bluuebunny/crossref_metadata_2025 huggingface dataset:
Actionable Genomic Alterations in Prostate Cancer Among Black and White United States Veterans
Authors: Valle Luca F , Nickols Nicholas G , Hausler Ryan , Alba Patrick R , Anglin-Foote Tori , Perez Cristina , Yamoah Kosj , Rose Brent S , Kelley Michael J , DuVall Scott L , Garraway Isla P , Maxwell Kara N , Lynch Julie A
Published: April 2023

Black Veterans have higher a incidence of localized and metastatic prostate cancer compared to White Veterans yet are underrepresented in reports of frequencies of somatic and germline alterations. This retrospective analysis of somatic and putative germline alterations was conducted in a large cohort of Veterans with prostate cancer (N = 835 Black, 1613 White) who underwent next generation sequencing through the VA Precision Oncology Program, which facilitates molecular testing for Veterans with metastatic cancer. No differences were observed in gene alterations for FDA approved targetable therapies (13.5% in Black Veterans vs. 15.5% in White Veterans, P = .21), nor in any potentially actionable alterations (25.5% vs. 28.7%, P =.1). Black Veterans had higher rates of BRAF (5.5% vs. 2.6%, P < .001) alterations, White Veterans TMPRSS2 fusions (27.2% vs. 11.7%, P < .0001). Putative germline alteration rates were higher in White Veterans (12.0% vs. 6.1%, P < .0001). Racial disparities in outcome are unlikely attributable to acquired somatic alterations in actionable pathways.
Left to their own devices: Radio, radiomen and radio stations in the making of Tibet’s modern political landscape
Authors: Zhang Huasha
Published: April 2023

This article illuminates a correlation between Tibet’s national identity and technological peripheralization through three intertwined tales involving Chinese, British and Tibetan radio stations in Lhasa between 1934 and 1950. Instead of a political backwater, Tibet was crucial to the competition between an expansionist British Empire and a growingly nationalistic Republic of China in the Himalayas throughout the first half of the twentieth century. As Britain and China monopolized the radio to substantiate their respective political ambitions, Tibet was compelled to adopt an image of geographical remoteness and technological underdevelopment. Upon breaking the foreign monopoly, the Tibetan government managed to appropriate this image for the propagation of its definitions of Tibetan state and national identities. Both the radio and the lack thereof in Tibet, therefore, became key to the Chinese, British and Tibetan governments’ efforts in furthering their respective portrayals of the Tibetan state and nation, as well as Tibet’s position in relation to its neighbours and the rest of the world. In addition to illustrating the interaction of power and technology in the creation of peripheral regions and competing identities, the history of radio in Tibet also reveals the essential roles played by the individuals who oversaw the radio’s daily operations in such processes. Refusing to remain mere extensions of the state that they represented or the machine that they operated, these agents and technicians actively pursued their individual objectives, sometimes against the interests of their employers, shaping Tibet’s modern political landscape in unexpected yet significant ways
Impending Civil Strife or Further Evidence of Non-Attitudes? A Review Article
Authors: Iyengar Shanto
Published: April 2023

In this review article, Shanto Iyengar summarizes the book's key findings on the psychological antecedents of support for violence and the political contexts that either facilitate or discourage outbreaks of violence. Given recent events, the book is certainly timely and theoretically insightful. However, the evidence on which the book is based is limited; it is likely that that the authors have provided vastly inflated estimates of support for violence caused by “non-attitudes” and measurement unreliability.
Diversity in Schools: Immigrants and the Educational Performance of U.S.-Born Students
Authors: Figlio David , Giuliano Paola , Marchingiglio Riccardo , Ozek Umut , Sapienza Paola
Published: April 2023

We study the effect of exposure to immigrants on the educational outcomes of U.S.-born students, using a unique dataset combining population-level birth and school records from Florida. This research question is complicated by the substantial school selection of U.S.-born students, especially among White and comparatively affluent students, in response to the presence of immigrant students in the school. We propose a new identification strategy, comparing sibling outcomes with the inclusion of family fixed effects, to partial out the unobserved non-random selection of native-born families into schools. We find that the presence of immigrant students has a positive effect on the academic achievement of U.S.-born students, especially for students from disadvantaged backgrounds. Moreover, the presence of immigrants does not negatively affect the performance of affluent U.S.-born students, who typically show a higher academic achievement compared to immigrant students. We provide suggestive evidence on potential channels.
Connected Funds
Authors: Fricke Daniel , Wilke Hannes
Published: April 2023

Mutual funds often invest in other funds. In this paper, we analyze the economics behind such cross-fund investments and investigate their financial stability implications. Using granular data for the German fund sector, our main findings are that cross-fund investments (a) are becoming increasingly important over time, (b) were heavily liquidated during March 2020, and (c) display measurable contagion effects. Overall, cross-fund investments can elevate structural fund sector vulnerabilities.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Resveratrol inhibits AhR/Notch axis and reverses Th17/Treg imbalance in purpura by activating Foxp3
Authors: Cheng Jing , Wang Sheng , Lv Shi-Qin , Song Yuan , Guo Ning-Hong
Published: April 2023

Background

Resveratrol has been reported to reverse the imbalance of T helper 17/regulatory T (Th17/Treg) by inhibiting the aryl hydrocarbon receptor pathway to treat immune thrombocytopenia. However, the regulation mechanism of the Notch signaling pathway by resveratrol has not been reported in purpura. This study is aimed to explore the mechanism of resveratrol ultrafine nanoemulsion (Res-mNE) in immune thrombocytopenia.

