bluuebunny/crossref_metadata_2025 huggingface dataset:
Integrated, person-centred care for patients with complex cardiovascular disease, diabetes mellitus and chronic kidney disease: a randomized trial
Authors: Evén Gudrun , Stenfors Terese , Jacobson Stefan H , Jernberg Tomas , Franzén-Dahlin Åsa , Jäghult Susanna , Kahan Thomas , Spaak Jonas
Published: October 2024

Background

Patients with cardiovascular disease (CVD), diabetes mellitus (DM) and chronic kidney disease (CKD) often experience fragmented care, which negatively impacts outcomes and health-related quality of life (HRQoL). This study assessed whether multidisciplinary, person-centred care at an integrated clinic improves clinical outcomes and HRQoL.

Methods

This prospective, open, blinded-endpoint trial (CareHND; NCT03362983) included 131 patients with CVD, DM and CKD stages 3–4, most of whom were enrolled during or shortly after acute hospitalization. The intervention group received person-centred care from cardiologists, nephrologists, endocrinologists and specialist nurses at an integrated clinic; the control group received traditional care from separate specialists. Primary disease progression outcome was the composite of major adverse renal and cardiovascular events (MARCE) including death, heart failure (HF) readmission, myocardial infarction, percutaneous coronary intervention/coronary artery bypass graft, acute or end-stage kidney failure, or transient ischaemic attack/stroke at 2 years. Co-primary person-centred outcomes was self-reported HRQoL by RAND-36.

Results

In a pre-specified interim analysis, patients randomized to integrated care had lower estimated glomerular filtration rate and higher NT-proBNP (N-terminal pro brain natriuretic peptide) than traditional care. Follow-up ranged from 2.0 to 5.7 years. Kaplan–Meier analysis showed no difference in MARCE between groups. Cox-regression adjusting for baseline differences, indicated a trend towards reduced HF hospitalizations for integrated care (hazard ratio 0.53; confidence interval 0.28–1.01; P = .054). Integrated care improved role physical and social function scores, and self-rated health (P = .021, P = .019 and P = .011, respectively).

Conclusions

Integrated care improved several dimensions of HRQoL but did not improve MARCE compared with traditional care in this small trial. We observed a trend towards reduced HF hospitalizations. Overall, integrated care presents a promising alternative.
Comparison of strategies for vascular ACCESS closure after Transcatheter Aortic Valve Implantation: the ACCESS-TAVI randomized trial
Authors: Rheude Tobias , Ruge Hendrik , Altaner Niklas , Pellegrini Costanza , Alvarez Covarrubias Hector , Mayr Patrick , Cassese Salvatore , Kufner Sebastian , Taniguchi Yousuke , Thilo Christian , Klos Markus , Erlebach Magdalena , Schneider Simon , Jurisic Martin , Laugwitz Karl-Ludwig , Lange Rüdiger , Schunkert Heribert , Kastrati Adnan , Krane Markus , Xhepa Erion , Joner Michael
Published: October 2024

Background and Aims

Data from randomized trials investigating different access closure strategies after transfemoral transcatheter aortic valve implantation (TF-TAVI) remain scarce. In this study, two vascular closure device (VCD) strategies to achieve haemostasis after TF-TAVI were compared.

Methods

The ACCESS-TAVI (Comparison of Strategies for Vascular ACCESS Closure after Transcatheter Aortic Valve Implantation) is a prospective, multicentre trial in which patients undergoing TF-TAVI were randomly assigned to a strategy with a combined suture-/plug-based VCD strategy (suture/plug group) using one ProGlide™/ProStyle™ (Abbott Vascular) and one Angio-Seal® (Terumo) vs. a suture-based VCD strategy (suture-only group) using two ProGlides™/ProStyles™. The primary endpoint was a composite of major or minor access site-related vascular complications during index hospitalization according to Valve Academic Research Consortium 3 criteria. Key secondary endpoints included time to haemostasis, bleeding type ≥ 2, and all-cause mortality over 30 days.

Results

Between September 2022 and April 2024, 454 patients were randomized. The primary endpoint occurred in 27% (62/230) in the suture/plug group and 54% (121/224) in the suture-only group [relative risk .55 (95% confidence interval: .44, .68); P < .001]. Time to haemostasis was significantly shorter in the suture/plug group compared with the suture-only group (108 ± 208 s vs. 206 ± 171 s; P < .001). At 30 days, bleeding type ≥ 2 occurred less often in the suture/plug group compared with the suture-only group [6.2% vs. 12.1%, relative risk .66 (.43, 1.02); P = .032], with no significant difference in mortality.

Conclusions

With regard to the composite of major or minor access site-related vascular complications, a combined suture-/plug-based VCD strategy was superior to a suture-based VCD strategy for vascular access closure in patients undergoing TF-TAVI.
Genome-Wide Comparisons Reveal Extensive Divergence Within the Lichen Photobiont Genus, Trebouxia
Authors: Poquita-Du Rosa Celia , Otte Jürgen , Calchera Anjuli , Schmitt Imke
Published: October 2024

