bluuebunny/crossref_metadata_2025 huggingface dataset:
Mental health and addiction service utilization among people living with chronic kidney disease
Authors: Bhasin Arrti A , Molnar Amber O , McArthur Eric , Nash Danielle M , Busse Jason W , Cooper Rebecca , Heale Esti , Ip Jane , Pang Jocelyn , Blake Peter G , Garg Amit X , Kurdyak Paul , Kim S Joseph , Sultan Heebah , Walsh Michael
Published: November 2023

Background

Mental health problems, particularly anxiety and depression, are common in patients with chronic kidney disease (CKD) and negatively impact quality of life, treatment adherence and mortality. However, the degree to which mental health and addiction services are utilized by those with CKD is unknown. We examined the history of mental health and addiction service use of individuals across levels of kidney function.

Methods

We performed a population-based cross-sectional study using linked healthcare databases from Ontario, Canada from 2009 to 2017. We abstracted the prevalence of individuals with mental health and addiction service use within the previous 3 years across levels of kidney function [estimated glomerular filtration rate (eGFR) ≥60, 45 to <60, 30 to <45, 15 to <30, <15 ml/min/1.73 m2 and maintenance dialysis]. We calculated prevalence ratios (PRs) to compare prevalence across kidney function strata, while adjusting for age, sex, year of cohort entry, urban versus rural location, area-level marginalization and Charlson comorbidity index.

Results

Of 5 956 589 adults, 9% (n = 534 605) had an eGFR <60 ml/min/1.73 m2 or were receiving maintenance dialysis. Fewer individuals with an eGFR <60 ml/min/1.73 m2 had a history of any mental health and addiction service utilization (crude prevalence range 28–31%) compared with individuals with an eGFR ≥60 ml/min/1.73 m2 (35%). Compared with an eGFR ≥60 ml/min/1.73 m2, the lowest prevalence of individuals with any mental health and addiction service utilization was among those with an eGFR of 15 to <30 ml/min/1.73 m2 {adjusted PR 0.86 [95% confidence interval (CI) 0.85 to 0.88]}, an eGFR <15 ml/min/1.73 m2 [adjusted PR 0.81 (95% CI 0.76–0.86)] and those receiving maintenance dialysis [adjusted PR 0.83 (95% CI 0.81–0.84)]. Less use of outpatient services accounted for differences in service utilization.

Conclusions

Mental health and addiction service utilization is common but less so in individuals with advanced CKD in Ontario, Canada.
An Automated Virtual Reality Program Accurately Diagnoses HIV-Associated Neurocognitive Disorders in Older People With HIV
Authors: Moore Raeanne C , Kuehn Kevin S , Heaton Anne , Sundermann Erin E , Campbell Laura M , Torre Peter , Umlauf Anya , Moore David J , Kosoris Nicole , Wright David W , LaPlaca Michelle C , Waldrop Drenna , Anderson Albert M
Published: November 2023

Background

HIV-associated neurocognitive disorders (HANDs) remain prevalent despite antiretroviral therapy, particularly among older people with HIV (PWH). However, the diagnosis of HAND is labor intensive and requires expertise to administer neuropsychological tests. Our prior pilot work established the feasibility and accuracy of a computerized self-administered virtual reality program (DETECT; Display Enhanced Testing for Cognitive Impairment and Traumatic Brain Injury) to measure cognition in younger PWH. The present study expands this to a larger sample of older PWH.

Methods

We enrolled PWH who were ≥60 years old, were undergoing antiretroviral therapy, had undetectable plasma viral loads, and were without significant neuropsychological confounds. HAND status was determined via Frascati criteria. Regression models that controlled for demographic differences (age, sex, education, race/ethnicity) examined the association between DETECT's cognition module and both HAND status and Global Deficit Score (GDS) derived via traditional neuropsychological tests.

Results

Seventy-nine PWH (mean age, 66 years; 28% women) completed a comprehensive neuropsychological battery and DETECT's cognition module. Twenty-five (32%) had HAND based on the comprehensive battery. A significant correlation was found between the DETECT cognition module and the neuropsychological battery (r = 0.45, P < .001). Furthermore, in two separate regression models, HAND status (b = −0.79, P < .001) and GDS impairment status (b = −0.83, P < .001) significantly predicted DETECT performance. Areas under the curve for DETECT were 0.78 for differentiating participants by HAND status (HAND vs no HAND) and 0.85 for detecting GDS impairment.

Conclusions

The DETECT cognition module provides a novel means to identify cognitive impairment in older PWH. As DETECT is fully immersive and self-administered, this virtual reality tool holds promise as a scalable cognitive screening battery.
Epidermolysis bullosa in a mother-infant dyad
Authors: Prashanth R R , Kamble Pramod Dhanraj , Kumari Abhilasha , Haribalakrishna Anitha , Mahajan Sunanda Arun
Published: November 2023

Epidermolysis Bullosa is an inherited mechanobullous disorder which presents in the neonatal period as blistering skin lesions. In this case report, we describe an uncommon presentation of Epidermolysis Bullosa Simplex in a term infant, weighing 2640 g, born to a mother who was also diagnosed with Epidermolysis Bullosa Pruriginosa during the course of the evaluation of her newborn. The clinical situation presented us with a unique dilemma with regard to routine newborn care practices including handling, skin and diaper care. Though the presentation was typically characteristic of EB, we illustrate with images the diagnostic modalities and challenges faced in the hospital while caring for this fragile skin in a low and middle-income country’s neonatal intensive care unit. This is the first reported case of a neonate with Epidermolysis Bullosa Simplex born to a mother with Epidermolysis Bullosa Pruriginosa.
Lupus panniculitis as the initial presentation of systemic lupus erythematosus triggered by COVID-19 infection: case report and literature review
Authors: Abuhammad Aseel , AbuKhalaf Salsabeel M , AbuKhalaf Muhammad M , Janem Abdelrhman Muwafaq , Attawna Saed I Y
Published: November 2023