Methods

The immune thrombocytopenia mouse model was constructed to explore the effect of RES-mNE on immune thrombocytopenia. Cluster of differentiation 4 (CD4+) T cells were isolated and treated with different medications. CD4+ T cells were induced to differentiate into Th17 cells and Treg cells. Flow cytometry was used to detect the proportion of Th17 cells and Treg cells. The secretion was measured by the enzyme-linked immunosorbent assay (ELISA). Quantitative reverse-transcription polymerase chain reaction (qRT-PCR) and western blot were used to detect the mRNA and protein levels.

Results

Th17 cells, IL-17A and IL-22 increased in the immune thrombocytopenia mouse model, and the Treg cells and IL-10 decreased. Res-mNE promoted Treg cell differentiation and IL-10 secretion in CD4+ T cells while inhibiting Th17 cell differentiation and IL-17A and IL-22 levels. The AhR activator 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) reversed the effect of Res-mNE. Notch inhibitors reduced the ratio of Th17/Treg differentiation. Res-mNE activated the expression of Foxp3 by mediating AhR/Notch signaling to reverse the imbalance of Th17/Treg differentiation in immune thrombocytopenia.

Conclusion

Taken together, our findings demonstrated that RES-mNE inhibited the AhR/Notch axis and reversed Th17/Treg imbalance by activating Foxp3.
Molecular and Biological Characterization of Novel and Known Family Secoviridae Members Infecting Lettuce
Authors: Svanella-Dumas Laurence , Tsarmpopoulos Iason , Marais Armelle , Faure Chantal , Theil Sébastien , Glasa Miroslav , Predajna Lukas , Gaudin Jonathan , Tian Sixing , Porcher Laëtitia , Gentit Pascal , De Oliveira Milena Leite , Krause-Sakate Renate , Candresse Thierry
Published: April 2023

High-throughput sequencing of two lettuces showing virus-like symptoms in France provided evidence of infection by members of the family Secoviridae. One plant (JG1) had a complex mixed infection that involved, among others, a novel waikavirus (lettuce waikavirus 1) and two isolates of a sequivirus related to lettuce mottle virus (LeMoV). The second lettuce plant (JG2) was singly infected by LeMoV. Complete genomic sequences were obtained for all four isolates and, in addition, near complete genome sequences were obtained for other LeMoV or LeMoV-related isolates (from French cultivated and wild lettuces and from a Brazilian cultivated lettuce) and for two isolates of another family Asteraceae-infecting sequivirus, dandelion yellow mosaic virus (DaYMV). Analysis of these genomic sequences allows the proposal of tentative genome organization for the various viruses and clarification of their phylogenetic relationships. Sequence and host range comparisons point to significant differences between the two sequivirus isolates identified in the JG1 plant and LeMoV isolates from France and Brazil, suggesting they belong to a novel species for which the name lettuce star mosaic virus is proposed.
Adolescents and Young Adults With Sickle Cell Disease
Authors: Kuisell Clare , Ploutz-Snyder Robert , Williams David A. , Voepel-Lewis Terri , Hutchinson Raymond J. , Dudding Katherine M. , Bridges Celia , Lavoie Smith Ellen M.
Published: April 2023

Objectives:

Some patients with sickle cell disease (SCD) have features of nociplastic pain. While research suggests that many patients with nociplastic pain consume more opioids due to opioid nonresponsiveness, little is known about the impact of nociplastic pain and pain catastrophizing on opioid consumption and pain interference among adolescents and young adults (AYA) with SCD. The purpose of this study was to (1) characterize nociplastic pain and pain catastrophizing among AYA with SCD, and (2) determine whether these characterizations are associated with subsequent opioid consumption and pain interference 1 month after characterization.

Methods:

Participants completed surveys characterizing nociplastic pain and catastrophizing at a routine clinic visit (baseline). Thereafter, participants received weekly text messages that included pain interference and opioid consumption surveys. Multipredictor 2-part models were used to evaluate the predictive relationships between baseline characterizations and subsequent pain interference, and opioid consumption.

Results:

Forty-eight AYA aged 14 to 35 completed baseline measures. Twenty-five percent of participants had scores suggestive of nociplastic pain. Greater nociplastic pain features significantly increased the odds of consuming opioids (odds ratio=1.2) and having greater interference from pain (odds ratio=1.46). Regression analyses found that greater baseline nociplastic pain characteristics were significantly associated with opioid consumption (β=0.13) and pain interference (β=0.061); whereas higher pain catastrophizing scores predicted less opioid consumption (β=−0.03) and less pain interference (β=−0.0007).

Discussion:

In this sample of AYA with SCD, features of nociplastic pain predicted higher subsequent opioid consumption and pain interference. Being aware of nociplastic pain features in patients with SCD may better guide individualized pain management.
Development and validation of a CT-based radiomics model for differentiating pneumonia-like primary pulmonary lymphoma from infectious pneumonia: A multicenter study
Authors: Yu Xinxin , Kang Bing , Nie Pei , Deng Yan , Liu Zixin , Mao Ning , An Yahui , Xu Jingxu , Huang Chencui , Huang Yong , Zhang Yonggao , Hou Yang , Zhang Longjiang , Sun Zhanguo , Zhu Baosen , Shi Rongchao , Zhang Shuai , Sun Cong , Wang Ximing
Published: April 2023

Background:

Pneumonia-like primary pulmonary lymphoma (PPL) was commonly misdiagnosed as infectious pneumonia, leading to delayed treatment. The purpose of this study was to establish a computed tomography (CT)-based radiomics model to differentiate pneumonia-like PPL from infectious pneumonia.