The green algal genus Trebouxia is the most frequently encountered photobiont of the lichen symbiosis. The single-celled symbionts have a worldwide distribution, including all continents and climate zones. The vast, largely undescribed, diversity of Trebouxia lineages is currently grouped into four phylogenetic clades (A, C, I, and S), based on a multilocus phylogeny. Genomes are still scarce, however, and it is unclear how the phylogenetic diversity, the broad ecological tolerances, and the ability to form symbioses with many different fungal host species are reflected in genome-wide differences. Here, we generated PacBio-based de novo genomes of six Trebouxia lineages belonging to the Clades A and S, isolated from lichen individuals of the genus Umbilicaria. Sequences belonging to Clade S have been reported in a previous study, but were reassembled and reanalyzed here. Genome sizes ranged between 63.08 and 73.88 Mb. Repeat content accounted for 9% to 16% of the genome sequences. Based on RNA evidence, we predicted 14,109 to 16,701 gene models per genome, of which 5,203 belonged to a core set of gene families shared by all 6 lineages. Between 121 and 454, gene families are specific to each lineage. About 53% of the genes could be functionally annotated. The presence of biosynthetic gene clusters (6 to 17 per genome) suggests that Trebouxia algae are able to synthesize alkaloids, saccharides, terpenes, NRPSs, and T3PKSs. Phylogenomic comparisons of the six strains indicate prevalent gene gain during Trebouxia evolution. Some of the gene families that exhibited significant evolutionary changes (i.e. gene expansion and contraction) are associated with metabolic processes linked to protein phosphorylation, which is known to have a role in photosynthesis regulation, particularly under changing light conditions. Overall, there is substantial genomic divergence within the algal genus Trebouxia, which may contribute to the genus’ large ecological amplitude concerning fungal host diversity and climatic niches.
Challenges in Assembling the Dated Tree of Life
Authors: Schrago Carlos G , Mello Beatriz
Published: October 2024

The assembly of a comprehensive and dated Tree of Life (ToL) remains one of the most formidable challenges in evolutionary biology. The complexity of life's history, involving both vertical and horizontal transmission of genetic information, defies its representation by a simple bifurcating phylogeny. With the advent of genome and metagenome sequencing, vast amounts of data have become available. However, employing this information for phylogeny and divergence time inference has introduced significant theoretical and computational hurdles. This perspective addresses some key methodological challenges in assembling the dated ToL, namely, the identification and classification of homologous genes, accounting for gene tree-species tree mismatch due to population-level processes along with duplication, loss, and horizontal gene transfer, and the accurate dating of evolutionary events. Ultimately, the success of this endeavor requires new approaches that integrate knowledge databases with optimized phylogenetic algorithms capable of managing complex evolutionary models.
Parental-effect gene-drive elements under partial selfing, or why do Caenorhabditis genomes have hyperdivergent regions?
Authors: Rockman Matthew V
Published: October 2024

Self-fertile Caenorhabditis nematodes carry a surprising number of Medea elements, alleles that act in heterozygous mothers and cause death or developmental delay in offspring that do not inherit them. At some loci, both alleles in a cross operate as independent Medeas, affecting all the homozygous progeny of a selfing heterozygote. The genomic coincidence of Medea elements and ancient, deeply coalescing haplotypes, which pepper the otherwise homogeneous genomes of these animals, raises questions about how these apparent gene-drive elements persist for long periods of time. Here, I investigate how mating system affects the evolution of Medeas, and their paternal-effect counterparts, peels. Despite an intuition that antagonistic alleles should induce balancing selection by killing homozygotes, models show that, under partial selfing, antagonistic elements experience positive frequency dependence: the common allele drives the rare one extinct, even if the rare one is more penetrant. Analytical results for the threshold frequency required for one allele to invade a population show that a very weakly penetrant allele, one whose effects would escape laboratory detection, could nevertheless prevent a much more penetrant allele from invading under high rates of selfing. Ubiquitous weak antagonistic Medeas and peels could then act as localized barriers to gene flow between populations, generating genomic islands of deep coalescence. Analysis of gene expression data, however, suggests that this cannot be the whole story. A complementary explanation is that ordinary ecological balancing selection generates ancient haplotypes on which Medeas can evolve, while high homozygosity in these selfers minimizes the role of gene drive in their evolution.
Effect of integrated medicines management on quality of discharge medication information—a secondary endpoint in a randomized controlled trial
Authors: Mathiesen Liv , Nguyen Tram Bich Michelle , Dæhlen Ingrid , Mowé Morten , Lea Marianne
Published: October 2024

Background

High-quality discharge information is important to promote patient safety when patients are transferred from hospital to primary care. Patients with multiple long-term conditions are especially vulnerable to insufficient transfer of medication information, as they use many medications and have complex interactions with the healthcare services. The aim of this study was to investigate the effect of integrated medicines management provided to hospitalized multimorbid patients on the quality of the discharge medication information.

Methods

Multimorbid patients ≥18 years, using a minimum of four regular medications from a minimum of two therapeutic medication classes were recruited from the Internal Medicine ward, Oslo University Hospital, Norway, from August 2014 to March 2016 and randomly assigned, 1:1, to the intervention or control group. Intervention patients received integrated medicines management throughout the hospital stay. Control patients received standard care. This paper reports the results of a prespecified secondary endpoint analysis of the randomized controlled trial; the difference between the intervention and control group in the quality of discharge medication information.

Results

The analysis population comprised 384 patients. Integrated medicines management improved the discharge summary quality score of the medication information from 5.8 ± 1.5 to 8.6 ± 2.6 [mean difference 2.7, 95% confidence interval (CI) 2.3–3.2, P < .001]. In total, 171 intervention patients (89%) received a patient discharge information letter, compared to 66 control patients (35%), P < .001. The quality score of the medication information in the patient discharge information letter was improved from 6.0 ± 1.8 in the control group to 10.0 ± 1.3 in the intervention group (mean difference 4.0, 95% CI 3.6–4.4, P < .001).