COVID-19 has many complications that affect many systems, including rheumatology and inflammatory skin conditions such as cutaneous lupus erythematosus. Herein, we describe the case of a patient with lupus panniculitis who presented with systemic lupus erythematosus in the setting of recent COVID-19 infection. A 66-year-old female patient presented to the hospital with expanded skin lesions all over her limbs, fever, joint pain, and fatigue. Lab tests and imaging revealed a second recent infection with COVID-19, positive titers of systemic lupus erythematosus antibodies, and biopsy confirmed lupus erythematosus panniculitis. She was treated with oral prednisone and hydroxychloroquine for SLE and symptomatic management for recent COVID-19 infection without ICU admission. Lupus erythematosus panniculitis (LEP) is a rare manifestation of lupus erythematosus. Although some cases of SLE following COVID-19 infection have been reported, lupus panniculitis as the initial presentation of systemic lupus erythematosus in these patients is extremely rare.

Highlights Lupus panniculitis (LP) as the initial presentation of Systemic Lupus Erythematosus is uncommon. SLE diagnosis can be difficult in patients with COVID-19 infection because both have some common characteristics. Erythema nodosum is an important differential diagnosis for lupus erythematosus panniculitis.
Applications of Synthetic Pentatricopeptide Repeat Proteins
Authors: Kwok van der Giezen Farley , Honkanen Suvi , Colas des Francs-Small Catherine , Bond Charles , Small Ian
Published: November 2023

RNA-binding proteins play integral roles in the regulation of essential processes in cells and as such are attractive targets for engineering to manipulate gene expression at the RNA level. Expression of transcripts in chloroplasts and mitochondria is heavily regulated by pentatricopeptide repeat (PPR) proteins. The diverse roles of PPR proteins and their naturally modular architecture make them ideal candidates for engineering. Synthetic PPR proteins are showing great potential to become valuable tools for controlling the expression of plastid and mitochondrial transcripts. In this review, by ‘synthetic’, we mean both rationally modified natural PPR proteins and completely novel proteins designed using the principles learned from their natural counterparts. We focus on the many different applications of synthetic PPR proteins, covering both their use in basic research to learn more about protein–RNA interactions and their use to achieve specific outcomes in RNA processing and the control of gene expression. We describe the challenges associated with the design, construction and deployment of synthetic PPR proteins and provide perspectives on how they might be assembled and used in future biotechnology applications.
The transcription factor MdBPC2 alters apple growth and promotes dwarfing by regulating auxin biosynthesis
Authors: Zhao Haiyan , Wan Shuyuan , Huang Yanni , Li Xiaoqiang , Jiao Tiantian , Zhang Zhijun , Ma Baiquan , Zhu Lingcheng , Ma Fengwang , Li Mingjun
Published: November 2023

Auxin plays important roles throughout plant growth and development. However, the mechanisms of auxin regulation of plant structure are poorly understood. In this study, we identified a transcription factor (TF) of the BARLEY B RECOMBINANT/BASIC PENTACYSTEINE (BBR/BPC) family in apple (Malus × domestica), MdBPC2. It was highly expressed in dwarfing rootstocks, and it negatively regulated auxin biosynthesis. Overexpression of MdBPC2 in apple decreased plant height, altered leaf morphology, and inhibited root system development. These phenotypes were due to reduced auxin levels and were restored reversed after exogenous indole acetic acid (IAA) treatment. Silencing of MdBPC2 alone had no obvious phenotypic effect, while silencing both Class I and Class II BPCs in apple significantly increased auxin content in plants. Biochemical analysis demonstrated that MdBPC2 directly bound to the GAGA-rich element in the promoters of the auxin synthesis genes MdYUC2a and MdYUC6b, inhibiting their transcription and reducing auxin accumulation in MdBPC2 overexpression lines. Further studies established that MdBPC2 interacted with the polycomb group (PcG) protein LIKE HETEROCHROMATIN PROTEIN 1 (LHP1) to inhibit MdYUC2a and MdYUC6b expression via methylation of histone 3 lysine 27 (H3K27me3). Silencing MdLHP1 reversed the negative effect of MdBPC2 on auxin accumulation. Our results reveal a dwarfing mechanism in perennial woody plants involving control of auxin biosynthesis by a BPC transcription factor, suggesting its use for genetic improvement of apple rootstock.
How to Work with Muslim Clients in a Successful, Culturally Relevant Manner: A National Sample of American Muslims Share Their Perspectives
Authors: Hodge David R , Zidan Tarek , Husain Altaf
Published: November 2023

Despite the growing size of the American Muslim community, little research exists on the provision of culturally relevant services to members of this population. The purpose of this study was to identify American Muslims’ perceptions regarding what practitioners should know about Muslims and Islamic culture to provide successful mental health services to members of this community. To conduct this study, a purposive snowball sampling method was employed to obtain a national sample of community-dwelling American Muslims (N = 213). Qualitative analysis identified eight interlaced themes, which can be summarized as follows: (1) know basic Islamic beliefs, (2) recognize intragroup ethnic/cultural differences, (3) develop self-awareness of personal biases, (4) respect Islamic gender roles, (5) avoid making assumptions, (6) use Islamic beliefs/practices as strengths, (7) understand bias in the larger secular culture, and (8) consult with Muslim therapists/Imams. The findings equip practitioners with the information they need to provide effective, culturally relevant services to members of the unique American Muslim community from a posture of respect and cultural humility.
Credit instruments to alleviate global food insecurity: focus on crop receipts
Authors: Johnson Thomas
Published: November 2023

