bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicted leukocyte telomere length and risk of myeloid neoplasms
Authors: Sullivan Shannon M , Cole Ben , Lane John , Meredith John J , Langer Erica , Hooten Anthony J , Roesler Michelle , McGraw Kathy L , Pankratz Nathan , Poynter Jenny N
Published: August 2023

Maintenance of telomere length has long been established to play a role in the biology of cancer and several studies suggest that it may be especially important in myeloid malignancies. To overcome potential bias in confounding and reverse causation of observational studies, we use both a polygenic risk score (PRS) and inverse-variance weighted (IVW) Mendelian randomization (MR) analyses to estimate the relationship between genetically predicted leukocyte telomere length (LTL) and acute myeloid leukemia (AML) risk in 498 cases and 2099 controls and myelodysplastic syndrome (MDS) risk in 610 cases and 1759 controls. Genetic instruments derived from four recent studies explaining 1.23–4.57% of telomere variability were considered. We used multivariable logistic regression to estimate odds ratios (OR, 95% confidence intervals [CI]) as the measure of association between individual single-nucleotide polymorphisms and myeloid malignancies. We observed a significant association between a PRS of longer predicted LTL and AML using three genetic instruments (OR = 4.03 per ~1200 base pair [bp] increase in LTL, 95% CI: 1.65, 9.85 using Codd et al. [Codd, V., Nelson, C.P., Albrecht, E., Mangino, M., Deelen, J., Buxton, J.L., Hottenga, J.J., Fischer, K., Esko, T., Surakka, I. et al. (2013) Identification of seven loci affecting mean telomere length and their association with disease. Nat. Genet., 45, 422–427 427e421–422.], OR = 3.48 per one-standard deviation increase in LTL, 95% CI: 1.74, 6.97 using Li et al. [Li, C., Stoma, S., Lotta, L.A., Warner, S., Albrecht, E., Allione, A., Arp, P.P., Broer, L., Buxton, J.L., Alves, A.D.S.C. et al. (2020) Genome-wide association analysis in humans links nucleotide metabolism to leukocyte telomere length. Am. J. Hum. Genet., 106, 389–404.] and OR = 2.59 per 1000 bp increase in LTL, 95% CI: 1.03, 6.52 using Taub et al. [Taub, M.A., Conomos, M.P., Keener, R., Iyer, K.R., Weinstock, J.S., Yanek, L.R., Lane, J., Miller-Fleming, T.W., Brody, J.A., Raffield, L.M. et al. (2022) Genetic determinants of telomere length from 109,122 ancestrally diverse whole-genome sequences in TOPMed. Cell Genom., 2.] genetic instruments). MR analyses further indicated an association between LTL and AML risk (PIVW ≤ 0.049) but not MDS (all PIVW ≥ 0.076). Findings suggest variation in genes relevant to telomere function and maintenance may be important in the etiology of AML but not MDS.
PpARF6 acts as an integrator of auxin and ethylene signaling to promote fruit ripening in peach
Authors: Chen Xiaomei , Liu Yudi , Zhang Xian , Zheng Beibei , Han Yuepeng , Zhang Ruo-Xi
Published: August 2023

Although auxin is known to induce ethylene biosynthesis in some Rosaceae fruit crops, the mechanisms underlying the auxin–ethylene interaction during fruit ripening remain largely unknown. Here, the regulatory role of an auxin response factor, PpARF6, in fruit ripening was investigated in peach. Peach fruits showed accelerated ripening after treatment with auxin and PpARF6 was found to be significantly induced. PpARF6 not only could induce ethylene synthesis by directly activating the transcription of ethylene biosynthetic genes, but also competed with EIN3-binding F-box proteins PpEBF1/2 for binding to ethylene-insensitive3-like proteins PpEIL2/3, thereby keeping PpEIL2/3 active. Moreover, PpARF6 showed an interaction with PpEIL2/3 to enhance the PpEIL2/3-activated transcription of ethylene biosynthetic genes. Additionally, ectopic overexpression of PpARF6 in tomato accelerated fruit ripening by promoting the expression of genes involved in ethylene synthesis and fruit texture. In summary, our results revealed a positive regulatory role of PpARF6 in peach fruit ripening via integrating auxin and ethylene signaling.
Predictors of Severity of Influenza-Related Hospitalizations: Results From the Global Influenza Hospital Surveillance Network (GIHSN)
Authors: Cohen Lily E , Hansen Chelsea L , Andrew Melissa K , McNeil Shelly A , Vanhems Philippe , Kyncl Jan , Domingo Javier Díez , Zhang Tao , Dbaibo Ghassan , Laguna-Torres Victor Alberto , Draganescu Anca , Baumeister Elsa , Gomez Doris , Raboni Sonia M , Giamberardino Heloisa I G , Nunes Marta C , Burtseva Elena , Sominina Anna , Medić Snežana , Coulibaly Daouda , Salah Afif Ben , Otieno Nancy A , Koul Parvaiz A , Unal Serhat , Tanriover Mine Durusu , Mazur Marie , Bresee Joseph , Viboud Cecile , Chaves Sandra S
Published: August 2023

Background

The Global Influenza Hospital Surveillance Network (GIHSN) has since 2012 provided patient-level data on severe influenza-like-illnesses from >100 participating clinical sites worldwide based on a core protocol and consistent case definitions.

Methods

We used multivariable logistic regression to assess the risk of intensive care unit admission, mechanical ventilation, and in-hospital death among hospitalized patients with influenza and explored the role of patient-level covariates and country income level.

