants of VDR and pathology of the primary tumor. Demographic/clinical parameters were recorded in 407 prospectively recruited CM patients of a multi-center controlled study (ViDMe trial). We determined VDR expression both in the nucleus and in the cytoplasm by semi-quantitative assessment in CM tissue using histochemistry in 279 patients, expressed in percentages and histoscore (H-score). Genomic DNA from 332 patients was extracted to genotype thirteen VDR single nucleotide polymorphisms (SNPs) using TaqMan. VDR expression in CM tissue from 279 patients was correlated with clinical/demographic parameters and 25OHD levels (univariable and multivariable analysis), VDR SNPs (univariable analysis) and pathology parameters of primary CM tissue (univariable analysis). Cytoplasmic VDR expression was increased in patients who stated to have a high sun exposure during their life compared to patients with low sun exposure (pH-score,univariable: 0.001, pH-score,multivariable: 0.004). The A allele of the genetic VDR polymorphism Fok1 was associated with a higher expression of the VDR in the cytoplasm (pcytoplasmic, univariable: 0.001 and pH-score, univariable: 0.02) In the primary tumor, presence of mitosis (pnucleus,%, univariable: 0.002) and perineural invasion (pnucleus,%,univariable: 0.03) were significantly associated with low nuclear VDR expression. ClinicalTrials.gov Identifier: NCT01748448.
Novel Management of Ocular Surface Inflammation in Patients With Ocular Graft-Versus-Host Disease in the Setting of Cataract Surgery
Authors: Roca Daniela , Jain Sandeep , Mun Christine , Akbar Sarwar Monazzah , Shorter Ellen , Ortiz-Morales Gustavo , Tarib Imane , De La Cruz Jose
Published: February 2024

Purpose:

To report the outcomes of cataract surgery in patients with ocular graft-versus-host disease (oGVHD) using a novel preoperative immunomodulatory regimen in a collaborative subspecialty care setting.

Methods:

Retrospective case series of patients with oGVHD who underwent cataract surgery using a novel preoperative immunomodulatory regimen in a collaborative care setting. A preoperative regimen consisting of pooled human immune globulin 1%, autologous serum 50%, and methylprednisolone 1% eye drops was prescribed. Outcome measures included visual acuity (VA), ocular surface disease index (OSDI) score, lissamine green staining, and complications with a minimum of 2 years of follow-up.

Results:

Thirty-five eyes from 20 patients with oGVHD were studied. The mean age was 59 years (range 30–70 years). A healthy comparison group included 35 eyes from 24 patients with a mean age of 63 years (range 44–74 years). At the 2-year follow-up, the mean corneal staining score was 2.3/15, the mean OSDI score was 37.5, and the mean VA was 20/30 (logarithm of the minimal angle of resolution 0.17). The global complication rate was 2.8% at the last follow-up with no difference versus a healthy comparison group.

Conclusions:

A collaborative care model improving ocular surface health before cataract surgery with dry eye and cataract subspecialists can optimize outcomes in patients with oGVHD.
Melanoma Arising Beneath the Lateral Rectus Muscle in a Teenager With Ocular Melanocytosis: Possible Origin From Intrascleral Melanocytes
Authors: Chiou Carolina A. , Lin Lisa Y. , Stagner Anna M. , Lee Nahyoung Grace
Published: February 2024

Ocular melanocytosis is a well-established risk factor for choroidal melanomas but, despite its reported associations in the literature, it is infrequently discussed in relation to orbital melanomas. The authors describe a teenage patient with ocular melanocytosis who presented with an asymptomatic ipsilateral right orbital mass associated with the lateral rectus muscle. An exploratory orbitotomy revealed a lesion lightly adherent to the underlying sclera. Histopathology demonstrated a markedly atypical epithelioid melanocytic proliferation, bound by a thin rim of superficial sclera, implying an origin from intrascleral melanocytes, likely within an emissary canal. Next-generation sequencing identified GNAQ and NF1 mutations. The histopathology and molecular genetics designated the lesion as having a uveal melanoma-like profile, suggesting that it may behave as a choroidal melanoma. This case underscores the importance of the association between ocular melanocytosis and orbital melanoma and provides additional evidence for primary orbital melanoma etiopathogenesis.
Lower Functional Status and Sternal Precaution Noncompliance May Not Be Related to Dehiscence Post-Median Sternotomy
Authors: Shoemaker Michael J. , Van Dam Ashley , Erickson Katelyn , Gregory Jared , Ureste Gabrielle , Preston Katelyn , Griswold Amy
Published: February 2024

Introduction:

The purpose of this study was to examine the relationship between functional status, compliance with sternal precautions, and aseptic osseous postoperative incision complications.

Review of Literature:

Although there is limited research on upper extremity use and noncompliance with sternal precautions and sternal motion, there is a paucity of literature on functional status and noncompliance with sternal precautions and their effect on actual sternal complications, specifically aseptic osseous dehiscence.