Methods:

In this retrospective study, 79 patients with pneumonia-like PPL and 176 patients with infectious pneumonia from 12 medical centers were enrolled. Patients from center 1 to center 7 were assigned to the training or validation cohort, and the remaining patients from other centers were used as the external test cohort. Radiomics features were extracted from CT images. A three-step procedure was applied for radiomics feature selection and radiomics signature building, including the inter- and intra-class correlation coefficients (ICCs), a one-way analysis of variance (ANOVA), and least absolute shrinkage and selection operator (LASSO). Univariate and multivariate analyses were used to identify the significant clinicoradiological variables and construct a clinical factor model. Two radiologists reviewed the CT images for the external test set. Performance of the radiomics model, clinical factor model, and each radiologist were assessed by receiver operating characteristic, and area under the curve (AUC) was compared.

Results:

A total of 144 patients (44 with pneumonia-like PPL and 100 infectious pneumonia) were in the training cohort, 38 patients (12 with pneumonia-like PPL and 26 infectious pneumonia) were in the validation cohort, and 73 patients (23 with pneumonia-like PPL and 50 infectious pneumonia) were in the external test cohort. Twenty-three radiomics features were selected to build the radiomics model, which yielded AUCs of 0.95 (95% confidence interval [CI]: 0.94–0.99), 0.93 (95% CI: 0.85–0.98), and 0.94 (95% CI: 0.87–0.99) in the training, validation, and external test cohort, respectively. The AUCs for the two readers and clinical factor model were 0.74 (95% CI: 0.63–0.83), 0.72 (95% CI: 0.62–0.82), and 0.73 (95% CI: 0.62–0.84) in the external test cohort, respectively. The radiomics model outperformed both the readers' interpretation and clinical factor model (P <0.050).

Conclusions:

The CT-based radiomics model may provide an effective and non-invasive tool to differentiate pneumonia-like PPL from infectious pneumonia, which might provide assistance for clinicians in tailoring precise therapy.
Single-cell RNA sequencing reveals the transcriptomic landscape of kidneys in patients with ischemic acute kidney injury
Authors: Tang Rong , Jin Peng , Shen Chanjuan , Lin Wei , Yu Leilin , Hu Xueling , Meng Ting , Zhang Linlin , Peng Ling , Xiao Xiangcheng , Eggenhuizen Peter , Ooi Joshua D. , Wu Xueqin , Ding Xiang , Zhong Yong
Published: April 2023

Background:

Ischemic acute kidney injury (AKI) is a common syndrome associated with considerable mortality and healthcare costs. Up to now, the underlying pathogenesis of ischemic AKI remains incompletely understood, and specific strategies for early diagnosis and treatment of ischemic AKI are still lacking. Here, this study aimed to define the transcriptomic landscape of AKI patients through single-cell RNA sequencing (scRNA-seq) analysis in kidneys.

Methods:

In this study, scRNA-seq technology was applied to kidneys from two ischemic AKI patients, and three human public scRNA-seq datasets were collected as controls. Differentially expressed genes (DEGs) and cell clusters of kidneys were determined. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, as well as the ligand–receptor interaction between cells, were performed. We also validated several DEGs expression in kidneys from human ischemic AKI and ischemia/reperfusion (I/R) injury induced AKI mice through immunohistochemistry staining.

Results:

15 distinct cell clusters were determined in kidney from subjects of ischemic AKI and control. The injured proximal tubules (PT) displayed a proapoptotic and proinflammatory phenotype. PT cells of ischemic AKI had up-regulation of novel pro-apoptotic genes including USP47, RASSF4, EBAG9, IER3, SASH1, SEPTIN7, and NUB1, which have not been reported in ischemic AKI previously. Several hub genes were validated in kidneys from human AKI and renal I/R injury mice, respectively. Furthermore, PT highly expressed DEGs enriched in endoplasmic reticulum stress, autophagy, and retinoic acid-inducible gene I (RIG-I) signaling. DEGs overexpressed in other tubular cells were primarily enriched in nucleotide-binding and oligomerization domain (NOD)-like receptor signaling, estrogen signaling, interleukin (IL)-12 signaling, and IL-17 signaling. Overexpressed genes in kidney-resident immune cells including macrophages, natural killer T (NKT) cells, monocytes, and dendritic cells were associated with leukocyte activation, chemotaxis, cell adhesion, and complement activation. In addition, the ligand–receptor interactions analysis revealed prominent communications between macrophages and monocytes with other cells in the process of ischemic AKI.

Conclusion:

Together, this study reveals distinct cell-specific transcriptomic atlas of kidney in ischemic AKI patients, altered signaling pathways, and potential cell–cell crosstalk in the development of AKI. These data reveal new insights into the pathogenesis and potential therapeutic strategies in ischemic AKI.
Systematic Review and Meta-Analyses: Safety and Efficacy of Complementary and Alternative Treatments for Pediatric Attention-Deficit/Hyperactivity Disorder
Authors: Zulauf-McCurdy Courtney A. , LaCount Patrick A. , Shelton Christopher R. , Morrow Anne S. , Zhao Xin A. , Russell Douglas , Sibley Margaret H. , Arnold L. Eugene
Published: April 2023

Objective:

Complementary and alternative treatments (CATs) for ADHD have proliferated over the past decade; however, their safety and efficacy remain uncertain. We completed a systematic review and meta-analyses across CAT domains.