Results

The data set included 73 121 patients hospitalized with respiratory illness in 22 countries, including 15 660 with laboratory-confirmed influenza. After adjusting for patient-level covariates we found a 7-fold increase in the risk of influenza-related intensive care unit admission in lower middle-income countries (LMICs), compared with high-income countries (P = .01). The risk of mechanical ventilation and in-hospital death also increased by 4-fold in LMICs, though these differences were not statistically significant. We also find that influenza mortality increased significantly with older age and number of comorbid conditions. Across all severity outcomes studied and after controlling for patient characteristics, infection with influenza A/H1N1pdm09 was more severe than with A/H3N2.

Conclusions

Our study provides new information on influenza severity in underresourced populations, particularly those in LMICs.
Antibacterial effect of seven days exposure to ceftolozane-tazobactam as monotherapy and in combination with fosfomycin or tobramycin against Pseudomonas aeruginosa with ceftolozane-tazobactam MICs at or above 4 mg/l in an in vitro pharmacokinetic model
Authors: Attwood Marie , Griffin Pippa , Noel Alan R , Albur Maha , Macgowan Alasdair P
Published: August 2023

Objectives

To use a pre-clinical pharmacokinetic infection model to assess the antibacterial effect of ceftolozane/tazobactam alone or in combination with fosfomycin or tobramycin against Pseudomonas aeruginosa strains with MICs at or higher than the clinical breakpoint (MIC ≥ 4 mg/L).

Methods

An in vitro model was used to assess changes in bacterial load and population profiles after exposure to mean human serum concentrations of ceftolozane/tazobactam associated with doses of 2 g/1 g q8h, fosfomycin concentrations associated with doses of 8 g q8h or tobramycin at doses of 7 mg/kg q24 h over 168 h.

Results

Simulations of ceftolozane/tazobactam at 2 g/1 g q8h alone produced 3.5–4.5 log reductions in count by 6 h post drug exposure for strains with MIC ≤32 mg/L. The antibacterial effect over the first 24 h was related to ceftolozane/tazobactam MIC. There was subsequent regrowth with most strains to bacterial densities of >106 CFU/mL. Addition of either fosfomycin or tobramycin resulted in suppression of regrowth and in the case of tobramycin more rapid initial bacterial killing up to 6 h. These effects could not be related to either fosfomycin or tobramycin MICs. Changes in population profiles were noted with ceftolozane/tazobactam alone often after 96 h exposure but such changes were suppressed by fosfomycin and almost abolished by the addition of tobramycin.

Conclusions

The addition of either fosfomycin or tobramycin to ceftolozane/tazobactam at simulated human clinically observed concentrations reduced P. aeruginosa bacterial loads and the risk of resistance to ceftolozane/tazobactam when strains had ceftolozane/tazobactam MIC values at or above the clinical breakpoint.
Exploring the views of infection consultants in England on a novel delinked funding model for antimicrobials: the SMASH study
Authors: Baltas Ioannis , Gilchrist Mark , Koutoumanou Eirini , Gibani Malick M , Meiring James E , Otu Akaninyene , Hettle David , Thompson Ameeka , Price James R , Crepet Anna , Atomode Abolaji , Crocker-Buque Timothy , Spinos Dimitrios , Guyver Hudson , Tausan Matija , Somasunderam Donald , Thoburn Maxwell , Chan Cathleen , Umpleby Helen , Sharp Bethany , Chivers Callum , Vaghela Devan Suresh , Shah Ronak J , Foster Jonathan , Hume Amy , Smith Christopher , Asif Ammara , Mermerelis Dimitrios , Reza Mohammad Abbas , Haigh Dominic A , Lamb Thomas , Karatzia Loucia , Bramley Alexandra , Kadam Nikhil , Kavallieros Konstantinos , Garcia-Arias Veronica , Democratis Jane , Waddington Claire S , Moore Luke S P , Aiken Alexander M
Published: August 2023

Objectives

A novel ‘subscription-type’ funding model was launched in England in July 2022 for ceftazidime/avibactam and cefiderocol. We explored the views of infection consultants on important aspects of the delinked antimicrobial funding model.

Methods

An online survey was sent to all infection consultants in NHS acute hospitals in England.

Results

The response rate was 31.2% (235/753). Most consultants agreed the model is a welcome development (69.8%, 164/235), will improve treatment of drug-resistant infections (68.5%, 161/235) and will stimulate research and development of new antimicrobials (57.9%, 136/235). Consultants disagreed that the model would lead to reduced carbapenem use and reported increased use of cefiderocol post-implementation. The presence of an antimicrobial pharmacy team, requirement for preauthorization by infection specialists, antimicrobial stewardship ward rounds and education of infection specialists were considered the most effective antimicrobial stewardship interventions. Under the new model, 42.1% (99/235) of consultants would use these antimicrobials empirically, if risk factors for antimicrobial resistance were present (previous infection, colonization, treatment failure with carbapenems, ward outbreak, recent admission to a high-prevalence setting).

Significantly higher insurance and diversity values were given to model antimicrobials compared with established treatments for carbapenem-resistant infections, while meropenem recorded the highest enablement value. Use of both ‘subscription-type’ model drugs for a wide range of infection sites was reported. Respondents prioritized ceftazidime/avibactam for infections by bacteria producing OXA-48 and KPC and cefiderocol for those producing MBLs and infections with Stenotrophomonas maltophilia, Acinetobacter spp. and Burkholderia cepacia.