Methods:

A retrospective medical record review was performed on 113 patients with an incisional complication following median sternotomy. Functional status was assessed using the AM-PAC “6-Clicks” Basic Mobility Short Form and initial gait distance. Compliance to sternal precautions was assessed using clinical documentation to determine the percentage of therapy sessions requiring cues. Propensity score matching was performed to select matched comparator records for those with aseptic osseous dehiscence. A descriptive, in-depth chart review was then performed to determine other possible clinical factors contributing to complication.

Results:

Eight of 113 patients had aseptic osseous dehiscence. Initial AM-PAC “6-Clicks” score (U = 4.375, P = .036), initial gait distance (U = 7.252, P = .007), and number of ventilator days (U = 2.790, P = .005) were significantly different in the aseptic osseous group compared to other complication types. However, the number of ventilator days was the only variable that remained significant (U = 52.5, P = .028) between those with aseptic osseous dehiscence and the 8 matched comparators. The in-depth chart review revealed that the aseptic osseous group had respiratory complications in 5 of 8 records as compared with 2 of 8 records in the comparator group.

Discussion and Conclusion:

The findings of this study suggest that confounding clinical factors besides functional status and compliance to sternal precautions could have contributed to aseptic osseous dehiscence following median sternotomy. Respiratory complications postoperatively may be a key confounding factor in aseptic osseous dehiscence. Therefore, the effect of functional status and noncompliance to traditional sternal precautions remains unclear.
Importance of age at 2nd implantation and interimplant interval to the outcome of bilateral prelingually deafened pediatric cochlear implantation
Authors: Chen Shih-Lung , Zhang Bang-Yan , Lee Yi-Chieh , Lin Chia-Chen , Sun Yu-Sheng , Chan Kai-Chieh , Wu Che-Ming
Published: February 2024

Background:

In Taiwan, the number of cases of sequential bilateral pediatric cochlear implantation (CI) is increasing but data regarding its effectiveness and impact of the reimbursement policy are lacking. We examined the speech perception and quality of life (QOL) of bilateral prelingually deaf children who underwent sequential CI, considering the effects of age at the time of second implantation and interimplant interval.

Methods:

We enrolled 124 Mandarin-speaking participants who underwent initial cochlear implant (CI1) in 2001-2019 and a second CI (CI2) in 2015-2020. Patients were followed up for ≥2 years and were categorized into groups based on age at the time of CI2 implantation (<3.5, 3.6-7, 7.1-10, 10.1-13, and 13.1-18 years) and interimplant interval (0.5-3, 3.1-5, 5.1-7, 7.1-10, and >10 years). We evaluated speech perception, device usage rates, and QOL using subjective questionnaires (Speech, Spatial, and Qualities of Hearing and Comprehension Cochlear Implant Questionnaire).

Results:

Speech perception scores of CI2 were negatively correlated with ages at the time of CI1 and CI2 implantation and interimplant interval. Older age and a longer interimplant interval were associated with higher nonuse rates for CI2 and worse auditory performance and QOL. Among individuals aged >13 years with interimplant intervals >10 years, up to 44% did not use their second ear. Patients aged 7.1 to 10 years had better speech perception and higher questionnaire scores than those aged 10.1 to 13 and 13.1 to 18 years. Furthermore, patients aged 10.1 to 13 years had a lower rate of continuous CI2 usage compared to those aged 7.1 to 10 years.

Conclusion:

Timely implantation of CI2 is essential to achieve optimal outcomes, particularly among sequentially implanted patients with long-term deafness in the second ear and no improvement with hearing aids following CI1 implantation. For CI2 implantation, an upper limit of age of 10 years and interimplant interval of 7 years are essential to prevent suboptimal outcomes. These data can provide useful information to implant recipients, their families, and medical and audiological professionals, enabling a comprehensive understanding of the benefits and potential impacts of the timing of CI2 implantation.
Systemic Occupational Health Needs of Gender-Based Violence Advocates
Authors: Haen Lisa Sophia , McGown Molly , Taylor Simone , Conroy Lorraine , Velonis Alisa
Published: February 2024

Objective

This study explores occupational health burdens faced by domestic and sexual violence advocates, many of which intensified during the COVID-19 pandemic. It identifies key stressors and offers advocate-driven recommendations to improve their wellbeing, addressing the lack of system-level interventions in the occupational health literature.

Methods

Semistructured interviews were conducted with 22 advocacy professionals. Thematic content analysis guided transcript coding, and researchers shared initial results with participants in two member checking sessions to validate the preliminary findings.

Results

Advocates experienced logistical, emotional, and systemic stressors, including loss of peer support and unempathetic workplace cultures. Recommendations prioritize advocate wellbeing and call for systemic changes.

Conclusions

Advocates’ occupational stressors highlight the need for system-level solutions to enhance their occupational wellbeing, particularly during large-scale emergencies. Collaborative efforts among employers, funders, and staff are essential to address system deficiencies.
Nonsurgical salvage options for locally recurrent prostate cancer after primary definitive radiotherapy: A systematic review and meta-analysis
Authors: Yang Jie , Xiong Xingyu , Liao Xinyang , Zheng Weitao , Xu Hang , Yang Lu , Wei Qiang
Published: February 2024

Objective:

To conduct a meta-analysis to provide the latest evidence of nonsurgical local salvage options in the first-line radiotherapy failure setting for localized prostate cancer patients.