Conclusion

Integrated medicines management delivered to multimorbid patients during a hospital stay improved the quality of the medication information in discharge summaries as well as patient discharge information letters and ensured that a discharge information letter in lay language was prepared for almost all patients who were involved in the management of their medications after discharge.
Antimicrobial use in hospitalized patients: a point prevalence survey across four tertiary hospitals in Niger
Authors: Tapha Ounoussa , Degbey Cyriaque Comlan , Yacouba Abdourahamane , Mahouna Tchioundjro Espère , Nadakou N’Kpingou Théodore , Alkassoum Salifou Ibrahim , Moussa Saley Sahada , Daou Mamane , Brah Souleymane , Omar Adehossi Eric , Vikkey Hinson Antoine , Mamadou Saidou
Published: October 2024

Background

Antimicrobial resistance (AMR) is a global threat to public health. Misuse or overuse of antimicrobials contributes to the emergence of AMR. Data on antimicrobial prescribing represent the cornerstone for guiding antimicrobial stewardship strategies. This study aimed to assess the use, indications, classification, and quality indicators of antimicrobials prescribed to patients in four tertiary hospitals in Niger.

Methods

This cross-sectional study used the methodology for Global Point Prevalence Surveys in tertiary hospitals between January and April 2024. Hospital records of all inpatients on admission at 08:00 hours on a specific day were reviewed for antimicrobial use during the survey.

Results

The overall prevalence of antibiotic use across hospitals was 54.5% (n = 470/862), ranging between 66.2% (n = 149/234) and 44.3% (n = 183/258). Most antibiotics used were antibacterials (89.0%, n = 637). Third-generation cephalosporins (48.2%, 307/637), imidazole derivatives (14.7%, 105/716), penicillins with extended spectrum (9.6%, 69/716), and fluoroquinolones (6.1%, 44/716) were the most commonly prescribed classes of antibiotics. Most antibiotics (84.9%, n = 608) were prescribed to treat community-acquired infections, while surgical prophylaxis accounted for 6.4% (n = 47/716). Most antibiotics (96.1%; n = 688/716) were used empirically, and less than a quarter (20.7%) of antibiotics prescribed had a documented stop/review date recorded. Only, 4.2% (n = 31/716) of prescribed antibiotics had cultures and susceptibility testing requested.

Conclusion

This study shows that antibiotic prescription rates are high in tertiary hospitals, with relatively high use of third-generation cephalosporins. Most antibiotics were empirically used and not guided by culture and susceptibility testing. These results could be the subject of key interventions for hospital antibiotic stewardship strategies in Niger.
Improved dopant fraction variance estimation in statistical ALCHEMI based on correct error propagation rule
Authors: Ishizuka Akimitsu , Ohtsuka Masahiro , Muto Shunsuke
Published: October 2024

This report revisits the statistical atom location by channeling enhanced microanalysis method, correcting the dopant site occupancy error by applying an appropriate error propagation rule. A revised equation for calculating the uncertainty in the determined dopant fractions is proposed. The revised equation is expected to correct the uncertainty in the determined dopant fractions, which is particularly significant in cases of low dopant concentrations and variable dopant occupancies across inequivalent host atomic sites. The approach is validated using Eu-doped Ca2SnO4 as a typical model system.
Supplemental breast cancer screening after negative mammography in US women with dense breasts
Authors: Foster Victoria M , Trentham-Dietz Amy , Stout Natasha K , Lee Christoph I , Ichikawa Laura E , Eavey Joanna , Henderson Louise , Miglioretti Diana L , Tosteson Anna N A , Bowles Erin A , Kerlikowske Karla , Sprague Brian L
Published: October 2024

The extent and determinants of supplemental screening among women with dense breasts are unclear. We evaluated a retrospective cohort of 498 855 women aged 40-74 years with heterogeneously or extremely dense breasts who obtained 1 176 251 negative screening mammography examinations during 2011-2019 in the United States. Overall, 2.8% and 0.3% of mammograms had supplemental ultrasound or magnetic resonance imaging (MRI) within 1 year, respectively. Onsite availability was associated with ultrasound (odds ratio [OR] = 4.35, 95% confidence interval [CI] = 4.21 to 4.49) but not MRI (OR = 0.94, 95% CI = 0.85 to 1.04). Facility academic affiliation and for-profit status were inversely associated with supplemental ultrasound (OR = 0.53, 95% CI = 0.49 to 0.57, and OR = 0.83, 95% CI = 0.81 to 0.86, respectively) and positively associated with supplemental MRI (OR = 3.04, 95% CI = 2.86 to 3.46, and OR = 1.88, 95% CI = 1.66 to 2.12, respectively). Supplemental screening was more likely to occur after passage of state-specific density notification laws than before passage (OR = 3.56, 95% CI = 3.30 to 3.84, and OR = 1.79, 95% CI = 1.60 to 2.00, respectively). These results show that supplemental breast imaging utilization has been uncommon and was related to facility factors and density legislation.
A phylogenetic study of South-Western Tibetic
Authors: Dhakal Dubi Nanda , List Johann-Mattis , Roberts Seán G
Published: October 2024

