bluuebunny/crossref_metadata_2025 huggingface dataset:
Real-World Effectiveness of Vedolizumab vs Anti-TNF in Biologic-naïve Crohn’s Disease Patients: A 2-year Propensity-score-adjusted Analysis from the VEDOIBD-Study
Authors: Bokemeyer Bernd , Plachta-Danielzik Sandra , di Giuseppe Romina , Efken Philipp , Mohl Wolfgang , Hoffstadt Martin , Krause Thomas , Schweitzer Axel , Schnoy Elisabeth , Atreya Raja , Teich Niels , Trentmann Leo , Ehehalt Robert , Hartmann Petra , Schreiber Stefan
Published: July 2023

Background

The aim of this observational, real-world evidence, modified intention-to-treat (mITT) study based on prospectively collected data from the VEDOIBD registry was to compare the effectiveness of vedolizumab (VEDO) vs antitumor necrosis factor (anti-TNF) in biologic-naïve Crohn’s disease (CD) patients.

Methods

Between 2017 and 2020, 557 CD patients starting therapy with VEDO or anti-TNF were consecutively enrolled in 45 IBD centers across Germany. Per study protocol, the analysis excluded biologic-experienced patients and those with a missing Harvey-Bradshaw Index score, resulting in a final sample of 327 biologic-naïve CD patients. Clinical remission was measured using the Harvey-Bradshaw Index at the end of induction therapy and after 1 and 2 years. Switching to a different therapy was considered an outcome failure. Propensity score adjustment with inverse probability of treatment weighting was used to correct for confounding.

Results

The effectiveness of both VEDO (n = 86) and anti-TNF (n = 241) was remarkably high for induction treatment, but VEDO performed significantly less well than anti-TNF (clinical remission: 56.3% vs 73.9%, P < .05). In contrast, clinical remission after 2 years was significantly better for VEDO compared with anti-TNF (74.2% vs 44.7%; P < .05; odds ratio, 0.45; 95% CI, 0.22-0.94). Remarkably, only 17% of patients switched from VEDO to another biologic vs 44% who received anti-TNF.

Conclusions

The results of this prospective, 2-year, real-world evidence study suggest that the choice of VEDO led to higher remission rates after 2 years compared with anti-TNF. This could support the role of VEDO as a first-line biologic therapy in CD.
Appendectomy and Risk of Advanced Colorectal Neoplasia in Inflammatory Bowel Disease: A Nationwide Population-based Cohort Study
Authors: Mark-Christensen Anders , Kristiansen Eskild Bendix , Myrelid Pär , Laurberg Søren , Erichsen Rune
Published: July 2023

Background

The aim of this study was to examine the association between appendectomy and advanced colorectal neoplasia (aCRN) in patients with inflammatory bowel disease (IBD).

Methods

Inflammatory bowel disease patients diagnosed in Denmark in the period 1977 to 2017 were identified from the Danish National Patient Registry. Inflammatory bowel disease patients who underwent appendectomy were matched with up to 10 IBD patients without appendectomy and followed until aCRN, death, or emigration. Absolute risks of aCRN were calculated, treating death and bowel resections as competing risks. Stratified Cox regression was used to calculate adjusted hazard ratios (aHRs) of aCRN, comparing IBD patients with appendectomy to IBD patients without appendectomy.

Results

We identified 3789 IBD patients with appendectomy and 37 676 IBD patients without appendectomy. A total of 573 patients (1.4%) developed aCRN, with an absolute risk of aCRN at 20 years of 4.9% (95% confidence interval [CI], 2.9%-7.7%) for ulcerative colitis (UC) patients with appendectomy after UC diagnosis compared with 2.8% (95% CI, 2.3%-3.3%) for UC patients without appendectomy. Appendectomy after UC was associated with an increased rate of aCRN 5 to 10 years (aHR, 2.5; 95% CI, 1.1-5.5) and 10 to 20 years after appendectomy (aHR, 2.3; 95% CI, 1.0-5.5). Appendectomy prior to UC diagnosis was not associated with an increased rate of aCRN, and Crohn’s disease was not associated with the rate of aCRN, regardless of timing or histological diagnosis of the appendix specimen.

Conclusions

Although appendectomy may have a positive effect on the clinical course of UC, our study suggests that this may come at the expense of a higher risk of aCRN.
The Limits of Liberalization: WTO Entry and Chinese State-Owned Firms
Authors: Tan Yeling , Davis Christina L
Published: July 2023

Does state ownership limit the liberalizing effects of the WTO? We examine the case of China, which is not only the largest exporting state but also lends active support to state-owned enterprises (SOEs) that could distort global trade. Using data on import purchases disaggregated by ownership from 1993 to 2012, we analyze how WTO entry affects the commercial orientation of state-owned and private imports. We demonstrate that after WTO entry, tariff cuts have a larger effect on private compared to SOE trade. We then show that state ownership alone does not block the WTO’s liberalizing effects. For most industries, SOEs and private firms are alike in their commercial orientation. However, where strategic goods targeted by industrial policy hold a large share of bilateral trade, lowering tariffs has no impact on SOE trade. These findings highlight the tensions between state-led economic models and global trade law premised upon market principles.
Contested Sacredness: The Struggle for Bears Ears
Authors: Keegan Brennan
Published: July 2023