Background:

Recurrence of localized prostate cancer after primary radiotherapy (RT) remains a clinical challenge. There is no consensus on optimal nonsurgical local salvage therapies, which mainly consist of cryotherapy (CRYO), high-intensity focused ultrasound (HIFU), high/low-dose-rate brachytherapy (HDR/LDR), and stereotactic body radiotherapy (SBRT).

Methods:

Our study was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. We systematically searched PubMed, Web of Science, Cochrane Library and ClinicalTrials.gov up to September 2023 to identify potentially relevant studies. The risk of bias was assessed using the European Association of Urology (EAU) items. Biochemical recurrence-free survival (bRFS) and genitourinary/gastrointestinal toxicities were the outcomes of interest. Pooled rates with 95% confidence intervals (CIs) were evaluated.

Results:

A total of 99 studies comprising 8440 patients were included. The pooled rate of 1-year biochemical control (BC) was highest for LDR (0.88, 95%CI 0.72-0.95) and lowest for SBRT (0.68, 95%CI 0.49-0.83). The pooled rate of 5-year BC was highest for CRYO (0.52, 95%CI 0.33-0.69) and lowest for HDR (0.23, 95%CI 0.08-0.51). HIFU presented the worst outcome of grade ≥3 genitourinary toxicities (GU3), with a rate of 0.22 (95%CI 0.12-0.3). Conversely, CRYO (0.09, 95%CI 0.04-0.14), HDR (0.05, 95%CI 0.02-0.07), LDR (0.10, 95%CI 0.06-0.14) and SBRT (0.06, 95%CI 0.03-0.09) presented low rates of GU3. All subgroups induced a quite low incidence of grade ≥3 gastrointestinal toxicities (GI3).

Conclusions:

Nonsurgical salvage therapies are promising modalities for prostate cancer in the local radiorecurrence setting. Based on the preliminary evidence from this study, CRYO and SBRT might present a relatively steady efficacy of BC with acceptable treatment-related toxicities.
Suitability of the MP1000 system for robot-assisted partial nephrectomy: A multicenter randomized controlled noninferiority trial
Authors: Gao Yu , Yang Yang , Niu Shaoxi , He Wang , Tao Jin , Guo Shengjie , Li Hongzhao , Ma Xin , Huang Jian , Ai Xing , Zhou Fangjian , Zhang Xuepei , Zhang Xu
Published: February 2024

Purpose:

This study aimed to compare the safety and effectiveness of the MP1000 surgical system with the da Vinci® Si robot system in robot-assisted partial nephrectomy (RAPN) through a prospective, single-blinded, randomized control trial.

Materials and Methods:

A total of 62 patients who were scheduled to undergo RAPN were randomly assigned to either the da Vinci® Si robot or MP1000 group. A noninferiority test was conducted with a non-inferior intermediate value of 10%. The study compared installation and operation times, estimated blood loss, warm ischemia time, postoperative surgical margin, rate of conversion to open surgery, eGFR level, complications, and other safety indicators between the two groups.

Results:

All procedures were successfully completed without the need for conversion to open or laparoscopic surgery, and no major complications were observed during the process. The test of noninferiority was achieved. There were no significant differences in median installation time, operation time, complication rate at 3 months, rate of positive surgical margin, and eGFR level at 3 months between the groups. Additionally, no evidence of recurrence was found on imaging in both groups. No difference in National Aeronautics and Space Administration task load index results for ergonomic considerations. A limitation of this study was its small sample size.

Conclusions:

The MP1000 system is a suitable platform for RAPN with safety and effectiveness comparable with da Vinci® Si system.
Concomitant tricuspid valve surgery in patients undergoing left ventricular assist device: a systematic review and meta-analysis
Authors: Luo Yuxiang , Leng Jiajie , Shi Rui , Jiang Yingjiu , Chen Dan , Wu Qingchen , Tie Hongtao
Published: February 2024

Introduction:

This study aims to investigate the effect of concomitant tricuspid valve surgery (TVS) during left ventricular assist device (LVAD) implantation due to the controversy over the clinical outcomes of concomitant TVS in patients undergoing LVAD.

Methods:

A systematic literature search was performed in PubMed and EMbase from the inception to Aug 1st, 2023. Studies comparing outcomes in adult patients undergoing concomitant TVS during LVAD implantation (TVS group) and those who did not (no-TVS group) were included. The primary outcomes were right heart failure (RHF), right ventricular assist device (RVAD) implantation and early mortality. All meta-analyses were performed using random-effects models, and a two-tailed P<0.05 was considered significant.

Results:

21 studies were included, and 16 of them were involved in the meta-analysis, with 660 patients in the TVS group and 1291 in the no-TVS group. Patients in the TVS group suffered from increased risks of RHF (risk ratios [RR]=1.31, 95% confidence interval [CI]: 1.01-1.70, P=0.04; I
2=38%, p

H
=0.13), RVAD implantation (RR=1.56, 95%CI: 1.16-2.11, P=0.003; I

2
=0%, p

H
=0.74), and early mortality (RR=1.61, 95%CI: 1.07-2.42, P=0.02; I

2
=0%, p

H
=0.75). Besides, the increased risk of RHF holds true in patients with moderate to severe tricuspid regurgitation (RR=1.36, 95%CI: 1.04-1.78, P=0.02). TVS was associated with a prolonged cardiopulmonary bypass time. No significant differences in acute kidney injury, re-operation requirement, hospital length of stay, or intensive care unit stay were observed.