This study performs primary data collection, transcription, and cognate coding for eight South West Tibetic languages (Lowa, Gyalsumdo, Nubri, Tsum, Yohlmo, Kagate, Jirel, and Sherpa). This includes partial cognate coding, which analyses linguistic relations at the morpheme level. Prior resources and inferences are leveraged to conduct a Bayesian phylogenetic analysis. This helps estimate the extent to which the historical relationships between the languages represent a tree-like structure. We argue that small-scale projects like this are critical to wider attempts to reconstruct the cultural evolutionary history of Sino-Tibetan and other families.
Micromechanical simulation of interfacial fracture behavior using cohesive zone modeling for TRIP steel composite with ceramic particles
Authors: Chiu ChenChun , Tseng ShaoChen , Qayyum Faisal , Hama Takayuki , Prahl Ulrich , Chao ChingKong
Published: October 2024

In this work, ceramic particle and metal matrix interfacial delamination in transformation-induced plasticity steel composite reinforced with magnesium partially stabilized zirconia particles is investigated using a parametric modeling approach. The global behavior of the composite is modeled using elastic and Johnson-Cook plasticity models for the ceramic particles and the austenite matrix. Interfacial degradation is implemented through a cohesive zone model with a traction-separation law. Both perfect and damaged models are considered in the global stress-strain curve analysis. In the damaged model, the plastic region is characterized by softening and hardening stages, corresponding to unstable and stable crack propagation, respectively. To comprehensively identify the interfacial evolution, parameters such as normal contact strength, normal separation and stiffness degradation are evaluated along the particle/matrix interface. From a statistical perspective, the mechanical behavior of the system is analyzed through the kernel distribution plots for both the particles and the matrix. As the strain level increases, right- and left-skewed distributions are observed in the particles and matrix, respectively, particularly under high-strain conditions. Consequently, in the plastic hardening region, the median value exceeds the mean value, indicating that relying solely on the average stress value results in an underestimation during significant delamination.
Viewing the PLATO LOPS2 field through the lenses of TESS
Authors: Eschen Yoshi Nike Emilia , Bayliss Daniel , Wilson Thomas G , Kunimoto Michelle , Pelisoli Ingrid , Rodel Toby
Published: October 2024

PLATO will begin observing stars in its Southern Field (LOPS2) after its launch in late 2026. By this time, TESS will have observed the stars in LOPS2 for at least four years. We find that by 2025, on average each star in the PLATO field will have been monitored for 330 d by TESS, with a subset of stars in the TESS continuous viewing zone having over 1000 d of monitoring. There are currently 101 known transiting exoplanets in the LOPS2 field, with 36 of these residing in multiplanet systems. The LOPS2 field also contains more than 500 TESS planet candidate systems, 64 exoplanets discovered by radial velocity only, over 1000 bright (V<13) eclipsing binary systems, 7 transiting brown dwarf systems, and 2 bright white dwarfs (G<13). We calculate TESS and PLATO sensitivities to detecting transits for the bright FGK stars that make up the PLATO LOPS2 P1 sample. We find that TESS should have discovered almost all transiting giant planets out to approximately 30 d within the LOPS2 field, and out to approximately 100 d for the regions of the LOPS2 field within the TESS CVZ ($\sim 20$ per cent of the LOPS2 field). However, we find that for smaller radius planets in the range 1 – 4 R$_{\oplus }$PLATO will have significantly better sensitivity, and these are likely to make up the bulk of new PLATO discoveries.
The effect of helium reionization on the Ly α forest hydrogen flux statistics
Authors: Meiksin Avery , Puchwein Ewald
Published: October 2024

We assess the impact of quasi-stellar objects (QSOs) on the high-redshift ($z\gt 4$) intergalactic medium using Monte Carlo realizations of QSO populations and the He $\rm \scriptstyle III$ regions they generate, applied to the Sherwood–Relics simulations, allowing for uncertainties in the QSO luminosity function, its evolution, and QSO spectra and ages. While QSO luminosity functions based on optical–infrared selection are unable to reproduce the broadening H $\rm \scriptstyle I$ Ly $\alpha$ optical depth distributions at $z\gt 5$, much broader distributions are found for the higher numbers of QSOs based on X-ray selection, suggesting a large QSO contribution to the ultraviolet background at $z\gt 5$ may offer an alternative to late reionization models to account for the broad H $\rm \scriptstyle I$ Ly $\alpha$ optical depth distributions. Realizations using QSOs based on the higher QSO counts also much better recover the measured pixel flux autocorrelation function at $z\gt 5$. The He $\rm \scriptstyle III$ regions from QSO sources according to both types of luminosity function suppress the pixel flux power spectrum on small scales, $k\gt 0.02\, \mathrm{s\, km^{-1}}$, while enhancing it on larger, both by amounts of up to tens of per cent at $z\gt 4$, with the magnitude increasing with the intergalactic He $\rm \scriptstyle III$ filling factor and the boost in temperature within the He $\rm \scriptstyle III$ regions.
The Meissner effect in neutron stars
Authors: Lander S K
Published: October 2024

We present the first model aimed at understanding how the Meissner effect in a young neutron star affects its macroscopic magnetic field. In this model, field expulsion occurs on a dynamical time-scale, and is realized through two processes that occur at the onset of superconductivity: fluid motions causing the dragging of field lines, followed by magnetic reconnection. Focusing on magnetic fields weaker than the superconducting critical field, we show that complete Meissner expulsion is but one of four possible generic scenarios for the magnetic-field geometry, and can never expel magnetic flux from the centre of the star. Reconnection causes the release of up to $\sim 5\times 10^{46}\, \mathrm{erg}$ of energy at the onset of superconductivity, and is only possible for certain favourable early-phase dynamics and for pre-condensation fields $10^{12}\, \mathrm{G}\lesssim B\lesssim 5\times 10^{14}\, \mathrm{G}$. Fields weaker or stronger than this are predicted to thread the whole star.
Alternative substrate kinetics of SARS-CoV-2 Nsp15 endonuclease reveals a specificity landscape dominated by RNA structure
Authors: Kalia Nidhi , Snell Kimberly C , Harris Michael E
Published: October 2024