Conclusions

The ‘subscription-type’ model was viewed favourably by infection consultants in England.
Multi-head de-noising autoencoder-based multi-task model for fault diagnosis of rolling element bearings under various speed conditions
Authors: Park Jongmin , Yoo Jinoh , Kim Taehyung , Ha Jong Moon , Youn Byeng D
Published: August 2023

Fault diagnosis of rolling element bearings (REBs), one type of essential mechanical element, has been actively researched; recent research has focused on the use of deep-learning-based approaches. However, conventional deep-learning-based fault-diagnosis approaches are vulnerable to various operating speeds, which greatly affect the vibration characteristics of the system studied. To solve this problem, previous deep-learning-based studies have usually been carried out by increasing the complexity of the model or diversifying the task of the model. Still, limitations remain because the reason of increasing complexity is unclear and the roles of multiple tasks are not well-defined. Therefore, this study proposes a multi-head de-noising autoencoder-based multi-task model for robust diagnosis of REBs under various speed conditions. The proposed model employs a multi-head de-noising autoencoder and multi-task learning strategy to robustly extract features under various speed conditions, while effectively disentangling the speed- and fault-related information. In this research, we evaluate the proposed method using the signals measured from bearing experiments under various speed conditions. The results of the evaluation study show that the proposed method outperformed conventional methods, especially when the training and test datasets have large discrepancies in their operating conditions.
Can TV make you a better stats communicator?
Authors: Stoudt Sara
Published: August 2023

Sara Stoudt explains how to glean presentation tips from the small screen and win over even the most statistics-anxious audience
Trihelix transcription factor SlGT31 regulates fruit ripening mediated by ethylene in tomato
Authors: Fu Mengjie , Li Fenfen , Zhou Shengen , Guo Pengyu , Chen Yanan , Xie Qiaoli , Chen Guoping , Hu Zongli
Published: August 2023

Trihelix proteins are plant-specific transcription factors that are classified as GT factors due to their binding specificity for GT elements, and they play crucial roles in development and stress responses. However, their involvement in fruit ripening and transcriptional regulatory mechanisms remains largely unclear. In this study, we cloned SlGT31, encoding a trihelix protein in tomato (Solanum lycopersicum), and determined that its relative expression was significantly induced by the application of exogenous ethylene whereas it was repressed by the ethylene-inhibitor 1-methylcyclopropene. Suppression of SlGT31 expression resulted in delayed fruit ripening, decreased accumulation of total carotenoids, and reduced ethylene content, together with inhibition of expression of genes related to ethylene and fruit ripening. Conversely, SlGT31-overexpression lines showed opposite results. Yeast one-hybrid and dual-luciferase assays indicated that SlGT31 can bind to the promoters of two key ethylene-biosynthesis genes, ACO1 and ACS4. Taken together, our results indicate that SlGT31 might act as a positive modulator during fruit ripening.
“We’re tough, but so is quitting.” Barriers to Smoking Cessation: The Royal Malaysian Navy Perspective
Authors: Hashim Muhamad Arham bin , Ismail Ikmal Hisham bin , Md Sabri Budi Aslinie binti
Published: August 2023

Introduction

Tobacco kills half of its users. Despite this, there are over 1.1 billion smokers worldwide. Its harmful effects impair performance and readiness. Unfortunately, smoking has deeply ingrained in the military culture, as evidenced by the high prevalence. Hence, this study aims to identify the barriers to smoking cessation among this population.

Methods

A study involving two groups of current smokers (commissioned officers and non-commissioned officers) was conducted using the modified nominal group technique (mNGT), a qualitative research method of judgmental decision-making involving four phases: Generating ideas, recording, evaluation, and prioritization. The mNGT was used to solicit respondents’ barriers to smoking cessation.

Results

The mNGT yielded seven main barriers to smoking cessation: (1) Addiction, (2) difficulty in staying focused without the usage of cigarettes, (3) smoking has been incorporated into an individual’s lifestyle, (4) environmental influence, (5) coping mechanism, (6) the long-interval period between orders and duties exacerbates the desire to smoke, and (7) smoking has evolved into a permanent habit. Although nicotine addiction and habit were ranked as the most important barriers, the military working environment and nature of the job exposed them physically and mentally to unfavorable situations, complicating the quitting attempt. Furthermore, the acceptance of smoking in military culture leads to a positive smoker identity, further hindering cessation.

Conclusions

The findings indicate that in addition to barriers affecting the general population, military-specific barriers related to the nature of the job exist, complicating cessation. Hence, any intervention program should address these barriers to achieve positive outcomes.
Cigarette Smoking Among Veterans at High Risk for Suicide: Challenges and Opportunities for Intervention
Authors: Herbst Ellen , Hoggatt Katherine J , McCaslin Shannon
Published: August 2023

Preventing suicide remains a top clinical priority of the Department of Veterans Affairs (VA). In 2019, U.S. military veterans experienced a suicide rate of 52.3% higher than non-Veteran U.S. adults. Cigarette smoking has been found to be independently associated with an elevated risk of suicidal ideation, attempts, plans, and deaths among veterans and non-veterans. However, tobacco use is frequently overlooked in suicide risk assessment and mitigation and is not yet a target for intervention in VA suicide prevention protocols. In this commentary, we recommend that cigarette smoking be considered in suicide risk assessment protocols and that tobacco cessation interventions be considered as a potential beneficial treatment intervention to reduce the risk of suicide. Given the public health threat of suicide among veterans, it is essential to elucidate promising areas of intervention for those at high risk of suicide. Cigarette smoking is a modifiable target, associated with suicide risk, for which there are evidence-based interventions. Therefore, tobacco use disorder identification and treatment should be considered for inclusion in VA suicide risk protocols.
Discovery of the shell structure via break radii in the outer halo of the Milky Way
Authors: Ye Dashuang , Du Cuihua , Shi Jianrong , Ma Jun
Published: August 2023