Conclusions:

Concomitant TVS failed to show benefits in patients undergoing LVAD, and it was associated with increased risks of RHF, RVAD implantation, and early mortality.
Microvascular abnormalities induced by hand-transmitted vibration reflects in finger systolic blood pressure: a cross-sectional study in China
Authors: Yan Maosheng , Zheng Hanjun , Liu Qian , Xiao Bin , Wang Chengmin , Jia Yanxia , Pan Siyu
Published: February 2024

Objective

Local vibration can cause microcirculatory abnormalities such as blood stasis and symmetrical intermittent digital artery vasospasm. Finger SBP (FSBP) measurement is a potential way of assessing vascular components. This study aims to comprehensively investigate the relationship between the occurrence of the vibration-induced white finger (VWF) and changes in FSBP and then set the application value of FSBP measurements in the early diagnosis of VWF.

Methods

All samples were judgmental sampling from one factory. Totally 50 patients with VWF were the case group, while 50 without occupational hand-transmitted vibration exposure were the control group. FSBP measurements and epidemiological feature investigations were taken.

Results

There were significant reductions in FSBP level and %FSBP index at both 10 °C and 30 °C in fingers reported VWF (P < 0.05). The %FSBP abnormal rate of the index, ring and little finger in the VWF group was higher than the control (44.00% vs. 18.00%, 78.00% vs. 26.00%, 64.00% vs. 8.00%). The %FSBP of the ring and little finger had a relatively high application value (area under curve = 0.902, 0.737), while their standard regression coefficients were −0.23 and −0.412. The diagnostic cutoff value of the ring finger was 77.60%, while the sensitivity and specificity were 86.67%.

Conclusion

FSBP measurements were proven helpful in monitoring and diagnosing VWF prospectively and proved to have great application value in our study. %FSBP of the ring finger was the appropriate diagnostic index in FSBP measurements, while its abnormal value could be set as 80.00%.
Clinically significant macular edema in an underserved population: Association with demographic factors and hemoglobin A1c
Authors: Parimi Vamsi , Elsner Ann E. , Gast Thomas J. , Chen Zhongxue , Baskaran Karthikeyan , Alhamami Mastour A. , Litvin Taras V. , Ozawa Glen Y. , Cuadros Jorge A.
Published: February 2024

SIGNIFICANCE

Suspected clinically significant macular edema (SCSME) from exudates differed among ethnic groups in our underserved population. African American and Asian subjects had higher prevalence than Hispanics and non-Hispanic Caucasians, from the same clinics. Men had higher prevalence than women. Highly elevated blood glucose was frequent and associated with SCSME.

PURPOSE

We investigated the association between the presence of SCSME from exudates and hemoglobin A1c (HbA1c), as well as demographic factors such as age, sex, and ethnic group. Our population was underserved diabetic patients from the same geographic locations. Ethnic groups were White Hispanic, non-Hispanic Caucasian, African American, and Asian, with a high proportion of underrepresented minorities.

METHODS

In a diabetic retinopathy screening study at four community clinics in Alameda County, California, nonmydriatic 45° color fundus images were collected from underserved diabetic subjects following the EyePACS imaging protocol. Images were analyzed for SCSME from exudates by two certified graders. Logistic regression assessed the association between SCSME from exudates and age, sex, ethnic group, and HbA1c.

RESULTS

Of 1997 subjects, 147 (7.36%) had SCSME from exudates. The mean ± standard deviation age was 53.4 ± 10.5 years. The mean ± standard deviation HbA1c level was 8.26 ± 2.04. Logistic regression analysis indicated a significant association between presence of SCSME from exudates and HbA1c levels (p<0.001), sex (p=0.027), and ethnicity (p=0.030). African Americans (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.06 to 2.50; p=0.025) and Asians (OR, 1.63; 95% CI, 1.05 to 2.54; p=0.029) had a higher risk than Hispanics. After adjusting for ethnicity, sex, and age, the odds of developing SCSME from exudates increased by 26.5% with every 1% increase in HbA1c level (OR, 1.26; 95% CI, 1.18 to 1.36; p<0.001).

CONCLUSIONS

In our underserved population, many diabetic patients had very high HbA1c values. Ethnic background (African American > Asians > Hispanics), sex (male > female), and HbA1c level were strong indicators for identifying who is at increased risk of developing SCSME from exudates.
Brief Report: Mapping Colorectal Distribution of Cell-Free and Cell-Associated HIV Surrogates Following Simulated Anal Intercourse to Aid Rectal Microbicide Development
Authors: Weld Ethel D. , Ogasawara Ken , Fuchs Edward J. , Louissaint Nicolette , Caffo Brian , Hendrix Craig W.
Published: February 2024

Background:

Anal sex remains the greatest HIV transmission risk for men who have sex with men and carries substantial population attributable risk among women. Despite a growing array of HIV preexposure prophylaxis (PrEP) options, rectal microbicides remain desirable as on-demand, nonsystemic PrEP. Rectal microbicide product development for PrEP requires understanding the spatiotemporal distribution of HIV infectious elements in the rectosigmoid to optimize formulation development.