Coronavirus endoribonuclease Nsp15 contributes to the evasion of host innate immunity by suppressing levels of viral dsRNA. Nsp15 cleaves both ssRNA and dsRNA in vitro with a strong preference for unpaired or bulged U residues, and its activity is stimulated by divalent ions. Here, we systematically quantified effects of RNA sequence and structure context that define its specificity. The results show that sequence preference for U↓A/G, observed previously, contributes only ca. 2-fold to kcat/Km. In contrast, dsRNA structure flanking a bulged U residue increases kcat/Km by an order of magnitude compared to ssRNA while base pairing in dsRNA essentially blocks cleavage. Despite enormous differences in multiple turnover kinetics, the effect of RNA structure on the cleavage step is minimal. Surprisingly, although divalent ion activation of Nsp15 is widely considered to be important for its biological function, the effect on kcat/Km is only ∼2-fold and independent of RNA structure. These results reveal a specificity landscape dominated by RNA structure and provide a quantitative framework for identifying interactions that underlie specificity, determining mechanisms of inhibition and resistance and defining targets important for coronavirus biology.
Understanding Use of E-cigarettes for Smoking Cessation Among a Sample of U.S. Adults
Authors: Sharma Akshika , Morean Meghan E , Krishnan-Sarin Suchitra , O’Malley Stephanie S , Bold Krysten W
Published: October 2024

Introduction

Many adults who smoke cigarettes report trying e-cigarettes to quit smoking. Understanding the use of e-cigarettes for smoking cessation and the type of support that adults desire when trying to quit smoking is important for supporting cessation attempts and maximizing smoking abstinence.

Aims and Methods

In the summer of 2021, an online survey of 857 adults who reported a history of regular cigarette smoking and endorsed using e-cigarettes in a recent smoking cessation attempt was conducted. Survey items assessed reasons for using e-cigarettes to quit smoking, what was helpful about e-cigarettes, and what information participants desired when using e-cigarettes to quit smoking.

Results

Common reasons for using e-cigarettes to quit smoking included beliefs that vaping would be helpful for quitting (53.6%), vaping is safer than smoking (50.5%), and favorable comparisons relative to other nicotine replacement treatments like nicotine patches and gum (24.7%). 23.8% selected e-cigarettes because they were cheaper than other smoking cessation aids. 89% of participants reported still smoking cigarettes at the time of the survey. The most common information people wanted when quitting was advice on how to gradually reduce nicotine over time to become nicotine-free (46.3%), how different vaping devices work (39.7%), and what nicotine concentration to start with (37.7%).

Conclusions

Findings identified common beliefs about e-cigarettes as a smoking cessation aid and how they compare to other treatments including nicotine replacement treatment. Understanding factors that support cessation is critical especially due to high relapse rates. Results may help to inform support programs, especially for individuals who are interested in using e-cigarettes to quit smoking.

Implications

Despite greater reporting, there is a limited understanding of e-cigarette use for quitting among those who smoke cigarettes. Our study highlights the reasons for using e-cigarettes among those who have recently tried e-cigarettes for quitting smoking, and the components of e-cigarettes that were helpful. We also examined the desired support in a program designed to use e-cigarettes for quitting smoking. The majority of participants who attempted to quit smoking using an e-cigarette relapsed to smoking, indicating the gap in cessation support that can be filled with a greater understanding of the desired support.
Impact of microvascular invasion risk on tumor progression of hepatocellular carcinoma after conventional transarterial chemoembolization
Authors: Yang Guanhua , Chen Yuxin , Wang Minglei , Wang Hongfang , Chen Yong
Published: October 2024

Objective

To assess tumor progression in patients with hepatocellular carcinoma (HCC) without macrovascular invasion who underwent treatment with conventional transarterial chemoembolization (cTACE) based on microvascular invasion (MVI) risk within 2 years.

Methods

This retrospective investigation comprised adult patients with HCC who had either liver resection or cTACE as their first treatment from January 2016 to December 2021. A predictive model for MVI was developed and validated using preoperative clinical and MRI data from patients with HCC treated with liver resection. The MVI predictive model was applied to patients with HCC receiving cTACE, and differences in tumor progression between the MVI high- and low-risk groups were examined throughout 2 years.

Results

The MVI prediction model incorporated nonsmooth margin, intratumoral artery, incomplete or absent tumor capsule, and tumor DWI/T2WI mismatch. The area under the receiver operating characteristic curve (AUC) for the prediction model, in the training cohort, was determined to be 0.904 (95% CI, 0.862-0.946), while in the validation cohort, it was 0.888 (0.782-0.994). Among patients with HCC undergoing cTACE, those classified as high risk for MVI possessed a lower rate of achieving a complete response after the first tumor therapy and a higher risk of tumor progression within 2 years.