Global institutions have been looking for tools to alleviate food insecurity for years. COVID-19 and the conflict in Ukraine have exacerbated the situation, necessitating the mobilization of additional financial resources. This article focuses on financing instruments that can alleviate food insecurity by promoting financing in the pre-harvest phase, particularly crop receipts. Crop receipts recently attracted attention from international financial institutions, responding to inquiries from domestic policymakers about tools to increase access to credit for farmers. Crop receipts legislation has been enacted in Brazil, Ukraine, and Serbia, and several States are considering the enactment of such legislation. This article analyses the interaction of crop receipts with secured transactions and warehouse receipts legislation as well as regulatory frameworks applicable to banking, commodity exchanges, and capital markets. Guidance for those States contemplating enactment of crop receipts legislation is necessary to produce coherent secured transactions and warehouse receipts regimes and to forestall any approaches that might thwart their modernization along the lines of existing and emerging international standards. This article sheds light on the aspects of crop receipts finance for which guidance should be provided. It proposes that such guidance be included in the Agricultural Legal Financing Guide, which has been approved by the Governing Council of the International Institute for Unification of Private Law for the 2023–5 Work Programme.
Total Hip Arthroplasty in Teenagers: A Systematic Literature Review
Authors: te Velde Jens P. , Buijs George S. , Schafroth Matthias U. , Saouti Rachid , Kerkhoffs Gino M.M.J. , Kievit Arthur J.
Published: November 2023

Background:

Total hip arthroplasty (THA) in teenagers is generally avoided. Nevertheless, recent THA procedures in a very young patient show improved functional outcomes and implant survival, resulting in lower revision rates. This review aims to present an overview of the available literature on THA in teenagers and to provide evidence to inform caregivers.

Methods:

In this systematic review, studies required a primary THA method and a teenage patient population. Studies must report at least one of the following outcome measures: functional outcomes, implant survival, and complications. In addition, demographic and surgical data were collected.

Results:

Sixteen studies were analyzed, including 2040 patients and 2379 hips, with an average 7.7-year follow-up. The mean patient age was 18 years, with an average revision rate of 11.7%. The overall average relative improvement of the 2 most frequently used patient-reported (functional) outcome measures were 84.3 and 92.3% at the latest follow-up. Prosthesis, or liner loosening, was the cause of revision in 50.2% of the cases. Loosening was the most frequent complication (14.8%), together with prosthesis/liner wear (14.8%). Cementless fixation (70.7%), ceramic-on-ceramic articulation (34.7%), and the posterior surgical approach (82.3%) were the most applied techniques.

Conclusions:

The functional outcomes after THA in teenagers improved at follow-up. The average revision rate is relatively high, especially in the pre-1995 studies, with post-1995 studies reporting similar revision rates to the adult patient group. Research to further improve implant survival as well as the ease of revisions in teenagers is needed.

Level of evidence:

Level III—systematic review.
Creatine Supplementation and Resistance Training in Patients With Breast Cancer (CaRTiC Study)
Authors: Martinez Aguirre-Betolaza Aitor , Cacicedo Jon , Castañeda-Babarro Arkaitz
Published: November 2023

Background/Aims:

Creatine supplementation is an effective ergogenic nutrient for athletes, as well as for people starting a health or fitness program. Resistance training has previously been identified as an important method of increasing muscle mass and strength, especially in people with cancer to avoid sarcopenia. The potential of creatine supplementation for adaptations produced by resistance training in patients with cancer is still unknown. The primary aim of this study is to evaluate the effectiveness of a supervised resistance training program intervention with and without creatine supplementation in patients with breast cancer.

Methods:

Is a multicentre, randomized, blind, placebo-controlled study. Patients will be randomly assigned to a control group and 2 experimental groups. The first training resistance group (RG) will perform resistance training, while the second experimental resistance-creatine group will perform the same resistance training as the RG and will also receive a 5 g/d creatine supplementation during the intervention. RG participants will follow the same daily dosing protocol, but in their case, with dextrose/maltodextrin. Resistance training will be a 16-week supervised workout that will consist of a series of resistance exercises (leg press, knee extension, knee bends, chest press, sit-ups, back extensions, pull-ups, and shoulder press) that involve the largest muscle groups, performed 3 times a week on nonconsecutive days. Both the RG and the resistance-creatine group will receive a supplement of soluble protein powder (20 to 30 g) daily.

Conclusions:

This intervention will help to better understand the potential of nonpharmacological treatment for improving strength and well-being values in patients with breast cancer with and without creatine supplementation.
Airway management in neonates and infants
Authors: Disma Nicola , Asai Takashi , Cools Evelien , Cronin Alexandria , Engelhardt Thomas , Fiadjoe John , Fuchs Alexander , Garcia-Marcinkiewicz Annery , Habre Walid , Heath Chloe , Johansen Mathias , Kaufmann Jost , Kleine-Brueggeney Maren , Kovatsis Pete G. , Kranke Peter , Lusardi Andrea C. , Matava Clyde , Peyton James , Riva Thomas , Romero Carolina S. , von Ungern-Sternberg Britta , Veyckemans Francis , Afshari Arash
Published: November 2023