Setting:

Outpatient setting with healthy research participants.

Methods:

Six healthy men underwent simulated receptive anal sex with an artificial phallus fitted with a triple-lumen catheter in the urethral position. To simulate ejaculation of HIV-infected semen, autologous seminal plasma laden with autologous blood lymphocytes from apheresis labeled with 111Indium-oxine (cell-associated) and 99mTechnetium-sulfur colloid (cell-free) as HIV surrogates was injected into the rectal lumen through the phallic urethra. Spatiotemporal distribution of each radioisotope was assessed using single-photon emission computed tomography/CT over 8 hours. Analysis of radiolabel distribution used a flexible principal curve algorithm to quantitatively estimate rectal lumen distribution.

Results:

Cell-free and cell-associated HIV surrogates distributed to a maximal distance of 15 and 16 cm, respectively, from the anorectal junction (∼19 and ∼20 cm from the anal verge), with a maximal signal intensity located at 6 and 7 cm, respectively. There were no significant differences in any distribution parameters between cell-free and cell-associated HIV surrogates.

Conclusions:

Cell-free and cell-associated HIV surrogate distribution in the rectosigmoid can be quantified with spatiotemporal pharmacokinetic methods. These results describe the ideal luminal target distribution to guide rectal microbicide development.
Liver Biliary Function Evaluation on a 1.5T Magnetic Resonance Imaging Scan by T1 Reduction Rate Assessment Using Variable-Flip-Angle Sequences
Authors: Di Stasio Marco , Cordopatri Cesare , Nardi Cosimo , Busoni Simone , Noferini Linhsia , Colagrande Stefano , Calistri Linda
Published: February 2024

Objective

Magnetic resonance (MR) relaxometry is an absolute and reproducible quantitative method, compared with signal intensity for the evaluation of liver biliary function. This is obtainable by the T1 reduction rate (T1RR), as it carries a smaller systematic error than the pre/post contrast agent T1 measurement. We aimed to develop and test an MR T1 relaxometry tool tailored for the evaluation of liver T1RR after gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid administration on 1.5T MR.

Methods

In vitro/vivo (liver) T1RR values with two 3D FLASH variable-flip-angle sequences were calculated by a MATLAB algorithm. In vitro measurements were done by 2 physicists, in consensus. The prospective in vivo study was approved by the local ethical committee and performed on 13 normal/26 cirrhotic livers. A supplemental test in 5 normal/5 cirrhotic livers, out of the studied series, was done to compare the results of our method (without B1 inhomogeneity correction) and those of a standardized commercial tool (with B1 inhomogeneity correction). All in vivo evaluations were performed by 2 radiologists with 7 years of experience in abdominal imaging. Open-source Java-based software ImageJ was used to draw the free-hand regions of interest on liver section and for the measurement of hepatic T1RR values. The T1RR values of each group of patients were compared to assess statistically significant differences. All statistical analyses were performed with IBM-SPSS Statistics. In vivo evaluations, the intrareader and interreader reliability was assessed by intraclass correlation coefficient.

Results

Our method showed good accuracy in evaluating in vitro T1RR with a maximum percentage error of 9% (constant at various time points) with T1 values in the 200- to 1400-millisecond range. In vivo, a high concordance between the T1RR evaluated with the proposed method and that calculated from the standardized commercial software was verified (P < 0.05). The median T1RRs were 74.8, 67.9, and 52.1 for the normal liver, Child-Pugh A, and Child-Pugh B cirrhotic groups, respectively. A very good agreement was found, both within intrareader and interreader reliability, with intraclass correlation coefficient values ranging from 0.88 to 0.95 and from 0.85 to 0.90, respectively.

Conclusions

The proposed method allowed accurate reliable in vitro/vivo T1RR assessment evaluation of the liver biliary function after gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid administration.
Optimizing High-Resolution MR Angiography: The Synergistic Effects of 3D Wheel Sampling and Deep Learning–Based Reconstruction
Authors: Sasaki Goh , Uetani Hiroyuki , Nakaura Takeshi , Nakahara Keiichi , Morita Kosuke , Nagayama Yasunori , Kidoh Masafumi , Iwashita Koya , Yoshida Naofumi , Hokamura Masamichi , Yamashita Yuichi , Nakajima Makoto , Ueda Mitsuharu , Hirai Toshinori
Published: February 2024

Objective

The aim of this study was to assess the utility of the combined use of 3D wheel sampling and deep learning–based reconstruction (DLR) for intracranial high-resolution (HR)–time-of-flight (TOF)–magnetic resonance angiography (MRA) at 3 T.