Conclusions

The MVI prediction model developed in this study demonstrates a considerable degree of accuracy. Patients at high risk for MVI who underwent cTACE treatment exhibited a higher risk of tumor progression within 2 years.
Chemical neurolysis of genicular nerves for chronic non-cancer knee pain: a scoping review
Authors: Tay Matthew Rong Jie , Mittal Nimish , Yao Samantha , Farag Jordan
Published: October 2024

Objective

Chemical neurolysis of the genicular nerves is a treatment option for intractable non-cancer knee pain. This scoping review synthesizes the available literature on the effectiveness, adverse events, and procedural techniques of chemical neurolysis of genicular nerves for the management of knee pain.

Design

Scoping review.

Setting

All clinical and research settings.

Subjects

Adult participants with chronic non-cancer knee pain undergoing chemical neurolysis of genicular nerves.

Methods

A literature search in MEDLINE, EMBASE, and Cochrane Library was conducted up to September 4, 2023. Articles were searched via terms and keywords relating to “knee,” “pain,” “knee osteoarthritis,” “ablation,” “alcohol,” “phenol,” and “chemical neurolysis.” Included articles were full-text primary studies and in English. Data were extracted by 2 independent reviewers using an electronic database.

Results

Eight studies were included in this review (including 1 randomized controlled trial), comprising 192 patients. Of the 8 studies, 4 used phenol, 3 used alcohol, and 1 used either alcohol or phenol for chemical neurolysis. Fluoroscopy, ultrasound guidance, or both were used for nerve target identification. All studies demonstrated that chemical neurolysis resulted in improved pain or functional outcomes, with no serious adverse events reported.

Conclusions

Chemical neurolysis of the genicular nerves is a promising treatment strategy for chronic knee pain. Interpretation of the available studies is limited by study heterogeneity and small sample sizes. High-quality randomized controlled trials are required to clarify the selection of appropriate nerve targets and choice of image guidance and to compare with other ablative modalities.

Study registration

Open Science Framework (https://osf.io/jg8wh).
Exercise and footwear in medial knee osteoarthritis: a randomized controlled trial comparing flat flexible footwear to stable supportive shoes
Authors: Dainese Paolo , Stautemas Jan , De Mits Sophie , Wittoek Ruth , Van Ginckel Ans , Huysse Wouter , Demeyer Heleen , Mahieu Hanne , Calders Patrick
Published: October 2024

Objective

This randomized controlled trial (RCT) investigated whether adding daily use of flat flexible footwear (FFF) to a strengthening and aerobic exercise program improved short- and longer-term outcomes compared with adding stable supportive shoes (SSS) in people with medial tibiofemoral OA.

Methods

Participants (n = 97) with medial tibiofemoral OA were randomly assigned (1:1) to the FFF (n = 50) or SSS (n = 47) group. Participants in both groups received a 9-month intervention (3 months supervised followed by 6 months unsupervised exercise). The primary outcome was the change in knee pain on walking at 3 months measured using an 11-point numeric rating scale (NRS). Secondary outcomes included the change from baseline to 3 and 9 months in the severity of knee pain overall (NRS), physical function (WOMAC subscale), habitual physical activity level (Physical Activity Scale for the Elderly), quality of life (QoL) (European Quality of Life 5-Dimensions 5-Levels questionnaire) and markers of inflammation (effusion and Hoffa synovitis) and structural disease progression (bone marrow lesions).

Results

There were no significant differences between the groups in the change in pain on walking [between-group difference −0.67 (95% CI −1.62, 0.29)] at 3 months. Knee pain on walking and overall knee pain significantly decreased in both groups at 3 and 9 months. Physical function and QoL improved in both groups at 3 and 9 months. We found no between-group differences in any secondary outcome at any time.

Conclusions

FFF added to exercise therapy did not provide additional better symptom nor structure-modification benefit compared with conventional SSS and exercise in people with medial tibiofemoral OA.

Trial registration

ClinicalTrials.gov (http://clinicaltrials.gov), NCT03796832.
Freshwater jellyfish in northeastern Argentina: a risk to human health
Authors: Casafús Milena Gisela , Gritti Micaela Andrea , Miranda Cecilia , Guimarães Paula , Montalto Luciana , Peichoto María Elisa
Published: October 2024

Background

Although cnidarians are mostly marine organisms, the occurrence of freshwater jellyfish frequently arouses the interest of ecologists, due to their sudden and unusual appearances in natural and artificial water bodies around the world.

Methods

This study describes a series of cases compatible with cnidarian envenomation that occurred coincidentally in time and space with the presence of Craspedacusta sowerbii Lankester, 1880 jellyfish in the province of Misiones (El Saltito stream) in January 2022. A year later, its presence was confirmed in another watercourse of this province (Cazador stream). Based on these findings, its possible toxicological consequences in humans were evaluated by characterizing the jellyfish extract using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and enzymatic/toxic activities.

Results

We revealed the presence of proteolytic enzymes and cytolytic toxin(s), which—by means of activating the inflammatory cascade—could explain the stinging skin lesions observed in the suspected cases described.

Conclusions

In addition to recording for the first time the occurrence of this cnidarian in northeastern Argentina, this work provides, for the first time, a toxinological explanation for the clinical observations after contact with the most widespread freshwater jellyfish species in the world, giving support to health professionals in the diagnosis and management of such accidents/envenomation.
The Benefits of Early Rehabilitation for Patients With Acute Heart Failure Requiring IV Inotropic Drugs
Authors: Ueno Kensuke , Kaneko Hidehiro , Kamiya Kentaro , Okada Akira , Konishi Masaaki , Imamura Teruhiko , Suzuki Yuta , Fujiu Katsuhito , Takeda Norifumi , Morita Hiroyuki , Ako Junya , Node Koichi , Yasunaga Hideo , Takeda Norihiko , Komuro Issei
Published: October 2024

OBJECTIVES:

The benefits of early rehabilitation for patients with acute heart failure (HF) requiring IV inotropic drugs have yet to be determined. We investigated the association between early rehabilitation and short-term clinical outcomes in patients with acute HF requiring IV inotropic drugs.