Based on the Gaia DR3 RR Lyrae catalogue, we use two methods to fit the density profiles with an improved broken power law, and find that there are two break radii coinciding with the two apocentre pile-ups of high-eccentricity Gaia-Sausage-Enceladus (GSE) merger. Also, there is a break caused by the Sagittarius (Sgr) stream. Combining the positions of all breaks, we briefly analyse the metallicity and its dispersion as a function of r as well as its distribution in cylindrical coordinates. For the clean sample, the z−x ellipsoid axial ratio q in $36\, {\rm kpc}\, \lt \, r\, \lt \, 96\, {\rm kpc}$ becomes much smaller than that of the inner halo $(r\, \lt \, 36\, {\rm kpc})$, while the major axis has a large uncertainty in the region of $36-66\, {\rm kpc}$ and the one in the region of $66-96\, {\rm kpc}$ is obviously different from that dominated by the Hercules–Aquila Cloud (HAC) and the Virgo Overdensity (VOD) in the inner halo, which indicates that there is an over-density structure distributed at low-zenithal angles. Finally, we found that the over-density structure in the outer halo ($r\, \gt \, 50\, {\rm kpc}$) is shell-shaped and relatively metal-rich compared to the outer background halo. We conclude that the shells could be the apocentre pile-ups of the high-eccentricity GSE merger, which is supported by previous numerical simulations.
Mortality After Nocardiosis: Risk Factors and Evaluation of Disseminated Infection
Authors: Yetmar Zachary A , Khodadadi Ryan B , Chesdachai Supavit , McHugh Jack W , Challener Douglas W , Wengenack Nancy L , Bosch Wendelyn , Seville Maria Teresa , Beam Elena
Published: August 2023

Background

Nocardia primarily infects patients who are immunocompromised or those with chronic lung disease. Although disseminated infection is widely recognized as an important prognostic factor, studies have been mixed on its impact on outcomes of nocardiosis.

Methods

We performed a retrospective cohort study of adults with culture-confirmed nocardiosis. Advanced infection was defined as disseminated infection, cavitary pulmonary infection, or pleural infection. The primary outcome was 1-year mortality, as analyzed by multivariable Cox regression.

Results

Of 511 patients with culture growth of Nocardia, 374 (73.2%) who had clinical infection were included. The most common infection sites were pulmonary (82.6%), skin (17.9%), and central nervous system (14.2%). In total, 117 (31.3%) patients had advanced infection, including 74 (19.8%) with disseminated infection, 50 (13.4%) with cavitary infection, and 18 (4.8%) with pleural infection. Fifty-nine (15.8%) patients died within 1 year. In multivariable models, disseminated infection was not associated with mortality (hazard ratio, 1.16; 95% CI, .62–2.16; P = .650) while advanced infection was (hazard ratio, 2.48; 95% CI, 1.37–4.49; P = .003). N. farcinica, higher Charlson Comorbidity Index, and culture-confirmed pleural infection were also associated with mortality. Immunocompromised status and combination therapy were not associated with mortality.

Conclusions

Advanced infection, rather than dissemination alone, predicted worse 1-year mortality after nocardiosis. N. farcinica was associated with mortality, even after adjusting for extent of infection. While patients who were immunocompromised had high rates of disseminated and advanced infection, immunocompromised status did not predict mortality after adjustment. Future studies should account for high-risk characteristics and specific infection sites rather than dissemination alone.
E-cigarette attitudes and behaviours amongst 15-30-year-olds in the UK
Authors: Pinho-Gomes Ana-Catarina , Santos Joseph A , Jones Alexandra , Thout Sudhir Raj , Pettigrew Simone
Published: August 2023

Background

The use of e-cigarettes has been rising in the UK, particularly by young people. This study investigated behaviours, attitudes and beliefs about e-cigarettes amongst 15–30-year-olds in the UK.

Methods

An online survey was administered to a sample of 1009 15–30-year-olds in the UK.

Results

About one in five participants currently used e-cigarettes at least monthly, with 1 in 10 using them daily. Amongst those using e-cigarettes at least monthly, 90% had used e-cigarettes containing nicotine. E-cigarettes were mainly obtained from vape shops and used at home. Having friends who used e-cigarettes and using them to help quit/reduce smoking were the most common reasons for vaping. About half of participants had been exposed to e-cigarette advertising, especially online, and warning labels on e-cigarettes. Most participants agreed that e-cigarettes are addictive (75%), help people quitting smoking (64%) and are bad for health (63%). Previous or current tobacco smokers were 9 and 22 times more likely to use e-cigarettes than never smokers, respectively. Perceiving e-cigarettes as harmful was associated with a 40% lower likelihood of use.