Methods

This prospective study enrolled 20 patients who underwent head MRI at 3 T, including TOF-MRA. We used 3D wheel sampling called “fast 3D” and DLR for HR-TOF-MRA (spatial resolution, 0.39 × 0.59 × 0.5 mm3) in addition to conventional MRA (spatial resolution, 0.39 × 0.89 × 1 mm3). We compared contrast and contrast-to-noise ratio between the blood vessels (basilar artery and anterior cerebral artery) and brain parenchyma, full width at half maximum in the P3 segment of the posterior cerebral artery among 3 protocols. Two board-certified radiologists evaluated noise, contrast, sharpness, artifact, and overall image quality of 3 protocols.

Results

The contrast and contrast-to-noise ratio of fast 3D-HR-MRA with DLR are comparable or higher than those of conventional MRA and fast 3D-HR-MRA without DLR. The full width at half maximum was significantly lower in fast 3D-MRA with and without DLR than in conventional MRA (P = 0.006, P < 0.001). In qualitative evaluation, fast 3D-MRA with DLR had significantly higher sharpness and overall image quality than conventional MRA and fast 3D-MRA without DLR (sharpness: P = 0.021, P = 0.001; overall image quality: P = 0.029, P < 0.001).

Conclusions

The combination of 3D wheel sampling and DLR can improve visualization of arteries in intracranial TOF-MRA.
Neuroendocrine Tumor Presented With Axillary Mass
Authors: Sicilia Pozo María de las Nieves , López-Bermejo García Fernando , Ruiz Disotuar Niletys , Alarcón Molero Lorena , Poblete García Víctor Manuel
Published: February 2024

A 79-year-old man presented with a palpable left axillary mass and ultrasonography findings of conglomerate lymph nodes. The initial clinical suspicion was a lymphoproliferative disorder, but histopathological results revealed a grade 3 neuroendocrine tumor. The mass showed somatostatin receptor overexpression in 99mTc-HYNIC-TOC scintigraphy and high uptake in 18F-FDG PET/CT. Bilateral hypermetabolic adrenal nodes suggestive of metastases were also detected. The patient was treated with chemotherapy and immunotherapy, and PET/CT scan showed a partial metabolic response after 4 cycles. According to this case, neuroendocrine tumor should be considered in the differential diagnosis of axillary masses.
Oroantral Communication After Segmental Le Fort I Osteotomy
Authors: Conceição Brito Gabriel , Henrique Ferreira Lima Luciano , Tadeu Sverzut Alexander
Published: February 2024

Segmental Le Fort I osteotomy is a very versatile technique for correcting mainly transverse discrepancies of the maxilla. However, there are possibilities of intraoperative and intraoperative complications. This article reports a case of oral-antral communication after maxillary segmentation with intraoperative identification and correction using the rotation of the palatal flap. The surgeon needs to know such possible complications when performing the technique to identify and correct them promptly to avoid further sequelae to the patient.
Hepatitis B virus infection during pregnancy and the risk of postpartum hemorrhage: a protocol for systematic review and meta-analysis
Authors: Zou Kang , Chen Jingwen , Guo Jin , Wei Wanqiang , Liao Mingyu , Cai Qixin , Xiong Yiquan
Published: February 2024

Background:

Hepatitis B virus (HBV) infection is a significant public health issue worldwide, with a hepatitis B surface antigen (HBsAg) seroprevalence of 3.5%. Maternal HBV infection during pregnancy, a common comorbidity, is associated with an increase in the risk of adverse obstetric and perinatal outcomes. However, the relationship between maternal HBV infection and postpartum hemorrhage (PPH), a leading contributor to maternal morbidity and mortality, is currently uncertain. The aim of this study is to comprehensively clarify the potential impact of maternal HBV on PPH risk.

Methods and Analysis:

The authors initially searched five English databases and three Chinese databases from their inception to 26th June 2023. Two reviewers will independently conduct study selection, data extraction, and quality assessment. Cohort and case–control studies investigating the effect of maternal HBV infection on PPH will be included, with study quality assessed using the Newcastle–Ottawa Scale (NOS). Meta-analyses will be performed using a fixed-effects model for I
2≤50% or a random-effects model otherwise. Several categories of subgroup analyses (e.g. sample size more than 1000 vs. less than 1000) and sensitivity analyses (e.g. omit NOS scores less than 7) will be conducted, and publication bias will be assessed through funnel plots, Begg’s and Egger’s tests using STATA 18.0.

Ethics and Dissemination:

This systematic review and meta-analysis do not require ethics approval and the results will be published in peer-reviewed journals. The findings of this systematic review will provide evidence on the impact of maternal HBV infection on PPH, which will contribute to better prevention and management of PPH in clinical practice and a better understanding of the disease burden of HBV infection.

PROSPERO registration number:

CRD42023442626
Beneath the surface: a case report on nonencapsulated Streptococcus pneumoniae-associated invasive disease in an immunocompromised patient
Authors: Zintgraff Jonathan , Sanchez Eluchans Nahuel , Gagetti Paula , Martinez Celeste , Pedersen Dina , Moscoloni María , Lewis Adrian , Lara Claudia , Corso Alejandra
Published: February 2024

Background.

Streptococcus pneumoniae

, a prominent human pathogen linked to various systemic diseases, includes non-typeable pneumococci marked by the absence of a detectable capsule. However, the majority of invasive infections are attributed to encapsulated strains. This case report details the first documented instance of invasive disease caused by non-typeable

S. pneumoniae

in Argentina since 2017.