Methods:

Systematic search and data extraction identified randomized controlled trials for pediatric ADHD (ages 3–19 years) that included probably blind ADHD symptom outcome measures. We evaluated basic (RCT of a CAT compared with sham/placebo, attention/active control, treatment as usual, and waitlist control), complementary (RCTs comparing an evidence-based treatment with a CAT and the same evidence-based treatment), and alternative (evidence-based treatment to CAT) efficacy. Random-effect meta-analyses were conducted when at least 3 blinded studies were identified for a specific CAT domain.

Results:

Eighty-seven of 2253 nonduplicate screened manuscripts met inclusion criteria. No study reported significantly greater adverse effects for CATs than controls; naturopathy reported fewer adverse effects than evidence-based treatments but did not demonstrate basic efficacy. In the systematic review of basic efficacy, evidence of effectiveness was mixed but replicated previous evidence for the possible efficacy of cognitive training, neurofeedback, and essential fatty acid supplementation for certain patients. With respect to alternative and complementary efficacy, no CAT outperformed or enhanced evidence-based treatments (stimulant medications and behavioral therapy) when replication was required. Individual meta-analyses indicated that cognitive training was the only CAT that demonstrated overall basic efficacy (SMD = 0.216; p = 0.032).

Conclusion:

Clinicians may cautiously recommend (but monitor) cognitive training when evidence-based treatments are not feasible or effective for a patient. Additional studies are needed to further understand the potential of CAT domains.
Stimulant Medication Treatment in Children with Congenital Heart Disease and Attention-Deficit/Hyperactivity Disorder: Cardiovascular Outcomes
Authors: Trairatvorakul Pon , Meinzen-Derr Jareen , Heydarian Haleh , Mason Karen , Anixt Julia S.
Published: April 2023

Objective:

Children with congenital heart disease (CHD) are at increased risk for attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to determine whether children with CHD and ADHD clinically treated with stimulant medication were at increased risk for changes in cardiovascular parameters or death compared with CHD-matched controls.

Methods:

In this retrospective cohort study, patients with CHD + ADHD treated with stimulant medication (exposed group [EG]) were matched by CHD diagnosis and visit age to patients not on stimulants (nonexposed group [NEG]). Cardiovascular parameters (heart rate [HR] and systolic and diastolic blood pressure [SBP and DBP]) and electrocardiograms (ECGs) from medical records over 12 months were compared using mixed effects models.

Results:

Cardiovascular parameters for 151 children with CHD (mean age 8 ± 4 years) were evaluated (N = 46 EG and N = 105 NEG). Stimulant medication use was not associated with sudden cardiac death. HR and SBP did not significantly change over time in the EG and remained similar between groups. EG children had higher DBP compared with NEG children over time (p = 0.001). Group × time interactions for HR, SBP, and DBP were not different between the EG and NEG. QTc was not significantly different between the EG and NEG (447 ms vs 439 ms, p = 0.23). EG children demonstrated improvement in ADHD symptoms.

Conclusion:

Stimulant medication use in children with CHD was not associated with clinically significant changes in cardiovascular parameters compared with controls. Stimulants should be considered for ADHD treatment in children with CHD when prescribed with appropriate monitoring and coordination with the cardiologist.
Exploring the Professional Identity Formation of Racial/Ethnic Minoritized Physician Assistants
Authors: Wooten Robert L. , Gillette Chris , Wyatt Tasha R. , Rockich-Winston Nicole , Crandall Sonia
Published: April 2023

Introduction

The purpose of this article is to (1) describe how professional identity intersects with physician assistants' (PAs') and PA students' racial and ethnic identities and cultural backgrounds; (2) examine how sociohistorical contexts shape professional identity in racial/ethnic minoritized PAs and PA students; and (3) identify the role of PA program administrators and faculty to address the needs of racial/ethnic minoritized PAs and PA students.

Methods

This study draws on elements of constructivist grounded theory to investigate the professional identity formation (PIF) experiences of 45 PA students and alumni from 3 institutions. Participants were recruited using a snowball method and identified as 23 Black/African American, 12 Hispanic/Latino, 6 mixed race, and 4 Native American/Indigenous. Interview data were analyzed using sociocultural theory as an analytic framework.

Results

The results suggest that participants felt that their racial/ethnic identity was an important part of their identity, yet many indicated they experienced frequent micro- and macroaggressions from fellow students, faculty, lecturers, administrators, preceptors, patients, and supervisors. Additionally, they indicated that they need more support from their programs than what is currently provided.

Discussion

The results of this study suggest that social experiences before, during, and after PA training strongly influence PIF development in racial/ethnic minoritized PAs. Administrators and professional PA organizations should evaluate methods to support those individuals who identify as a racial/ethnic minority throughout their careers.
Clinical Outcomes in Patients With Bacteremia and Concomitant Left Ventricular Assist Devices and Cardiac Implantable Electronic Devices
Authors: Schaffer Andrew J. , El-Harasis Majd A. , Tinianow Alex , Azose Aaron , Zalawadiya Sandip , Dee Kevin , Balsara Keki , Montgomery Jay A.
Published: April 2023