DESIGN:

Retrospective cohort study.

SETTING:

This study used data including more than 90% of patients at a tertiary emergency hospital in Japan.

PATIENTS:

This study included patients with acute HF who required IV inotropic drugs within 2 days of admission.

INTERVENTIONS:

We compared patients who commenced rehabilitation within 2 days of admission (the early rehabilitation group) and those who did not (the control group).

MEASUREMENTS AND MAIN RESULTS:

Propensity score matching was used to compare in-hospital mortality, 30-day all-cause and HF readmissions, length of stay, and Barthel Index (BI) at discharge between patients who received early rehabilitation and those who did not. Totally, 38,302 patients were eligible for inclusion; of these, 5,127 received early rehabilitation and 5,126 pairs were generated by propensity score matching. After propensity score matching, the patients who received early rehabilitation had a lower in-hospital mortality rate than those who did not (9.9% vs. 13.2%; p < 0.001). The relative risk (95% CI) of early rehabilitation for in-hospital mortality was 0.75 (0.67–0.83). Patients undergoing early rehabilitation exhibited a shorter mean length of stay (25.5 vs. 27.1; p < 0.001), lower 30-day all-cause (14.1% vs. 16.4%; p = 0.001) and HF (8.6% vs. 10.4%; p = 0.002) readmissions, and higher BI scores at discharge (68 vs. 67; p = 0.096). Consistent findings were observed across subgroups, including in patients 80 years old or older, those with a body mass index less than 18.5 kg/m2, and those with BI scores less than 60.

CONCLUSIONS:

The early prescription of rehabilitation was associated with favorable short-term outcomes even for patients with acute HF requiring IV inotropic drugs.
Air pollution mixture complexity and its effect on PM2.5-related mortality: A multicountry time-series study in 264 cities
Authors: Masselot Pierre , Kan Haidong , Kharol Shailesh K. , Bell Michelle L. , Sera Francesco , Lavigne Eric , Breitner Susanne , das Neves Pereira da Silva Susana , Burnett Richard T. , Gasparrini Antonio , Brook Jeffrey R. ,   on behalf of the MCC Collaborative Research Network
Published: October 2024

Background:

Fine particulate matter (PM2.5) occurs within a mixture of other pollutant gases that interact and impact its composition and toxicity. To characterize the local toxicity of PM2.5, it is useful to have an index that accounts for the whole pollutant mix, including gaseous pollutants. We consider a recently proposed pollutant mixture complexity index (PMCI) to evaluate to which extent it relates to PM2.5 toxicity.

Methods:

The PMCI is constructed as an index spanning seven different pollutants, relative to the PM2.5 levels. We consider a standard two-stage analysis using data from 264 cities in the Northern Hemisphere. The first stage estimates the city-specific relative risks between daily PM2.5 and all-cause mortality, which are then pooled into a second-stage meta-regression model with which we estimate the effect modification from the PMCI.

Results:

We estimate a relative excess risk of 1.0042 (95% confidence interval: 1.0023, 1.0061) for an interquartile range increase (from 1.09 to 1.95) of the PMCI. The PMCI predicts a substantial part of within-country relative risk heterogeneity with much less between-country heterogeneity explained. The Akaike information criterion and Bayesian information criterion of the main model are lower than those of alternative meta-regression models considering the oxidative capacity of PM2.5 or its composition.

Conclusions:

The PMCI represents an efficient and simple predictor of local PM2.5-related mortality, providing evidence that PM2.5 toxicity depends on the surrounding gaseous pollutant mix. With the advent of remote sensing for pollutants, the PMCI can provide a useful index to track air quality.
Short-term, lagged association of airway inflammation, lung function, and asthma symptom score with PM2.5 exposure among schoolchildren within a high air pollution region in South Africa
Authors: Buthelezi Minenhle S. , Mentz Graciela , Wright Caradee Y. , Phaswana Shumani , Garland Rebecca M. , Naidoo Rajen N.
Published: October 2024

Background:

Asthma affects millions of people globally, and high levels of air pollution aggravate asthma occurrence. This study aimed to determine the association between short-term lagged PM2.5 exposure and airway inflammation, lung function, and asthma symptom scores among schoolchildren in communities in the Highveld high-pollution region in South Africa.

Methods:

A cross-sectional study was conducted among schoolchildren aged 9–14 years in six communities in the Highveld region in South Africa, between October 2018 and February 2019. A NIOX 200 instrument was used to measure fractional exhaled nitric oxide (FeNO). Lung function indices (forced expiratory volume in one second [FEV1]; forced vital capacity [FVC] and FEV1/FVC) were collected using spirometry and the percent of predicted of these was based on the reference equations from the Global Lung Initiative, without ethnic correction. These values were further analyzed as binary outcomes following relevant thresholds (lower limits of normal for lung function and a cutoff of 35 ppb for FeNO). Asthma symptoms were used to create the asthma symptom score. Daily averages of PM2.5 data for the nearest monitoring station located in each community, were collected from the South African Air Quality Information System and created short-term 5-day lag PM2.5 concentrations. Additional reported environmental exposures were collected using standardized instruments.