Airway management is required during general anaesthesia and is essential for life-threatening conditions such as cardiopulmonary resuscitation. Evidence from recent trials indicates a high incidence of critical events during airway management, especially in neonates or infants. It is important to define the optimal techniques and strategies for airway management in these groups. In this joint European Society of Anaesthesiology and Intensive Care (ESAIC) and British Journal of Anaesthesia (BJA) guideline on airway management in neonates and infants, we present aggregated and evidence-based recommendations to assist clinicians in providing safe and effective medical care. We identified seven main areas of interest for airway management: i) preoperative assessment and preparation; ii) medications; iii) techniques and algorithms; iv) identification and treatment of difficult airways; v) confirmation of tracheal intubation; vi) tracheal extubation, and vii) human factors. Based on these areas, Population, Intervention, Comparison, Outcomes (PICO) questions were derived that guided a structured literature search. GRADE (Grading of Recommendations, Assessment, Development and Evaluation) methodology was used to formulate the recommendations based on those studies included with consideration of their methodological quality (strong ‘1’ or weak ‘2’ recommendation with high ‘A’, medium ‘B’ or low ‘C’ quality of evidence). In summary, we recommend: 1. Use medical history and physical examination to predict difficult airway management (1С). 2. Ensure adequate level of sedation or general anaesthesia during airway management (1B). 3. Administer neuromuscular blocker before tracheal intubation when spontaneous breathing is not necessary (1С). 4. Use a videolaryngoscope with an age-adapted standard blade as first choice for tracheal intubation (1B). 5. Apply apnoeic oxygenation during tracheal intubation in neonates (1B). 6. Consider a supraglottic airway for rescue oxygenation and ventilation when tracheal intubation fails (1B). 7. Limit the number of tracheal intubation attempts (1C). 8. Use a stylet to reinforce and preshape tracheal tubes when hyperangulated videolaryngoscope blades are used and when the larynx is anatomically anterior (1C). 9. Verify intubation is successful with clinical assessment and end-tidal CO2 waveform (1C). 10. Apply high-flow nasal oxygenation, continuous positive airway pressure or nasal intermittent positive pressure ventilation for postextubation respiratory support, when appropriate (1B).
MRI of caval compression during left-lateral tilt in singleton and twin pregnancies
Authors: Fujita Nobuko , Higuchi Hideyuki , Yonekura Yuki
Published: November 2023

BACKGROUND

It is unclear how different degrees of left-lateral tilt affect the volumes of the abdominal aorta and inferior vena cava (IVC) in pregnancy.

OBJECTIVE

To use magnetic resonance images to assess the volumes of the abdominal aorta and IVC in women with twin or singleton pregnancies in different degrees of left-lateral tilt.

DESIGN

Prospective cohort study.

SETTING

A single-centre university hospital.

PATIENTS

Women with singleton pregnancies (13) and twin pregnancies (13) at 32 to 38 weeks’ gestation.

MAIN OUTCOME MEASURES

Comparison of abdominal aortic and IVC volumes measured by MRI in women with singleton and twin pregnancies while in the supine or left-lateral tilt position at 15°, 30° and 45°.

RESULTS

Supine, the mean aortic and IVC volumes were not significantly different between the women with singleton and twin pregnancies. In a left-lateral tilt position of 15o compared with supine, the mean IVC volume was not increased in either group (singletons: 6.3 ± 6.6 ml, 95% CI, −2.4 to 0.4; P = 0.174; twins: 3.9 ± 2.4 ml, 95% CI, −2.6 to 0.4; P = 0.138). At tilt angles of 30° or 45°, the mean IVC volume significantly increased (singletons 30°: 9.7 ± 5.8 ml, 95% CI, −6.1 to −2.7; P < .001; singleton 45°:13.8 ± 5.0 ml, 95% CI, −11.3 to −5.7; P < .001; twins 30°: 5.7 ± 2.1 ml, 95% CI, −4.0 to −1.4; P < .001; twins 45°: 12.8 ± 9.4 ml, 95% CI, −17.2 to −2.6; P = 0.003). Aortic volume was not significantly increased in either group at any of the examined tilt angles compared with the supine.

CONCLUSION

IVC volume is significantly increased by 30° and 45° left-lateral tilt positions compared with supine in women with singleton and twin pregnancies.

TRIAL REGISTRATION

This study was registered in the University Hospital Medical Information Network (UMIN) clinical trial registration (# UMIN000031273).
Longitudinal analysis of microvascular changes in sickle cell disease using swept-source optical coherence tomography angiography
Authors: ENJALBERT Aurélie , GIOCANTI-AUREGAN Audrey , FAJNKUCHEN Franck , TORRES-VILLAROS Héloïse
Published: November 2023

Purpose:

To analyze the changes in macular vascular densities (VD) and foveal avascular zone (FAZ) over a 6-year period using swept-source optical coherence tomography angiography (OCTA) in sickle cell patients compared to unaffected controls.

Methods:

Thirty eyes of sickle cell patients and 12 eyes of unaffected controls matched for age and ethnicity were examined at a 6-year interval using the same imaging protocol, including ultra-wide-field angiography, swept-source OCT and 3x3mm OCTA. The macular VD and FAZ were measured on ImageJ software according to previously reported algorithms.

Results:

In sickle cell eyes, the mean FAZ significantly increased (p <0.01), and the VD decreased in the foveal (within a circle of 1.5 mm in diameter around the foveal center) and temporal areas in both the superficial and deep capillary plexuses (p <0.01). The VD did not change over time in the parafoveal area (annulus between two circles of 1.5 and 3 mm in diameter) and in the superior, inferior, and nasal sectors. No worsening of peripheral retinopathy was observed in the cohort during the follow-up, except for one eye that developed sea-fan. In the control eyes, no microvascular change was observed over time in terms of FAZ size and VD.