Infection remains a common cause of morbidity and mortality in patients with both left ventricular assist devices (LVADs) and cardiac implanted electronic devices (CIEDs) with limited data describing outcomes in patients who have both devices implanted. We performed a single-center, retrospective, observational cohort study of patients with both a transvenous CIED and LVAD who developed bacteremia. Ninety-one patients were evaluated. Eighty-one patients (89.0%) were treated medically and nine patients (9.9%) underwent surgical management. A multivariable logistic regression showed that blood culture positivity for >72 hours was associated with inpatient death, when controlled for age and management strategy (odds ratio [OR] = 3.73 [95% confidence interval {CI} = 1.34–10.4], p = 0.012). In patients who survived the initial hospitalization, the use of long-term suppressive antibiotics was not associated with the composite outcome of death or infection recurrence within 1 year, when controlled for age and management strategy (OR = 2.31 [95% CI = 0.88–2.62], p = 0.09). A Cox proportional hazards model showed that blood culture positivity for >72 hours was associated with a trend toward increased mortality in the first year, when controlled for age, management strategy, and staphylococcal infection (hazard ratio = 1.72 [95% CI = 0.88–3.37], p = 0.11). Surgical management was associated with a trend toward decreased mortality (hazard ratio = 0.23 [95% CI = 0.05–1.00], p = 0.05).
Percutaneous Cavopulmonary Assist: From Design to 96 Hour Survival in Lethal Cavopulmonary Failure Sheep
Authors: Li Li , Wang Jingkun , Zhao Guangfeng , Topaz Stephen , Morales David , Yoganathan Ajit , Ballard-Croft Cherry , Zwischenberger Joseph B. , Wang Dongfang
Published: April 2023

We are developing a clinically practical percutaneous double lumen cannula (DLC)–based cavopulmonary assist (CPA) system to support failing Fontan patients. In this study, our CPA DLC was redesigned for even blood flow, minimal recirculation, and easy insertion/deployment. After bench testing, this new CPA system was evaluated for 4 hours (n = 10) and 96 hours (n = 5) in our clinically relevant lethal cavopulmonary failure (CPF) sheep model for ease of cannulation/deployment, reversal of CPF hemodynamics/end-organ hypoperfusion, and durability/biocompatibility. Cavopulmonary failure was achieved in all sheep. All DLCs were successfully inserted/deployed into Fontan anatomy. Cavopulmonary assist reversed CPF with normalized central venous pressure and cardiac output. All survival sheep were ambulatory with normal eating/drinking. One sheep was euthanized after 6 hours from cannula kinking, and one sheep died of hypokalemia after 8 hours. Three sheep survived 96 hours with normal hemodynamics. Free hemoglobin was only 3.7 ± 1.2 mg/dl at 96 hours, indicating negligible hemolysis. Creatinine, blood urea nitrogen, and lactate increased from hypoperfusion but normalized by 72 hours CPA. Necropsy showed only a small, immobilized thrombus ring at umbrella attachment to DLC. Our DLC-based system provided total ambulatory CPA in a lethal CPF sheep model with 96 hour survival and complete reversal of hemodynamics and end-organ hypoperfusion.
Hematopoietic Stimulation During Impella 5.5 Support to Avoid Transfusions in a Jehovah’s Witness
Authors: Devich Robert , Neuendorff Nina Rosa , Frazier Oscar Howard , Eisen Howard J. , Dowling Robert , Freundt Miriam
Published: April 2023

The population presenting with cardiogenic shock is heterogenous. Anemia is common in advanced heart failure and associated with poor outcomes. Microaxial flow pumps may cause ongoing blood trauma and worsen anemia. Treatment with recombinant erythropoietin, iron, vitamin B, and folate is recommended before cardiac surgery to reduce perioperative transfusion requirements but no data exist on the feasibility and safety during support with microaxial flow pumps. This novel strategy was born out of necessity to support a Jehovah’s Witness who opposes blood transfusion but required mechanical circulatory support. We present its efficacy over the duration of 19 days of Impella 5.5 support where hemoglobin level remained stable, and platelet count significantly improved despite a brief episode of gastrointestinal bleeding. No thromboembolic complications occurred. We anticipate this strategy could help not only Jehovah’s Witnesses, but also patients awaiting cardiac transplantation since transfusions stimulate development of antibodies which may preclude or postpone finding a suitable donor organ. Furthermore, it may minimize or prevent perioperative needs for transfusions for patients being bridged to durable left ventricular assist devices.
The effectiveness of tivantinib for MET-high hepatocellular carcinoma: A protocol for meta analysis
Authors: Wang Yubin , Xu Hao , Yang Juan , Zhang Juyi
Published: April 2023

Background:

The efficacy of tivantinib for MET-high hepatocellular carcinoma remains controversial. We conduct this meta-analysis to explore the efficacy of tivantinib versus placebo for MET-high hepatocellular carcinoma.

Methods:

We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through November 2022 and included randomized controlled trials (RCTs) assessing the efficacy and safety of tivantinib versus placebo for MET-high hepatocellular carcinoma.

Results:

Three RCTs were included in the meta-analysis. Overall, compared with control group for MET-high hepatocellular carcinoma, tivantinib showed no obvious impact on overall survival (hazard ratio [HR] = 0.77; 95% confidence interval [CI] = 0.52–1.13; P = .18) or progression-free survival (HR = 0.78; 95% CI = 0.56–1.08; P = .14). In addition, tivantinib was associated with the increase in grade ≥3 neutropenia (odd ratio [OR] = 11.76; 95% CI = 2.77–49.89; P = .0008) and leukopenia (OR = 14; 95% CI = 1.68–116.82; P = .01), but demonstrated no impact on the incidence of grade ≥ 3 anemia (OR = 2.74; 95% CI = 0.14–53.43; P = .51).