Conclusion

Raising awareness on the uncertain long-term consequences of vaping and regulation of marketing and sales are crucial to protect young people in the UK.
Trend and distribution analysis of occupational radiation exposure among medical practices in Chongqing, China (2008–2020)
Authors: Zhou Jinghua , Li Wei , Deng Jun , Li Kui , Jin Jing , Zhang Huadong
Published: August 2023

The personal dose levels of medical radiation workers in Chongqing from 2008 to 2020 were investigated and analysed. The results showed that a total of 68 379 people were monitored from 2008 to 2020. The number of radiation workers increased year by year, and the number of female radiation workers increased rapidly. The monitoring data were analysed by Mann–Whitney test, Mann-Kendall test and Bonferroni method. The annual mean effective dose from 2008 to 2020 showed a decreasing trend (P < 0.0001). At the 5% significance level, six occupational categories showed a significant decreasing trend (P < 0.0001).The average annual effective dose for medical radiation workers in Chongqing in 2020 was 0.4482 mSv and 94.73% of radiation workers received annual doses less than the public dose limit (1 mSv). Personal dose monitoring results for most radiation workers were low. The protection of radiation workers in interventional radiology and nuclear medicine should be concerned.
The Relevance of Animal Models of Social Isolation and Social Motivation for Understanding Schizophrenia: Review and Future Directions
Authors: Powell Susan B , Swerdlow Neal R
Published: August 2023

Background and Hypotheses

Social dysfunction in schizophrenia includes symptoms of withdrawal and deficits in social skills, social cognition, and social motivation. Based on the course of illness, with social withdrawal occurring prior to psychosis onset, it is likely that the severity of social withdrawal/isolation contributes to schizophrenia neuropathology.

Study Design

We review the current literature on social isolation in rodent models and provide a conceptual framework for its relationship to social withdrawal and neural circuit dysfunction in schizophrenia. We next review preclinical tasks of social behavior used in schizophrenia-relevant models and discuss strengths and limitations of existing approaches. Lastly, we consider new effort-based tasks of social motivation and their potential for translational studies in schizophrenia.

Study Results

Social isolation rearing in rats produces profound differences in behavior, pharmacologic sensitivity, and neurochemistry compared to socially reared rats. Rodent models relevant to schizophrenia exhibit deficits in social behavior as measured by social interaction and social preference tests. Newer tasks of effort-based social motivation are being developed in rodents to better model social motivation deficits in neuropsychiatric disorders.

Conclusions

While experimenter-imposed social isolation provides a viable experimental model for understanding some biological mechanisms linking social dysfunction to clinical and neural pathology in schizophrenia, it bypasses critical antecedents to social isolation in schizophrenia, notably deficits in social reward and social motivation. Recent efforts at modeling social motivation using effort-based tasks in rodents have the potential to quantify these antecedents, identify models (eg, developmental, genetic) that produce deficits, and advance pharmacological treatments for social motivation.
Increasing Cultural Awareness in the Advanced Nursing Practice Program Through Active Learning
Authors: Franco-Tantuico Monina , Pajaro Annie
Published: August 2023

As student cultural diversity increases in higher education, educators must implement bias-free evaluations and active learning activities. The objective structured clinical examination (OSCE), an active learning strategy where simulated patients role-play specific clinical scenarios, can be part of the advanced nursing practice (ANP) educational program for either formative or summative competencies evaluation. This article describes active learning and theatrical techniques used in a grant-funded workshop to increase cultural awareness among ANP students, nurse educators, and simulated patients. The participants’ increased understanding of their potential biases can create a psychologically safe and bias-free OSCE for culturally diverse students.
The Prognostic Significance of the Depth of Cervical Stromal Invasion in Women With FIGO Stage II Uterine Endometrioid Carcinoma
Authors: Al Khatib Sondos , Bhatnagar Aseem , Elshaikh Noor , Ghanem Ahmed I , Burmeister Charlotte , Allo Ghassan , Alkamachi Bassam , Paridon Alex , Elshaikh Mohamed A.
Published: August 2023

Objective:

The objective of this study was to investigate the prognostic significance of the depth of cervical stromal invasion (CSI) in women with FIGO stage II uterine endometrioid adenocarcinoma (EC).

Methods:

Our database of women with EC was quired for patients with stage II EC. Pathologic slides were retrieved and reviewed by gynecologic pathologists to determine cervical stromal thickness and depth of CSI as a percentage of stromal thickness (%CSI). Kaplan-Meier, univariate, and multivariate analyses were used to compare recurrence-free, disease-specific (DSS), and overall survival (OS) between women who had<50% versus ≥50% CSI. Univariate and multivariate analyses were used to assess other prognostic variables associated with survival endpoints.

Results:

A total of 117 patients were included in our study who had hysterectomy between 1/1990 and 8/2021. Seventy-nine patients (68%) with <50% and 38 (32w%) with ≥50% CSI. After a median follow-up of 131 months, 5-year DSS was significantly worse for women with ≥50% CSI (78% vs. 91%; P=0.04). However, %CSI was not an independent predictor for any of the studied survival endpoints. Independent predictors of worse 5-year recurrence-free survival and DSS included FIGO grade 3 tumors (P=0.02) and the presence of lymphovascular space invasion (P=0.03). Grade 3 tumors were the only independent predictor of worse 5-year OS (P=0.02).