Conclusion:

These longitudinal OCTA findings in sickle cell patients showed an enlargement of the FAZ and a decrease in VD in the temporal and perifoveal regions despite the absence of progression of peripheral retinopathy, suggesting a worsening of the macular non-perfusion over time in sickle cell disease.
Vision Correction Habits After COVID-19 Onset in Spectacle and Contact Lens Wearers
Authors: Rueff Erin M. , Chen Elaine Y. , Nguyen Andrew Loc
Published: November 2023

Purpose:

To determine how vision correction habits changed after the 2019 coronavirus disease (COVID-19) pandemic onset.

Methods:

Participants reported vision correction habits, refractive error, screen time, mask wearing time, and dry eye symptoms since the COVID-19 pandemic onset through email survey.

Results:

A total of 133 participants completed the survey. Worsening dry eye symptoms were associated with increased screen time (P=0.04). Hours per day of spectacle wear increased by approximately 1 hr (P=0.001) and was associated with increased screen time (P=0.002). Worsening dry eye symptoms were associated with increased days per week of spectacle wear (P=0.02). Participants wore contact lenses about one day per week less than before the pandemic (P=0.0001). Increased mask wearing time was associated with increased days per week of contact lens wear (P=0.03).

Conclusions:

After pandemic onset, hours per day of spectacle wear increased, and days per week of contact lens wear decreased. Increases in hourly spectacle wear were associated with increased screen time, whereas increased daily contact lens wear was associated with increased mask wear time, suggesting that spectacles may be preferred for screen time activities and contact lenses for mask wear.
Validation of peritoneal neutrophil gelatinase-associated lipocalin as a biomarker for peritonitis: A comparison between laboratory-base method and rapid stick test
Authors: Morisi Niccolò , Virzì Grazia Maria , Barajas José David Gonzàlez , Diaz-Villavicencio Bladimir , Manani Sabrina Milan , Zanella Monica
Published: November 2023

Background:

Neutrophil gelatinase-associated lipocalin (NGAL) is a multifunctional protein with roles beyond biomarker status, influencing critical processes. This study aimed to assess dipstick test for NGAL (NGALds), a novel dipstick test, against the established laboratory-based NGAL (NGALlab) method for early peritonitis detection, focusing on peritoneal fluid analysis to provide a rapid and cost-effective diagnostic tool for peritonitis management.

Methods:

Conducted at San Bortolo Hospital, Italy, this retrospective study collected samples from suspected or confirmed peritonitis cases between May 1, 2021, and December 31, 2021. Samples included peritoneal dialysate effluents (PDE) and underwent white blood cell counts, NGALds, NGALlab, and effluent culture.

Results:

The study analyzed 27 peritonitis cases, involving 133 PDE samples from 22 patients. NGALds exhibited a strong correlation (Rs = 0.732, P < 0.05) with NGALlab, particularly for medium to high-risk peritonitis cases, with a 98% accuracy rate.

Conclusion:

NGALds effectively aligns with NGALlab for peritonitis diagnosis, offering a valuable diagnostic tool, particularly suitable for point-of-care and resource-limited healthcare settings. Further research should investigate its correlation with neutrophil levels in PDE, solidifying NGALds as an accessible and efficient resource for peritonitis management.
The Effectiveness of Instruction on Lumbar Spine Thrust Joint Manipulation Task Performance
Authors: Manton Cory , Conley Quincy , Cleland Joshua A. , Puentedura Emilio J.
Published: November 2023

Introduction.

Uncertainty exists regarding the best method for teaching thrust joint manipulation (TJM) to student physical therapists. The purpose of this study was to compare the effectiveness of Peyton's 4-step (P4) approach with the “see one, do one” (S1D1) approach for teaching students to perform a lumbar spine TJM task in an academic setting. Secondary objectives were to compare the effects of each instructional approach on students' attitudes and beliefs toward spinal TJM and on their motivation to learn to perform lumbar spine TJM.

Review of Literature.

The S1D1 approach is used in the health care professions for teaching clinical tasks to students. It is unclear whether the P4 approach may better prepare students to practice TJM.

Subjects.

Student physical therapists.

Methods.

Using a factorial quasi-experimental design, an equal number of students were assigned to a P4 or S1D1 instruction group for the TJM task. Students' performance accuracy, time, and outcome performing TJM in an academic setting were measured. Paper surveys were used to collect data about students' attitudes and beliefs toward spinal TJM and their motivation to learn TJM. A generalized estimating equations approach was used for data analysis.

Results.

Fifty-eight students (29 per group) completed the study. There was an interaction between the instruction group and time on task performance accuracy favoring the P4 approach (P = .03). There was no interaction between the instruction group and task performance time, task performance outcome, attitudes and beliefs toward spinal TJM, or motivation to learn TJM (all P > .19).

Discussion and Conclusion.

The P4 approach more effectively improved student accuracy when performing the TJM task in an academic setting than the S1D1 approach. However, no differences between instruction were found for performance time or outcome. Students reported a favorable perception of learning lumbar spine TJM. These preliminary results suggest that instructors may use the P4 approach to improve students' TJM procedural knowledge before task practice. However, limitations of the study may affect the internal validity and generalizability of results.
Representation of Racial Minorities in the United States Colonoscopy Surveillance Interval Guidelines
Authors: Zuberi Shaharyar A. , Burdine Lauren , Dong Jeffrey , Feuerstein Joseph D.
Published: November 2023

Background/Aims:

Clinical guidelines should ideally be formulated from data representative of the population they are applicable to; however, historically, studies have disproportionally enrolled non-Hispanic White (NHW) patients, leading to potential inequities in care for minority groups. Our study aims to evaluate the extent to which racial minorities were represented in the United States Colorectal Cancer Surveillance Guidelines.