Conclusions:

Tivantinib may not benefit to the treatment of MET-high hepatocellular carcinoma.
Association between vitamin B12 status and heart rate variability in patients with ischemic stroke
Authors: Park Eo Jin
Published: April 2023

Autonomic dysfunction is common in patients with ischemic stroke. An ischemic stroke may induce abnormalities in autonomic tone, resulting in poor heart rate regulation and an increased risk of severe cardiac arrest and sudden death. Heart rate variability (HRV) is a reliable index for evaluating autonomic dysfunction. Vitamin B12 deficiency is frequent among older adults and is a known risk factor for ischemic stroke. As vitamin B12 deficiency affects the peripheral nerves and the central nervous system, it can lead to autonomic dysfunction. However, no study has been published on the correlation between HRV and vitamin B12 status in patients with ischemic stroke. This study aimed to investigate the relationship between HRV and vitamin B12 status and to determine whether the serum vitamin B12 level can be a predictor of HRV parameters. This retrospective study enrolled patients with ischemic stroke between January 2015 and December 2022. The patients underwent serum vitamin B12 level measurements and 24-h Holter monitoring. Pearson correlation analysis was used to investigate the correlation between serum vitamin B12 levels and HRV parameters. The impact of serum vitamin B12 status on HRV parameters was determined using multiple linear regression analysis. A total of 87 patients with ischemic stroke were included in this study. HRV parameters were significantly correlated with serum vitamin B12 status in the frequency domain. In multiple linear regression analysis, the serum vitamin B12 status was a significant predictor of HRV parameters. HRV parameters may be correlated with serum vitamin B12 status in patients with ischemic stroke. Therefore, the serum vitamin B12 status may be a significant predictor of autonomic dysfunction. Our results may provide objective evidence for the impact of serum vitamin B12 status on autonomic dysfunction in patients with ischemic stroke.
Physical activity in the first postoperative week in 132 knee arthroplasty patients randomized to 3 different analgesic regimens
Authors: Husby Vigdis Schnell , Rian Torbjørn , Klaksvik Jomar , Wik Tina Strømdal , Winther Siri Bjørgen
Published: April 2023

Background:

The aim of this study was to investigate whether objectively recorded physical activity in the first week after surgery in total knee arthroplasty patients differed between patients allocated to 3 different analgesic regimens.

Methods:

A total of 132 total knee arthroplasty patients wore activity monitors 24 hours a day from day 1 after surgery for 6 consecutive days. The time mobilized (stepping/standing) and the number of steps were recorded. This study was a sub-study of a randomized controlled study comparing tapentadol extended-release (ER), oxycodone controlled-release (CR), or a non-opioid placebo analgesic regimen.

Results:

The placebo group spent significantly more time mobilized than the tapentadol ER and the oxycodone CR groups (P = .016 and .042, respectively), but no statistically significant differences were found between the groups in the number of steps taken. The activity levels of patients in all groups increased in the first week after surgery.

Conclusion:

Patients in the non-opioid placebo group spent more time mobilized the first week after surgery than those in the tapentadol ER and the oxycodone CR groups, while the number of steps was not different between the groups.
The role of early blood purification for miliary tuberculosis presenting as acute respiratory distress syndrome in pregnancy: A case report
Authors: Sari Anggraini Permata , Taufik Muhammad Azhari , Wibisana Krishna , Sarkoen Widyastuti
Published: April 2023

Rationale:

Acute respiratory distress syndrome (ARDS) in miliary tuberculosis (TB) remains rare, especially in pregnant women. The role of blood purification is potential in managing ARDS due to miliary TB.

Patient concerns:

A 36-year-old woman presenting with difficulty breathing 6 hours before admission. She never had any constitutional symptoms due to TB.

Diagnoses:

ARDS in TB was diagnosed based on the deterioration of PaO2/FiO2, increased acute phase reactants, positive gene-Xpert, and typical chest x-ray of miliary TB.

Interventions:

A C-section was performed and followed by continuous venovenous hemofiltration to tackle her inflammatory condition. antituberculosis drugs were given after the transaminases showed declining trends.

Outcomes:

No major complications associated with continuous venovenous hemofiltration occurred. After 14 days of hospitalization, the patient’s clinical condition improved and was finally discharged.

Lessons:

This case underscores the potential role of blood purification in ARDS due to miliary TB in pregnancy.
Chronic troponin elevation assessed by myocardial T1 mapping in patients with stable coronary artery disease
Authors: Segre Carlos Alexandre W. , de Lemos James A. , Assunção Junior Antonildes Nascimento , Nomura Cesar Higa , Favarato Desiderio , Strunz Celia Maria Cassaro , Villa Alexandre Volney , Parga Filho Jose Rodrigues , Rezende Paulo Cury , Hueb Whady , Ramires Jose Antonio Franchini , Kalil Filho Roberto , Serrano Junior Carlos Vicente
Published: April 2023

Background:

Cardiac troponin detected with sensitive assays can be chronically elevated, in the absence of unstable coronary syndromes. In patients with chronic coronary artery disease, clinically silent ischemic episodes may cause chronic troponin release. T1 mapping is a cardiovascular magnetic resonance technique useful in quantitative cardiac tissue characterization. We selected patients with anatomically and functionally normal hearts to investigate associations between chronic troponin release and myocardial tissue characteristics assessed by T1 mapping.