Case Presentation. A 19-year-old woman presented with haemorrhagic injuries attributed to chronic oral mucosa irritation. Subsequent hospitalization revealed bone marrow aplasia, leading to antibiotic, antifungal, antiviral, and immunosuppressive treatments, culminating in her discharge. Two weeks later, she was readmitted with sepsis related to a respiratory focus, exhibiting a negative COVID-PCR test. After ten days, ICU admission revealed additional infections: positive COVID-PCR test, fungal sinusitis, and

S. pneumoniae

bacteremia. Targeted treatments led to improvement, and the patient was subsequently discharged.

S. pneumoniae

characterization. Verification of the capsule’s absence utilized traditional methods such as the Quellung reaction, transmission electron microscopy, molecular assays, and Whole Genome Sequencing (WGS). The isolate, identified as ST18335, displayed genetic features and antibiotic resistance patterns, concordant between WGS and the agar dilution method. It demonstrated non-susceptibility to penicillin and cefotaxime, based on meningitis breakpoints, as well as meropenem and cotrimoxazole.

Conclusion. This case underscores the clinical significance of non-typeable

S. pneumoniae

, emphasizing the necessity for a comprehensive approach to identification and characterization. The findings contribute to ongoing discussions regarding the challenges posed by non-typeable strains in vaccine development, understanding clinical impacts, and addressing antibiotic resistance. As the pneumococcal epidemiological landscape evolves, this case serves as a valuable addition to the evolving knowledge surrounding non-typeable

S. pneumoniae

, highlighting the continued need for surveillance and research in infectious diseases.
Peritoneal Tuberculosis, an underestimated diagnosis: A case report
Authors: Laamara Leila , Benaissa Elmostafa , Achemlal Amine , Bounakhla Amal , Bssaibis Fatna , Ben Lahlou Yassine , Maleb Adil , Chadli Mariama , Elouennass Mostafa
Published: February 2024

Tuberculosis is an infectious disease that most often affects the lungs, it is of human-to-human transmission caused by Mycobacterium tuberculosis. 
Peritoneal tuberculosis is an extra-pulmonary form of the disease that usually manifests as an ascitic syndrome, with or without fever, in a context of altered general condition, often in endemic areas. The diagnosis of peritoneal tuberculosis is not always easy, as the clinical signs are often insidious and unspecific. 
We report a case of peritoneal tuberculosis in an 18-year-old young female, who had presented for 10 days with a progressive increase in abdominal volume associated with vomiting and diarrhea.
Neura: a specialized large language model solution in neurology
Authors: Barrit Sami , Torcida Nathan , Mazeraud Aurélien , Boulogne Sébastien , Benoit Jeanne , Carette Timothée , Carron Thibault , Delsaut Bertil , Diab Eva , Kermorvant Hugo , Maarouf Adil , Slootjes Sofia Maldonado , Redon Sylvain , Robin Alexis , Hadidane Sofiène , Harlay Vincent , Tota Vito , Madec Tanguy , Niset Alexandre , El Hadwe Salim , Massager Nicolas , Lagarde Stanislas , Carron Romain
Published: February 2024

Large language models’ (LLM) ability in natural language processing holds promise for diverse applications, yet their deployment in fields such as neurology faces domain-specific challenges. Hence, we introduce Neura: a scalable, explainable solution to specialize LLM. Blindly evaluated on a select set of five complex clinical cases compared to a cohort of 13 neurologists, Neura achieved normalized scores of 86.17% overall, 85% for differential diagnoses, and 88.24% for final diagnoses (55.11%, 46.15%, and 70.93% for neurologists) with rapid response times of 28.8 and 19 seconds (9 minutes and 37.2 seconds and 8 minutes and 51 seconds for neurologists) while consistently providing relevant, accurately cited information. These findings support the emerging role of LLM-driven applications to articulate human-acquired and integrated data with a vast corpus of knowledge, augmenting human experiential reasoning for clinical and research purposes.
Short and long-term prognosis after tissue negative transient ischemic attack
Authors: Purroy Francisco , Gallego Yhovany , Gil-Villar M Pilar , Begue Robert , Arque Gloria , Quilez Alejandro , Sanahuja Jordi , Vazquez-Justes Daniel , Mauri Gerard
Published: February 2024

Background

Recently, there has been a proposal to retire the concept of transient ischemic attack (TIA) because, in all likelihood, patients experiencing brief episodes of transient brain ischemia without associated cerebral lesions might be exceedingly rare or carry no risk of stroke recurrence (SR). However, only a few observational studies have evaluated the risk of SR exclusively among tissue-negative TIA patients. Our aim was to assess the early and long-term prognosis of consecutive tissue-negative TIA patients attended at an emergency department

Methods

We carried out a prospective cohort study of consecutive TIA patients with tissue negative TIA from January 2006 to June 2010. All patients underwent diffusion-weighted imaging on MRI (DWI) (4.0 [SD 1.8] days) after the index event. The risk and predictors of SR were determined at 1 year and after a median follow-up time of 6.6 (interquartile range, 5.0-9.6) years.