Methods:

We reviewed US guidelines between 1997 and 2020 and all identified studies cited by recommendations for surveillance after a baseline colonoscopy with no polyps, adenomas, sessile serrated polyps, and hyperplastic polyps. We analyzed the proportion of studies reporting race, and among these studies, we calculated the racial distribution of patients and compared the proportion of Non-NHW patients between each subtype.

Results:

For all guidelines, we reviewed 75 studies encompassing 9,309,955 patients. Race was reported in 24% of studies and 14% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for adenomas, 22% for sessile serrated polyps, and 15% for hyperplastic polyps. For the 2020 guidelines, we reviewed 33 studies encompassing 5,930,722 patients. Race was reported in 15% of studies and 21% of total patients. Non-NHW comprised 43% of patients in studies for normal colonoscopies, compared with 9% for tubular adenomas. Race was not cited for any other 2020 guideline.

Conclusion:

Racial minorities are significantly underrepresented in US Colorectal Cancer Surveillance Guidelines, which may contribute to disparities in care. Future studies should prioritize enrolling a diverse patient population to provide data that accurately reflects their population.
Change in Biologic Class Promotes Endoscopic Remission Following Endoscopic Postoperative Crohn’s Disease Recurrence
Authors: Bachour Salam P. , Shah Ravi S. , Joseph Abel , Syed Hareem , Ali Adel Hajj , Rieder Florian , Barnes Edward L. , Axelrad Jordan , Holubar Stefan D. , Regueiro Miguel , Cohen Benjamin L. , Click Benjamin H.
Published: November 2023

Goals:

Assess the outcomes of various therapeutic regimens to treat initial endoscopic postoperative recurrence despite biologic prophylaxis.

Background:

Postoperative biologic prophylaxis reduces postoperative Crohn’s disease (CD) recurrence rates. Optimal treatment strategies for endoscopic recurrence have not been elucidated.

Study:

Retrospective cohort study of adult CD patients who underwent ileocolonic resection between 2009 and 2020. Patients with endoscopic postoperative recurrence despite prophylactic biologic therapy and ≥1 subsequent colonoscopy were included. Treatment changes after recurrence were categorized as (1) therapy optimization or continuation or (2) new biologic class. The primary outcome was composite endoscopic or surgical recurrence at the time of or prior to subsequent follow-up colonoscopy.

Results:

Eighty-one CD patients with endoscopic recurrence (54.3% i2b, 22.2% i3, and 23.5% i4) despite biologic prophylaxis (86.4% anti-tumor necrosis factor, 8.6% vedolizumab, 4.9% ustekinumab) were included. Most patients received therapy optimization or continuation (76.3%, n=61) following recurrence compared to being started on a new biologic class. Sixty patients (N=48 therapy optimization; N=12 new biologic class) experienced composite recurrence (78.3% endoscopic, 21.7% surgical). On multivariable modeling, initiation of a new biologic class was associated with reduced risk for composite recurrence compared to therapy optimization or continuation (aOR: 0.26; P=0.04). Additionally, initiation of a new biologic class was associated with endoscopic improvement when adjusting for endoscopic severity at the time of recurrence (aOR: 3.4; P=0.05). On sensitivity analysis, a new biologic class was associated or trended with improved rates of endoscopic healing and composite recurrence when directly compared to therapy optimization or continuation.

Conclusion:

In patients with CD who experience endoscopic recurrence despite biologic prophylaxis, changing the mechanism of biologic action may promote endoscopic improvement.
Disparities in Rates of Multitarget Stool DNA Test Completion for Colorectal Cancer Screening
Authors: Dong Jeffrey , Said Hyder , Miller Samuel J. , Systrom Hannah K. , Feuerstein Joseph D.
Published: November 2023

Goals:

The aim was to assess patient adherence to multitarget stool DNA testing as well as factors associated with adherence.

Background:

In the United States, disparities in colorectal cancer screening exist along racial and socioeconomic lines. While some studies suggest that stool-based screening tests may help reduce the screening gap, the data for multitarget stool DNA testing is unclear.

Study:

We conducted a single-center retrospective cohort study on multitarget stool DNA testing ordered between April 2020 and July 2021. We calculated the proportion of patients who completed testing and used multivariate logistic regression to identify covariates associated with test adherence.

Results:

Among 797 patients ordered for multitarget stool DNA testing, 481 patients (60.4%) completed testing. Adherence rates by patient subgroups ranged from 35.8% to 78.1%. Higher test adherence was found in Asian patients (odds ratio 2.65, 95% CI 1.36-5.18) and those who previously completed colorectal cancer screening (OR 1.45, 95% CI 1.01-2.09), while Black patients (OR 0.58, 95% CI 0.39-0.87), patients with resident primary care physicians (OR 0.34, 95% CI 0.21-0.56), and patients contacted through an outreach program (OR 0.47, 95% CI 0.25-0.87) had lower adherence.