Methods:

We investigated the relationship between cardiac troponin I concentrations and cardiovascular magnetic resonance T1 mapping parameters in patients with stable coronary artery disease enrolled in MASS V study before elective revascularization. Participants had no previous myocardial infarction, negative late gadolinium enhancement, normal left ventricular function, chamber dimensions and wall thickness.

Results:

A total of 56 patients were analyzed in troponin tertiles: nativeT1 and extracellular volume (ECV) values (expressed as means ± standard deviations) increased across tertiles: nativeT1 (1006 ± 27 ms vs 1016 ± 27 ms vs 1034 ± 37 ms, ptrend = 0.006) and ECV (22 ± 3% vs 23 ± 1.9% vs 25 ± 3%, ptrend = 0.007). Cardiac troponin I concentrations correlated with native T1(R = 0.33, P = .012) and ECV (R = 0.3, P = .025), and were independently associated with nativeT1 (P = .049) and ventricular mass index (P = .041) in multivariable analysis.

Conclusion:

In patients with chronic coronary artery disease and structurally normal hearts, troponin I concentrations correlated with T1 mapping parameters, suggesting that diffuse edema or fibrosis scattered in normal myocardium might be associated with chronic troponin release.
Anxiety and associated factors among Vietnamese students during COVID-19 pandemic: A cross-sectional study
Authors: Nguyen Long Xuan , Dao Linh Thi Dieu , Ta Anh Nhat , Le Ha Thanh , Nguyen Hieu Van , Nguyen Lan Thi Mai , Nguyen Phuong Thi , Nguyen Thang Thi , Ta Thanh Chi , Nguyen Thuong Hiep , Nguyen Trang Thi , Huynh Tuan Anh , Hoang Anh Quynh , Duong Linh Thi Hanh , Do Ly Hoang , Pham Nam Tien
Published: April 2023

Mental health care for students in general, particularly anxiety, is a significant problem that needs more attention, especially during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to describe the prevalence of anxiety and examine the associated factors among students during the COVID-19 pandemic in Vietnam. A cross-sectional study was conducted from August to September 2021 among 5730 students. An online survey was used to collect sociodemographic information, and the generalized anxiety disorder questionnaire (GAD-7) was used to assess anxiety symptoms among Vietnamese students. Results showed that the prevalence of anxiety among study participants was 16.2% (95% confidence interval [CI]: 15.3%–17.2%). Factors related to anxiety among students were gender, type of housemate, COVID-19 exposure/infection status, vaccination status, health status, academic performance, and social relationships during the COVID-19 pandemic. A significant number of students experienced anxiety during COVID-19, and this rate was related to several factors. Psychological interventions are required to support students during and after the COVID-19 pandemic and other health crises. Further studies are required to confirm our findings.
Persistent weekly paclitaxel-induced peripheral neuropathy in early breast cancer patients enrolled in a randomized trial of cryotherapy
Authors: Shigematsu Hideo , Kimura Yuri , Itagaki Tomoko , Yasui Daisuke
Published: April 2023

Chemotherapy-induced peripheral neuropathy (CIPN) is a serious side effect of weekly paclitaxel-based chemotherapy for breast cancer, that can persist for years. Cryotherapy therapy is effective for preventing early CIPN, but its protective effect on persistent CIPN is uncertain. This is a cross-sectional study conducted as an ancillary analysis of a randomized trial investigating the preventive effect of cryotherapy on CIPN in breast cancer patients receiving weekly paclitaxel-based chemotherapy (UMIN000034966). Eligible patients were evaluated for CIPN at more than a year after completion of the chemotherapy (persistent CIPN). CIPN was defined as a 6 or more points reduction from baseline in the Functional Assessment of Cancer Therapy-Neurotoxicity (FACT-NTX) score. The incidence of early and persistent CIPN was compared between cryotherapy and control groups. Thirty-eight patients were examined for both early and persistent CIPN. The median time from completion of the weekly paclitaxel-based chemotherapy to the questionnaire for persistent CIPN was 2.3 (1.3–3.1) years. In all 38 patients, persistent CIPN was demonstrated in 10 (26.3%), respectively. There was a numerical, however not significant, reduction in the incidence of persistent CIPN (15.8% vs 36.8%, P = .1) in the cryotherapy group compared with the control group, respectively. In multivariate logistic regression analysis, age ≥ 65 was a substantial risk factor for persistent CIPN (HR: 14.7, 95%CI: 1.7–130.7, P = .01). In breast cancer patients receiving adjuvant weekly paclitaxel-based chemotherapy, cryotherapy resulted in a numerical, however not significant, reduction in the incidence of persistent CIPN and age>=65 was a risk factor for persistent CIPN.
Differences in preoperative gastric ultrasound findings in elderly compared to the mid-aged surgical patients: A retrospective observational study
Authors: Ahn Jin Hee , Shim Jae-Geum , Lee Sung Hyun , Ryu Kyoung-Ho , Lee Mi Yeon , Kim Sinae , Gahng Tae-Ryun , Cho Eun-Ah
Published: April 2023