Results:

Of the 706 participating schoolchildren, only 1.13% of the participants had doctor-diagnosed asthma, compared to a prevalence of 6.94% with an asthma symptom score suggestive of asthma. Lag 1 (odds ratio [OR]: 1.01; 95% confidence interval [CI]: 1.00, 1.02, P = 0.039) and 5-day average lagged PM2.5 (OR: 1.02; 95% CI: 0.99, 1.04, P = 0.050) showed increased odds of the FeNO > 35 ppb. Lung function parameters (FEV1 < lower limit of normal [LLN] [OR: 1.02, 95% CI: 1.00, 1.03, P = 0.018], and FEV1/FVC < LLN [OR: 1.01; 95% CI: 1.00, 1.02, P < 0.001]) and asthma symptom score ≥ 2 (OR: 1.02; 95% CI: 1.00, 1.04, P = 0.039) also showed significant associations with lag 2, lag 4 and lag 1 of PM2.5, respectively.

Conclusion:

Lagged PM2.5 exposure was associated with an increased odds of airway inflammation and an increased odds of lung function parameters below the LLN particularly for the later lags, but a significant dose–response relationship across the entire sample was not consistent.
Postoperative lymphopaenia as a risk factor for postoperative infections in cancer surgery
Authors: Petit Ludivine , Pastene Bruno , Dupont Guillaume , Baffeleuf Bruno , Goulevant Pierre-Alain , Fellahi Jean-Luc , Gricourt Yann , Lebuffe Gilles , Ouattara Alexandre , Fischer Marc-Olivier , Mertes Paul-Michel , Eyraud Daniel , Bouhemad Belaid , Gomola Alexandra , Montravers Philippe , Alingrin Julie , Flory Laura , Incagnoli Pascal , Boisson Matthieu , Leone Marc , Monneret Guillaume , Lukaszewicz Anne Claire , Pereira Bruno , Molliex Serge
Published: October 2024

BACKGROUND

Stress due to surgical trauma decreases postoperative lymphocyte counts (LCs), potentially favouring the occurrence of postoperative infections (PIs).

OBJECTIVES

We aimed to determine whether postoperative lymphopaenia following thoracic or gastrointestinal cancer surgery is an independent risk factor for PIs and to identify modifiable factors related to anaesthesia and surgical procedures that might affect its occurrence.

STUDY DESIGN

The EVALYMPH study was a prospective, multicentre cohort study with a 30-day patient follow-up. Multivariate analyses were performed to determine the risk factors for PIs and for postoperative lymphopaenia.

SETTING

Patients were included from January 2016 to September 2017 in 25 French centres.

PATIENTS

Adult patients admitted for thoracic or gastrointestinal cancer surgery were eligible for inclusion.

MAIN OUTCOME MEASURE

PIs within 30 days after surgery were defined as urinary tract infections, pneumonia, surgical site infections and other infections (bloodstream infections or pleurisy).

RESULTS

Of 1207 patients included, 273 (22.6%) developed at least one infection within 30 days after surgery, with a median [IQR] time to onset of 8 [5 to 11] days. An increased risk of PI was significantly associated with an ASA score of IV: hazard ratio (HR) 4.27 (95% confidence interval (CI), 1.87 to 9.72), surgery > 200 min (HR 1.58 (1.15 to 2.17) and lymphopaenia on postoperative day 1 (POD1) (HR 1.56 (1.08 to 2.25). This risk was associated with changes in postoperative LC over time (P = 0.001) but not with preoperative LC (P = 0.536).

POD1 lymphopenia was related to patient characteristics and duration of surgery but not to potentially modifiable other surgical or anaesthetics factors.

CONCLUSIONS

POD1 lymphopaenia was associated with PIs in patients undergoing thoracic or gastrointestinal cancer surgery. To individualise care, patient characteristics and surgery duration should be taken into account.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02799251
A new method of non-ultrasound monitoring of ovarian stimulation (NUMOS): Mission possible!—A pilot study
Authors: Vladimirov Iavor K. , Tacheva Desislava , Gatev Evan , Rangelova Magdalena , Vladimirov Martin
Published: October 2024

Purpose:

This study aims to establish the viability of monitoring an appropriate and safe ovarian stimulation without the use of ultrasound and serum hormone testing.

Method:

As a primary marker for monitoring the ovarian response, we used urinary estrone-3-glucuronide (E1-3G) growth rate, which was self-measured by patients daily at home, with a portable analyzer, during the stimulation. For an adequate ovarian response, an average daily rate of increase of E1-3G was estimated to be within 25%–77%. Ovulation trigger day was determined based on the length of the menstrual cycle.

The study included 24 women. Inclusion criteria were age below 41 years and AMH >1 ng/mL. A progestin-primed ovarian stimulation protocol (PPOS) with fixed doses of gonadotropins was used.

Results:

The average female age was 32.9 years (±4.4), BMI 22.7 kg/m2 (±4.3), AMH 3.7 ng/mL (±2.6), stimulation days 10.6 (±1.1), collected oocytes 12.5 (±8.5), MII oocytes 10.6 (±7.8), fertilization rate 83.6% (±22.5), blastocyst 66.4% (±28.6), good quality blastocysts 31.6% (±16.9).

Absence of oocyte aspiration was found in one of the cases. There were no cases of OHSS and ovarian stimulation cancellation.

Conclusions:

This is the first pilot study to successfully apply a new marker for ovarian stimulation monitoring.