Conclusions:

A significant proportion of patients ordered for multitarget stool DNA testing did not complete testing. Differences in adherence rates among patient subgroups may be reflective of underlying disparities in health care access.
Fecal Microbiota, Live-jslm for the Prevention of Recurrent Clostridioides difficile Infection
Authors: Feuerstadt Paul , Crawford Carl V. , Tan Xing , Pokhilko Victoria , Bancke Lindy , Ng Samson , Guthmueller Beth , Bidell Monique R. , Tillotson Glenn , Johnson Stuart , Skinner Andrew M.
Published: November 2023

Goals:

To assess fecal microbiota, live-jslm (REBYOTA, abbreviated as RBL, formerly RBX2660) efficacy and safety in participants grouped by recurrent Clostridioides difficile infection (rCDI) risk factors and treatment-related variables.

Background:

RBL is the first microbiota-based live biotherapeutic approved by the US Food and Drug Administration for the prevention of rCDI in adults after antibiotic treatment for rCDI.

Study:

Treatment success rates across subgroups for PUNCH CD3 (NCT03244644) were estimated using a Bayesian hierarchical model, borrowing data from PUNCH CD2 (NCT02299570). Treatment-emergent adverse events were summarized for the double-blind treatment period within 8 weeks.

Results:

Treatment differences between RBL and placebo at 8 weeks were similar to the total population for most subgroups. Treatment effect sizes were similar between CDI tests, higher for oral vancomycin courses >14 days versus ≤14 days and higher for antibiotic washout periods of 3 days versus ≤2 days. The largest reductions in the rate of rCDI with RBL versus placebo were observed for participants with a 3-day CDI antibiotic washout period and participants with ≥4 previous CDI episodes. Most RBL-treated participants experienced TEAEs that were mild or moderate in severity and related to preexisting conditions.

Conclusion:

This analysis provides further evidence of RBL efficacy and safety across subgroups, including those at high risk for rCDI.
Cold Versus Hot Endoscopic Mucosal Resection for Sessile Serrated Colorectal Polyps ≥10 mm
Authors: Malik Talia F. , Mohan Babu P. , Deliwala Smit , Kassab Lena L. , Chandan Saurabh , Sharma Neil R. , Adler Douglas G.
Published: November 2023

Introduction:

We performed a systematic review and meta-analysis studying the efficacy and safety of cold versus hot endoscopic mucosal resection (EMR) for resection of sessile serrated polyps (SSPs) ≥10 mm.

Methods:

Multiple databases were searched until January 2023 for studies reporting outcomes of cold versus hot EMR for SSPs ≥10 mm. The primary outcome was the residual SSP rate. Secondary outcomes included technical success rate, R0 resection rate, and adverse events. We used standard meta-analysis methods using the random-effects model, and I
2% was used to assess heterogeneity.

Results:

Thirteen studies were included in the final analysis. In all, 1896 SSPs were included with a mean polyp size of 23.7 mm (range, 15.9 to 33). A total of 1452 SSPs were followed up for a median follow-up duration of 15.3 months (range, 6 to 37). The pooled residual SSP rate for cold EMR was 4.5% (95% CI: 1.0-17.4), and 5.1% (95% CI: 2.4-10.4) for hot EMR (P=0.9). The pooled rates of technical success, R0 resection, immediate bleeding, and perforation were comparable. Hot EMR was significantly associated with lower piecemeal resection (59.2% vs. 99.3%, P<0.001), higher en-bloc resection (41.4% vs. 1.4%, P<0.001), and delayed bleeding rate (4% vs. 0.7%, P=0.05) compared to cold EMR.

Conclusions:

Cold EMR has similar efficacy compared to hot EMR for resection of SSP ≥ 10 mm, despite limitations in piecemeal R0 resection rate reporting. Although hot EMR was associated with a higher rate of en-bloc resection, it also showed an increased risk of delayed bleeding compared to cold EMR.
Thrombotic microangiopathy – the importance of a multidisciplinary approach
Authors: Tran Minh-Ha , Patel Samir , Desai Sheetal , Ciurea Stefan , Lee Benjamin J. , Hanna Ramy
Published: November 2023

Purpose of review

The purpose of this review is to highlight the importance of a multidisciplinary thrombotic microangiopathies (TMA) Team. This goal will be accomplished through review of the complement system, discuss various causes of thrombotic microangiopathies (TMA), and aspects of their diagnosis and management. In so doing, readers will gain an appreciation for the complexity of this family of disorders and realize the benefit of a dedicated multidisciplinary TMA Team.

Recent findings

TMA causes derive from multiple specialty areas, are difficult to timely recognize, pose complex challenges, and require multidisciplinary management. Hematopoietic stem cell transplant-associated TMA (TA-TMA) and TA-TMA related multiorgan dysfunction syndrome (TA-TMA MODS) are areas of burgeoning research; use of complement testing and eculizumab precision-dosing has been found to better suppress complement activity in TA-TMA than standard eculizumab dosing. Newer tests are available to risk-stratify obstetric patients at risk for severe pre-eclampsia, whose features resemble those of TA-TMA MODS. Numerous disorders may produce TMA-like findings, and a systematic approach aids in their identification. TMA Teams elevate institutional awareness of increasingly recognized TMAs, will help expedite diagnostic and therapeutic interventions, and create pathways to future TMA-related research and facilitate access to clinical trials.

Establishment of a TMA-Team is valuable in developing the necessary institutional expertise needed to promptly recognize and appropriately manage patients with TMA.
Optical Genome Mapping Reveals Novel Structural Variants in Lymphoblastic Lymphoma
Authors: Xu Hanli , Gao Huixia , Wang Chanjuan , Cheng Xiyu , Li Zhigang , Lei Cui , Huang XiaoTong , Li Weijing , Yue Zhixia , Tian Shuo , Zhao Xiaoxi , Xue Tianlin , Xing Tianyu , Li Jun , Wang Ying , Duan Yanlong , Wang Tianyou , Zhang Ruidong
Published: November 2023

Background:

Accurate histologic and molecular genetic diagnosis is critical for the pathogenesis study of pediatric patients with lymphoblastic lymphoma (LBL). Optical genome mapping (OGM) as all-in-one process allows the detection of most major genomic risk markers, which addresses some of the limitations associated with conventional cytogenomic testing, such as low resolution and throughput, difficulty in ascertaining genomic localization, and orientation of segments in duplication, inversions, and insertions. Here, for the first time, we examined the cytogenetics of 5 children with LBL using OGM.