This study aimed to compare gastric ultrasound assessments between young and elderly patients, to determine whether the cross-section area (CSA) cutoff values for elderly and young patients should be different, and to suggest CSA cutoff values for elderly patients. This study evaluated the data of 120 patients who underwent elective surgery under general anesthesia between July 2019 and August 2020. Demographic and gastric ultrasound assessment data were retrieved. Patients were divided into the elderly group (n = 58, age: ≥65 years) and young group (n = 62, age: <65 years). The CSAs in the supine and right lateral decubitus positions (RLDP), semiquantitative 3-point Perlas grade (grades 0, 1, and 2), and gastric volume (GV) were determined. CSAs according to different Perlas grades were compared between the 2 groups. To compare normally and non-normally distributed continuous data, Student t test and the Mann–Whitney U test were used, respectively. Categorical data were compared using the chi-square test or Fisher exact test, as appropriate. The receiver operating characteristic (ROC) curves were built for the CSAs to predict pulmonary aspiration. The CSA cutoff values for predicting a high risk of pulmonary aspiration in both the groups were determined. Among patients with Perlas grade 0, the CSAsupine (P = .002) and CSARLDP (P = .002) were greater in the elderly group than in the young group. The specificity, positive predictive value, and accuracy of the CSA decreased when the CSA cutoff value for the young group was applied to the elderly group. The CSA cutoff values for the elderly group were: CSAsupine, 6.92 cm2 and CSARLDP, 10.65 cm2. The CSA of the empty stomach was greater in elderly patients than in young patients. We suggest that the following CSA cutoff values should be used for predicting pulmonary aspiration risk in elderly patients: CSAsupine, 6.92 cm2 and CSARLDP, 10.65 cm2.
Implementing case-based collaborative learning curriculum via webinar in internal medicine residency training: A single-center experience
Authors: He Rong , Xie Ying , Liu Fang , Zhao Lanting , Zhang Ou , Xiang Wei , Kong Lingyun , Miao Le , Zhang Ping
Published: April 2023

This study aimed to investigate the effects of the Case-based collaborative learning (CBCL) curriculum in webinar format on internal medicine residents’ knowledge covering cardiologic topics and their attitudes toward the CBCL teaching module. CBCL is a novel small-group approach, that incorporates elements of problem-based learning and case-based learning, and it has shown to improve medical students’ knowledge mastery. However, few studies have explored its applicability for internal medicine residents, especially in the webinar format. This prospective cohort study included internal medicine residents in a residency program in Beijing, China. Eight CBCL sessions in webinar format covering cardiologic topics were delivered to them from February to April 2020. Pre-session reading materials included textbook and guidelines published by the academic societies. Multiple-choice questions were delivered to assess participants’ knowledge before and after the sessions. Changes in participants’ knowledge were determined using the paired t test to compare mean values. In addition, surveys based on 5-point Likert scale scores assessed satisfaction at the end of the second and eighth sessions. The Wilcoxon signed-rank test was used to identify any potential satisfaction improvement. In total, 9 internal medicine residents participated in the study, of whom 33.3% were male, and the overall rate of participation in CBCL sessions in webinar format was 94.4%. The mean scores of 50 multiple-choice questions were 68.0 ± 12.3 and 75.1 ± 9.9 in the pre- and post-curriculum assessments (P = .029). In the first survey performed at the second week, 5 (55.6%) residents chose “like” or “extremely like” in overall satisfaction, “neutral” by 3 (33.3%) residents and “dislike” by 1 (11.1%) resident. In the second survey, only 1 (11.1%) resident selected a neutral reply in satisfactory assessment, and the other 8 (88.9%) residents selected either “like” or “extremely like” choices. Compared with the results of the first survey, the overall satisfaction rate significantly improved (P = .031). Implementing the CBCL sessions in webinar format for cardiology residents was resulted in the improved knowledge mastery and a high acceptance rate.
Acetabular index and acetabular depth ratio in newborns and infants aged 6 months or less with the healthy development of hips: A retrospective cross-sectional study
Authors: Sari Ahmet Sinan , Karakus Ozgun , Gultekin Muhammet Zeki , Senaran Hakan
Published: April 2023

Radiographic assessment of the hip may render critical in the diagnosis of developmental dysplasia of the hip (DDH) in newborns and infants aged ≤6 months. There is no complete dataset on the acetabular index (AI) and acetabular depth ratio (ADR) values in this age group. The objective of this study was to assess the AI and ADR values in newborns and infants aged ≤6 months with healthy development. A retrospective analysis was performed on pelvic radiographs of newborns and infants (≤6 months) between August 2020 and September 2021. There were 3000 children with pelvic radiographic imaging. Normal sonographic findings and radiographs without any structural deformity of the hip were inclusion criteria. A total of 1132 newborns and infants (2264 hips) were analyzed. Measurements of AI and ADR (ischium and pubic bone as landmarks for acetabular depth ratio A [ADR-A] and acetabular depth ratio B [ADR-B]) were performed. Correlation and intraclass correlation coefficient (ICC) values were calculated. Left-sided AI values were significantly higher than the right-sided AI values, except in infants aged 4 to ≤5 months (P < .05). ADR-B values differed significantly between male and female newborns and infants both in terms of the side of the hip measured and age (P < .05). AI values were fairly correlated with age (r = −0.286 for left and r = −0.254 for right) in the negative direction and with ADR-A (r = 0.449 and r = 0.469 for left and right) and ADR-B (r = 0.545 and r = 0.592 for left and right) in the positive direction. Inter-observer ICC was 0.845 to 0.989 (excellent) for AI, 0.534 and 0.904 (moderate to excellent) for ADR-A, and −0.014 and 0.774 (slightly good to good) for ADR-B. Intra-observer ICC was 0.811 to 0.996 (excellent) for AI, 0.575 to 0.98 (moderate to excellent) for ADR-A, and 0.023 to 0.954 (slightly good to excellent) for ADR-B. This study features the first complete data set of AI and ADR measurements, which are essential for pelvic radiographic imaging of hip dysplasia, in newborns and infants aged ≤6 months.