Conclusions:

Our results suggest that deep CSI is not an independent prognostic factor for survival endpoints in women with stage II uterine endometroid adenocarcinoma. The lack of independent prognostic significance of the depth CSI needs to be validated in a multi-institutional analysis.
Effect Measure Modification by Covariates in Mediation: Extending Regression-based Causal Mediation Analysis
Authors: Li Yi , Mathur Maya B. , Solomon Daniel H. , Ridker Paul M. , Glynn Robert J. , Yoshida Kazuki
Published: August 2023

Existing methods for regression-based mediation analysis assume that the exposure-mediator effect, exposure-outcome effect, and mediator-outcome effect are constant across levels of the baseline characteristics of patients. However, investigators often have insight into how these underlying effects may be modified by baseline characteristics and are interested in how the resulting mediation effects, such as the natural direct effect (NDE), the natural indirect effect. (NIE), and the proportion mediated, are modified by these baseline characteristics. Motivated by an empirical example of anti-interleukin-1 therapy’s benefit on incident anemia reduction and its mediation by an early change in an inflammatory biomarker, we extended the closed-form regression-based causal mediation analysis with effect measure modification (EMM). Using a simulated numerical example, we demonstrated that naive analysis without considering EMM can give biased estimates of NDE and NIE and visually illustrated how baseline characteristics affect the presence and magnitude of EMM of NDE and NIE. We then applied the extended method to the empirical example informed by pathophysiologic insights into potential EMM by age, diabetes, and baseline inflammation. We found that the proportion modified through the early post-treatment inflammatory biomarker was greater for younger, nondiabetic patients with lower baseline level of inflammation, suggesting differential usefulness of the early post-treatment inflammatory biomarker in monitoring patients depending on baseline characteristics. To facilitate the adoption of EMM considerations in causal mediation analysis by the wider clinical and epidemiologic research communities, we developed a free- and open-source R package, regmedint.
Outcomes of Negative Pressure Wound Therapy on Immediate Breast Reconstruction after Mastectomy
Authors: Akhter Haris M. , Macdonald Collin , McCarthy Philip , Huang Ye , Meyer Bria R. , Shostrum Valerie K. , Cromer Kerry J. , Johnson Perry J. , Wong Shannon L. , Hon Heidi H.
Published: August 2023

Background:

Immediate expander/implant-based breast reconstruction after mastectomy has become more sought after by patients. Although many patients choose this technique due to good aesthetic outcomes, lack of donor site morbidity, and shorter procedure times, it is not without complications. The most reported complications include seroma, infection, hematoma, mastectomy flap necrosis, wound dehiscence, and implant exposure, with an overall complication rate as high as 45%. Closed incision negative pressure therapy (ciNPT) has shown value in wound healing and reducing complications; however, the current literature is inconclusive. We aimed to examine if ciNPT improves outcomes for patients receiving this implant-based reconstruction.

Methods:

This is a retrospective single-institution study evaluating the ciNPT device, 3M Prevena Restor BellaForm, on breast reconstruction patients. The study was performed between July 1, 2019 and October 30, 2020, with 125 patients (232 breasts). Seventy-seven patients (142 breasts) did not receive the ciNPT dressing, and 48 patients (90 breasts) received the ciNPT dressing. Primary outcomes were categorized by major or minor complications. Age, BMI, and final drain removal were summarized using medians and quartiles, and were compared with nonparametric Mann-Whitney test. Categorical variables were compared using chi-square or Fisher exact test.

Results:

There was a statistically significant reduction in major complications in the ciNPT group versus the standard dressing group (P = 0.0247). Drain removal time was higher in the ciNPT group.

Conclusion:

Our study shows that ciNPT may help reduce major complication rates in implant-based breast reconstruction patients.
Association of biopsy core number and location with pain in patients undergoing a transperineal prostate biopsy under local anaesthesia: A secondary analysis of the APROPOS trial
Authors: He Bi-Ming , Yang Qi-Wei , Shi Zhen-Kai , Ji Tang-Rao , Wang Shuai-Dong , Zhou Hai , Jin Zhi-Chao , Yan Zhi-Chao , Zhang Jia-Jun , Wang Hai-Feng
Published: August 2023

Background:

APROPOS was a multicentre, randomized, blinded trial focus on investigating the perineal nerve block versus the periprostatic block in pain control for men undergoing a transperineal prostate biopsy. In the analysis reported here, we aimed to evaluate the association of biopsy core count and location with pain outcomes in patients undergoing a transperineal prostate biopsy under local anaesthesia.

Methods:

APROPOS was performed at 6 medical centres in China. Patients with suspected prostate cancer were randomized to receive either a perineal nerve block or a periprostatic block (1:1), followed by a transperineal prostate biopsy. The secondary analysis outcomes were the worst pain experienced during the prostate biopsy and post-biopsy pain at 1,6 and 24 hours.

Results:

Between August 12, 2020, and July 20, 2022, a total of 192 patients were randomized in the original trial, and 188 were involved in this analysis, with 94 patients per group. Participants had a median (IQR) age of 68 (63-72) and a median (IQR) prostate volume of 42.51 (30.04-62.84). The patient population had a median (IQR) number of biopsy cores of15 (12-17.50), and 26.06% of patients had a biopsy cores count of more than 15. After adjusting tthe baseline characteristics, the number of biopsy cores was associated with the worst pain during the biopsy procedure in both the perineal nerve block group (Beta 0.19, 95% CI 0.12-0.26, P<0.001) and the periprostatic block group (beta 0.16, 95% CI 0.07-0.24, P<0.001). A similar association was also evident for the post-biopsy pain at 1, 6 and 24 hours. A lesser degree of pain in both groups at any time (r range −0.57 to −0.01 for both groups) was associated with biopsy cores from the peripheral zone of the middle gland, while other locations were associated with a higher degree of pain. In addition, the location of the biopsy core had less of an effect on pain during the biopsy (r range −0.01 to 0.25 for both groups) than it did on postbiopsy pain (r range −0.57 to 0.60 for both groups).