Results

A total of 370 patients were included. Previously, 244 patients with positive DWI results and 109 patients without MRI performed were excluded. ABCD2 score>5 was determined in 95 (26.2%) patients. 15 (4.1%) patients suffered SR at 1 year and 18 (4.9%) beyond 1 year. Predictive models for short-term and long-term prognosis were different. Large artery atherosclerosis etiology (Hazard ratio [HR] 3.7 [1.2-11.0]) was the only predictor of 1 year SR. In contrast, male sex (HR 4.17 [95% CI 1.14-15.23]; P=0.031), speech impairment (HR 4.90 [95% CI 1.05-22.93]; P=0.044), and presence of chronic microangiopathy expressed as Fazekas score of 3 (HR 1.84 [95% CI 1.15-2.97]; P=0.012) were predictors of long-term SR follow-up.

Conclusion

The risk of SR after tissue negative TIA is not insignificant. Predictors of short and long-term prognosis are different. Sex, clinical characteristics at onset, etiology and chronic microangiopathy determine the risk of SR.
Validation of “Days Alive and out of Hospital” as an Outcome Measure After Coronary Artery Bypass Graft Surgery, Acute Coronary Syndrome and Heart Failure Hospitalisation
Authors: Grant Robert , Liao Weiqi , Miksza Joanne , Roman Marius , Murphy Gavin
Published: February 2024

Background and Rationale

‘Days alive and out of hospital’ (DAOH) is a composite outcome measure that integrates several outcomes, including death, hospital length-of-stay, and hospital readmission. The minimum clinical important difference (MCID) in DAOH and its relation to clinically important long-term outcomes has not yet been studied for patients admitted to hospital for coronary artery bypass graft surgery (CABG), acute coronary syndrome (ACS), or heart failure (HF). We propose to determine whether differences in DAOH in common use as a MCID in clinical trials will be associated with significant differences in clinically important outcomes.

Methods and Analysis

This is a retrospective observational cohort study in three separate cohorts of adult (≥18 years) patients admitted to National Health Service (NHS) hospitals in England for: i) ACS ii) CABG iii) HF. Patients will be identified through Hospital Episode Statistics (HES) Admitted Patient Care (APC) data from 01/01/2009 – 31/12/2015 and followed up to 5 years after the index admission date.

Adjusted and unadjusted multivariable fractional polynomial Cox regression models will be used to estimate HRs for primary outcomes, according to pre-specified differences in DAOH.

Ethics and Dissemination

This is a sub study of the observational cohort study ‘In Silico Trials of Surgical Interventions - Using Routinely Collected Data to Model Trial Feasibility and Design Efficiency In Vivo Randomised Controlled Trials’ -ClinicalTrials.govIdentifier:NCT05853536. Ethical approval has been obtained from University of Leicester Research Ethics Committee (22322-yll15-ls:cardiovascularsciences). Findings from this study will be disseminated through peer-reviewed scientific publications and research conferences.
Inequalities in oral health: Estimating the longitudinal economic burden of dental caries by deprivation status in six countries
Authors: Dunleavy Gerard , Verma Neeladri , Raghupathy Radha , Jain Shivangi , Hofmeister Joao , Cook Rob , Vujicic Marko , Kebschull Moritz , Chapple Iain , West Nicola , Pitts Nigel
Published: February 2024

Background

The recent World Health Organization (WHO) resolution on oral health urges pivoting to a preventive approach and integration of oral health into the non-communicable diseases agenda. This study aimed to: 1) explore the healthcare costs of managing dental caries between the ages of 12 and 65 years across socioeconomic groups in six countries (Brazil, France, Germany, Indonesia, Italy, UK), and 2) estimate the potential reduction in direct costs from non-targeted and targeted oral health-promoting interventions.

Methods

A cohort simulation model was developed to estimate direct costs of over time for different socioeconomic groups. National-level DMFT (dentine threshold) data, the relative likelihood of receiving an intervention (such as a restorative procedure, tooth extraction and replacement), and clinically-guided assumptions were used to populate the model. A hypothetical group of upstream and downstream preventive interventions were applied either uniformly across all deprivation groups to reduce caries progression rates by 30% or in a levelled-up fashion with the greatest gains seen in the most deprived group.

Results

The population level direct costs of caries from 12 to 65 years of age varied between US10.2bn in Italy to US$36.2bn in Brazil. The highest per-person costs were in the UK at US$22,910 and the lowest in Indonesia at US$7,414. The per-person direct costs were highest in the most deprived group across Brazil, France, Italy and the UK. With the uniform application of preventive measures across all deprivation groups, the greatest reduction in per-person costs for caries management was seen in the most deprived group across all countries except Indonesia. With a levelling-up approach, cost reductions in the most deprived group ranged from US$3,948 in Indonesia to US$17,728 in the UK.

Conclusion

Our exploratory analysis shows the disproportionate economic burden of caries in the most deprived groups and highlights the significant opportunity to reduce direct costs via levelling-up preventive measures. The healthcare burden stems from a higher baseline caries experience and greater annual progression rates in the most deprived. Therefore, preventive measures should be primarily aimed at reducing early childhood caries, but also applied across all ages.