Methods:

OGM was used to analyze 5 samples of pediatric LBL patients treated according to the modified NHL-BFM95 backbone regimen. Whole-exon Sequencing (WES) was used to confirm the existence of structural variants (SVs) identified by OGM with potentially clinical significance on MGI Tech (DNBSEQ-T7) platform. According to the fusion exon sequences revealed by WES, the HBS1L::AHI1 fusion mRNA in case 4 was amplified by cDNA-based PCR.

Results:

In total, OGM identified 251 rare variants (67 insertions, 129 deletions, 3 inversion, 25 duplications, 15 intrachromosomal translocations, and 12 interchromosomal translocations) and 229 copy number variants calls (203 gains and 26 losses). Besides all of the reproducible and pathologically significant genomic SVs detected by conventional cytogenetic techniques, OGM identified more SVs with definite or potential pathologic significance that were not detected by traditional methods, including 2 new fusion genes, HBS1L::AHI1 and GRIK1::NSDHL, which were confirmed by WES and/or Reverse Transcription-Polymerase Chain Reaction.

Conclusions:

Our results demonstrate the feasibility of OGM to detect genomic aberrations, which may play an important role in the occurrence and development of lymphomagenesis as an important driving factor.
Sirolimus-induced Hypertriglyceridemia Leads to Acute Pancreatitis and Diabetic Ketoacidosis Post Stem Cell Transplant for Sickle Cell Disease
Authors: Paul Subhasish , Nirmal Garima , Chadha Vaibhav , Sharma Rahul , Kochar IPS , Jerath Namith , Vohra Rohit , Kharya Gaurav
Published: November 2023

Sirolimus (mammalian target of rapamycin inhibitor) is a potent immunosuppressive agent, used in patients receiving hematopoietic stem cell transplant (HSCT) for Graft vs Host disease prophylaxis. Compared to calcineurin inhibitors, sirolimus has no neurotoxicity or nephrotoxicity, but sirolimus causes dose-dependent thrombocytopenia, leukopenia, delayed wound healing, hyperlipidemia, and hypertriglyceridemia. Here we report a case of acute pancreatitis and diabetic ketoacidosis in a patient with sickle cell disease post haploidentical family donor HSCT which was managed conservatively without plasmapheresis. Based on our review of the literature, this is the first reported case of developing acute pancreatitis as an adverse effect of sirolimus-induced hypertriglyceridemia leading to diabetic ketoacidosis in a recipient of HSCT.
Paul Harry Roberts. 13 September 1929—17 November 2022
Authors: Soward FRS Andrew Michael
Published: November 2023

Paul Roberts was a physicist and applied mathematician. He made important and often pioneering contributions in diverse research areas, but mainly with a fluid dynamic theme, which include rotating fluids, geophysical and astrophysical flows and superfluids. The cornerstone was magnetohydrodynamics with particular application to the geodynamo. His most notable achievement was the first three-dimensional self-consistent numerical geodynamo model, which built on the equations he had derived previously governing the Earth's core dynamics. His considerations included the role of thermal and compositional convection, and the inner core boundary layer (a mixed phase region). In addition to his remarkable illustration of magnetic field reversals, he applied his model to core–mantle coupling and variations in the length of the day. Paul investigated superfluid liquid helium on two fronts. He had a lifelong interest in Bose–Einstein condensates on the microscale governed by the nonlinear Schrodinger equation. His early work on the robust derivation of the mean-field Hall–Vinen–Bekharevic–Khalatnikov equations was far ahead of its time. Their importance and relevance was not appreciated until much later.
Social uncertainty promotes signal complexity during approaches in wild chimpanzees (
Pan troglodytes verus
) and mangabeys (
Cercocebus atys atys
)
Authors: Grampp Mathilde , Samuni Liran , Girard-Buttoz Cédric , León Julián , Zuberbühler Klaus , Tkaczynski Patrick , Wittig Roman M. , Crockford Catherine
Published: November 2023

The social complexity hypothesis for the evolution of communication posits that complex social environments require greater communication complexity for individuals to effectively manage their relationships. We examined how different socially uncertain contexts, reflecting an increased level of social complexity, relate to variation in signalling within and between two species, which display varying levels of fission–fusion dynamics (sympatric-living chimpanzees and sooty mangabeys, Taï National Park, Ivory Coast). Combined signalling may improve message efficacy, notably when involving different perception channels, thus may increase in moments of high social uncertainty. We examined the probability of individuals to emit no signal, single or multisensory or combined (complex) signals, during social approaches which resulted in non-agonistic outcomes. In both species, individuals were more likely to use more combined and multisensory signals in post-conflict approaches with an opponent than in other contexts. The clearest impact of social uncertainty on signalling complexity was observed during chimpanzee fusions, where the likelihood of using complex signals tripled relative to other contexts. Overall, chimpanzees used more multisensory signals than mangabeys. Social uncertainty may shape detected species differences in variation in signalling complexity, thereby supporting the hypothesis that social complexity, particularly associated with high fission–fusion dynamics, promotes signalling complexity.