Conclusions:

In this secondary analysis of a randomized trial, biopsy core count and location were associated with pain in patients undergoing a transperineal prostate biopsy under local anaesthesia. These results may be helpful for making clinical decisions about the anaesthetic approach forscheduled transperineal prostate biopsies.
Single-incision robotic assisted surgery: a non-randomized cohort pilot study on a novel surgical platform in colorectal surgery
Authors: Guo Zichao , Shi Yiqing , Song Zijia , Jia Wenqing , Wang Shaodong , Zhang Yaqi , Ji Xiaopin , Liu Kun , Zhang Tao , Cheng Xi , Zhao Ren
Published: August 2023

Background:

The technological barriers and steep learning curve of single-incision laparoscopic surgery had kept it from further applications. Literature review had reported that robotic technology could preserve its advantages while simplifying its difficulties. This non-randomized cohort pilot study aims to evaluate the feasibility and safety of single-incision robotic assisted colorectal surgery based on a novel robotic surgical platform, the SHURUI Endoscopic Surgical Robotic System (SR-ENS-600).

Method:

This study enrolled 7 patients with colorectal malignancy who underwent single-incision robotic assisted surgery (SIRAS) at a tertiary general surgery center, and retrospectively included 23 patients who underwent robotic assisted surgery (RAS) from September 2015 to June 2016 and 35 patients who underwent single-incision laparoscopic surgery (SILS) from June 2017 to March 2018, which were labelled as the initial in-learning-curve attempts from the same surgical team. Technological feasibility and safety of SIRAS were evaluated. Perioperative outcomes, short-term postoperative outcomes, clinicopathologic outcomes and follow-up were reported.

Results:

Six SIRAS operations were completed successfully without eventful intraoperative complications, except one operation encountered a large volume of intraoperative hemorrhage. Two SIRAS cases were converted to multiport laparoscopic surgery because of intraoperative hemorrhage and difficulty in retraction. Postoperative pathology reported satisfactory specimen qualities. There was no short-term postoperative complication, no short-term mortality, no tumor recurrence or metastasis reported. There was 1 incisional hernia reported half a year after operation. Patients with advanced staging were sent to standard evaluation and chemotherapy, and follow-up is still on-going.

Conclusions:

SIRAS can be feasibly performed by skilled surgical team via SR-ENS-600 platform for strictly-selected patients, which provides preferable instrument maneuverability and stability in confined surgical fields and overcomes the technical difficulty of multisite dissection through a single incision. Large-volume investigations and high-level evidences are required to further validate its safety and superiority.
Long-term health-related quality of life in patients with gastric cancer after total or distal gastrectomy: A propensity score-matched cohort study
Authors: Yu Jianhong , Wang Zaozao , Yang Hong , Zhang Chenghai , Xing Jiadi , Cui Ming , Liu Hui , Wu Yu , Su Xiangqian
Published: August 2023

Background:

Surgical resection remains the cornerstone of treatment for locally advanced gastric cancer (LAGC) and is accompanied by potential deterioration in patients’ health-related quality of life (HRQOL). As an important indicator of the psychosocial burden, HRQOL has become an essential endpoint to evaluate the efficacy and impact of cancer treatment. We examined longitudinal changes in HRQOL among patients with LAGC receiving total gastrectomy (TG) or distal gastrectomy (DG) over time.

Materials and methods:

The patients in this study were from a prospective observational study (NCT) conducted during 2018–2022. We used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 and the stomach module questionnaire to evaluate HRQOL at baseline and at postoperative months 1, 3, 6, and 12. We used linear mixed models to analyze longitudinal changes in HRQOL between groups and correlations with follow-up time.

Results:

A total of 219 patients were included. After propensity score matching, 186 patients were ultimately analyzed. Compared with the DG group, patients in the TG group reported significantly poorer global health status, physical functioning, and role functioning and more severe fatigue, insomnia, appetite loss, pain, and financial problems. Gastric-specific symptoms, dysphagia, chest and abdominal pain, reflux, restricted eating, and anxiety were more common and severe in the TG group. Most scales showed deterioration at months 1 and 3 after surgery, with gradual recovery thereafter, except the scales for global health status, pain, chest and abdominal pain, and reflux, which improved continually compared with baseline. TG was associated with worsening in ≥ six HRQOL domains for each measure after baseline, compared with DG.

Conclusions:

In contrast with DG, TG had an adverse impact on postoperative HRQOL scales in patients with LAGC. Different HRQOL scales had various recovery trajectories after surgery. Effects of the gastrectomy scope on patients’ HRQOL should be considered together with sound oncology principles.
Evaluation of the Listening Environment of Bilateral Cochlear Implant Users through Data Logging: A Comparison of Bilateral Simultaneous and Sequential Implantation
Authors: Yoshida Tadao , Hara Daisuke , Kobayashi Masumi , Sugimoto Satofumi , Fukunaga Yukari , Sone Michihiko
Published: August 2023

Objective

To evaluate the listening conditions of bilateral cochlear implant (CI) users in their daily living environment.

Study Design

Retrospective study.

Setting

University hospital.

Patients

Thirty-one adult CI users 16 years or older; 18 underwent sequential surgery, and 13 underwent simultaneous surgery. Inclusion criteria included the availability of CI data logging features and a minimum duration of binaural use of 6 months.

Intervention

Retrospective analysis of data obtained from the automatic scene classifier data logging system.

Main Outcome Measure

Comparison of data logging and maximum speech discrimination scores of the two surgery groups (sequential vs. simultaneous) to investigate the potential influence of these factors on the listening conditions of CI users.

Results

The maximum speech discrimination score of the second CI in the sequential group was significantly worse than that of any other CI in the sequential and simultaneous CI groups. Additionally, the longer the interval between surgeries, the more significant the difference in “time on air” between the first and the second CIs. The second CI in sequential CI surgery had a shorter “time on air” than the first or the bilateral simultaneous CIs; the second CI was also used more frequently in noisy and speech with background noise environments.

Conclusions

A second CI may be more frequently used in challenging listening environments because of its binaural auditory effect, despite its lower speech discrimination performance. The timing of sequential implantation and the potential impact of binaural hearing should be considered when developing rehabilitation strategies for individuals with bilateral CIs.
MEESSI-AHF score to estimate short-term prognosis of acute heart failure patients in the Emergency Department: a prospective and multicenter study
Authors: Oberlin Mathieu , Buis Guillaume , Alamé Karine , Martinez Mikaël , Bitard Marie Paule , Berard Lise , Losset Xavier , Balen Frederic , Lehodey Bruno , Taheri Omide , Delannoy Quentin , Kepka Sabrina , Tran Duc-Minh , Bilbault Pascal , Godet Julien , Le Borgne Pierrick
Published: August 2023

Background

The assessment of acute heart failure (AHF) prognosis is primordial in emergency setting. Although AHF management is exhaustively codified using mortality predictors, there is currently no recommended scoring system for assessing prognosis. The European Society of Cardiology (ESC) recommends a comprehensive assessment of global AHF prognosis, considering in-hospital mortality, early rehospitalization rates and the length of hospital stay.

Objective

We aimed to prospectively evaluate the performance of the Multiple Estimation of risk based on the Emergency department Spanish Score In patients with AHF (MEESSI-AHF) score in estimating short prognosis according to the ESC guidelines.

Design, settings and patients

A multicenter study was conducted between November 2020, and June 2021. Adult patients who presented to eleven French hospitals for AHF were prospectively included.

Outcome measures and analysis

According to MEESSI-AHF score, patients were stratified in four categories corresponding to mortality risk: low-, intermediate-, high- and very high-risk groups. The primary outcome was the number of days alive and out of the hospital during the 30-day period following admission to the Emergency Department (ED).

Results

In total, 390 patients were included. The number of days alive and out of the hospital decreased significatively with increasing MEESSI-AHF risk groups, ranging from 21.2 days (20.3–22.3 days) for the low-risk, 20 days (19.3–20.5 days) for intermediate risk,18.6 days (17.6–19.6 days) for the high-risk and 17.9 days (16.9–18.9 days) very high-risk category.

Conclusion

Among patients admitted to ED for an episode of AHF, the MEESSI-AHF score estimates with good performance the number of days alive and out of the hospital.
Performance of the Fresno-Quebec Rule in identifying patients with concomitant fractures not requiring a radiograph before shoulder dislocation reduction: a multicenter retrospective cohort study
Authors: Benhamed Axel , Bonnet Margot , Miossec Auriane , Mercier Eric , Hernu Romain , Douplat Marion , Gorincour Guillaume , L’Huillier Romain , Abensur Vuillaume Laure , Tazarourte Karim
Published: August 2023

Background and importance

Although shoulder dislocation diagnosis is often solely based on clinical examination, physicians may order a radiograph to rule out a concomitant shoulder fracture before performing reduction. The Fresno-Québec decision rule aims to identify patients requiring a radiograph before reduction to avoid unnecessary systematic imaging. However, this novel approach needs further validation.

Objective

To evaluate the performance of the Fresno-Québec rule in identifying patients who do not require a prereduction radiograph and assess the variables associated with a clinically significant fracture.

Design, settings, and participants

A multicenter, retrospective cohort study from 2015 to 2021. Data were extracted from three ED university-affiliated tertiary-care centers. Patients aged ≥18 years with a final diagnosis of anterior glenohumeral dislocation were included.

Outcomes measure and analysis

Accuracy metrics [sensitivity (Se), specificity (Sp), positive (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR)] of the Fresno-Québec rule were measured. Multivariable logistic regression model was used to identify variables associated with the presence of a concomitant clinically significant fracture.

Main results

A total of 2129 patients were included, among whom 9.7% had a concomitant fracture. The performance metrics of the Fresno-Québec rule were as follows: Se 0.96 95% confidence interval (0.92–0.98), Sp 0.36 (0.34–0.38), PPV 0.14 (0.12–0.16), NPV 0.99 (0.98–0.99), PLR 1.49 (1.42–1.55) and NLR 0.12 (0.06–0.23). A total of 678 radiographs could have been avoided, corresponding to a reduction of 35.2%. Age ≥40 years, first dislocation episode [odds ratio (OR) = 3.18 (1.95–5.38); P < 0.001], the following mechanisms: road collision [OR = 6.26 (2.65–16.1)], low-level fall [OR = 3.49 (1.66–8.28)], high-level fall [OR = 3.95 (1.62–10.4)], and seizure/electric shock [OR = 10.6 (4.09–29.2)] were associated with the presence of a concomitant fracture.

Conclusion

In this study, the Fresno-Québec rule has excellent Se in identifying concomitant clinically significant fractures in patients with an anterior glenohumeral dislocation. The use of this clinical decision rule may be associated with a reduction of approximately a third of unnecessary prereduction radiographs.