Southern Utah and the Four Corners region is home to five Tribal nations, united by shared experiences of settler colonialism and a tie to the landscapes of Bears Ears National Monument. After years of Tribal advocacy to protect the site, President Obama designated the monument under the Antiquities Act in December 2016. A year later, President Trump reduced the 1.35-million-acre national monument by 85 percent to make way for uranium mining, officially sanctifying state control and natural resource extraction. Protests and lawsuits ensued. The legal status of Bears Ears continues to be contested. Religious freedom, capitalism, nationalism, environmental protection, and tourism have coalesced at the site in an example of the production, shift, and conflict of spatial relations. By mapping the constellation of spaces produced by the stakeholders, this article argues that a spatial lens points to moments of overlap and resolution as the case moves forward.
The impact of vaping ethanol-containing electronic cigarette liquids on roadside impairment investigations
Authors: Holt Alaina K , Anbil Akansha , Combs Madison M , Sales Erica R , Boone Edward L , Poklis Justin L , Greer Edgar L , Karaoghlanian Nareg , Breland Alison B , Peace Michelle R
Published: July 2023

Legal professionals and others have suggested that vaping electronic cigarettes (e-cigs) prior to or during ethanol breath testing may produce false positives. Preliminary breath tests (PBTs) and evidentiary breath tests (EBTs) measure ethanol in exhaled breath and standardized field sobriety tests (SFSTs) are used to assess impairment. Ethanol has been identified in e-cig liquids (e-liquids). Presented are a series of experiments designed to determine the mechanics of vaping ethanol using an e-cig and the effects of vaping ethanol on the SFSTs and breath tests used by law enforcement officers (LEO). Twelve participants (five females, age: 21–32 and seven males, age: 21–55), vaped either one or ten puffs of an e-liquid (0% or 20% ethanol). LEOs assessed impairment using SFSTs (12 and 42 min), PBTs (<1, 27, 32, 37 and 57 min) and EBTs (2, 29, 34, 39 and 59 min) post-vaping. A self-assessment test was administered post-vaping (22 and 52 min). Baseline responses for all measures were collected prior to vaping. Results demonstrated that ethanol in the e-liquids was aerosolized by e-cigs and produced particles that could reach the deep lung tissue based on mean-mass diameter. Ethanol was detected by PBT <3 min after participants vaped one (0.007–0.030 g/210 L) or ten puffs (013–0.074 g/210 L) of a 20% ethanol e-liquid. Ethanol was not detected by PBT at any subsequent time point. Ethanol was not detected by the EBT under any condition. Impairment was not indicated by the SFST. Some subjective effects were reported, but few statistically significant differences between conditions were indicated. A wait period prior to ethanol breath testing is not always mandated, depending on jurisdiction, or observed in all applications, such as workplace testing. The results demonstrate that a wait period must be employed to prevent vaping-related false-positive breath ethanol results.
A Pilot Replication Study of Implementing an Equine-Assisted Services Program Within a VA Residential Substance Use Disorder Treatment Program
Authors: Marchand William R , Smith Judy , Nazarenko Elena , Joubert Katryna , Black Heather , Osborne Makenna , Andersen Sarah , Bell Kylie , Baldwin Shannon , Klinger William , Connelly Heather , Sheppard Stephen , Hoopes Karl
Published: July 2023

Introduction

Veterans have high rates of substance use disorders and other mental health conditions including post-traumatic stress disorder. Effective treatments for these conditions exist; however, high attrition rates and residual symptoms after completing treatment are common. Complementary treatment approaches could enhance treatment engagement and/or response among this population. We previously reported a study of one such intervention, an equine-assisted learning, and psychotherapy incorporating horses intervention provided to veterans admitted to a Veterans Health Care Administration residential substance abuse treatment program. The first aim of this study was to replicate the previous study assessing the safety, feasibility, and preliminary outcomes of this intervention. The second aim was to examine the effect of participants attending multiple intervention sessions.

Materials and Methods

Participants were 94 veterans who participated in one to six sessions of a 3–4-hour program consisting of both equine-assisted learning and psychotherapy incorporating horses. Pre- and post-session administration of the Positive and Negative Affect Scale, State-Trait Anxiety Inventory, and Craving Experience Questionnaire was utilized to assess changes in affect, anxiety, and craving. Wilcoxon signed-rank or paired two-tailed t-tests were utilized for pre- to post-session comparisons of the outcome measures for sessions 1–4. Generalized linear mixed-effects (GLME) models were constructed to determine the impact of dosage. GLME models were constructed to determine the impact of dosage.

Results

As with our previous study, the intervention was safe and feasible to utilize for this population. There were statistically significant pre- to post-session improvements, with medium-to-large effect sizes, for sessions 1–3 for negative affect and sessions 1 and 2 for positive affect, anxiety, and craving. The GLME models revealed no statistical significance for any of the predictors.

Conclusions

Taken together, this study and our previous investigation of this equine-assisted services intervention suggest that it is safe and feasible to utilize for veterans admitted to a residential substance abuse treatment program and we have now found short-term benefits in two separate studies. Thus, a randomized controlled trial of this intervention is warranted to demonstrate cause and effect and determine whether longer-term benefits are associated with the intervention. The finding that there was no additional benefit from attendance at more than two intervention sessions suggests that dose–response relationship studies of equine-assisted services interventions for veterans are needed.
Bins, Spans, and Tolerance: Three Theories of Microtiming Behavior
Authors: Danielsen Anne , Johansson Mats , Stover Chris
Published: July 2023

This study compares three recent theories of expressive microtiming in music. While each theory was originally designed to engage a particular musical genre—Anne Danielsen’s beat bins for funk, Neo-Soul, and other contemporary Black musical expressions, Chris Stover’s beat span for “timeline musics” from Africa and the African diaspora, and Mats Johansson’s rhythmic tolerance for Scandinavian fiddle music—we consider how they can productively coexist in a shared music-analytic space, each revealing aspects of musical structure and process in mutually reinforcing ways. In order to explore these possibilities, we bring all three theories to bear on a recording of Thelonious Monk’s “Monk’s Dream,” focusing on Monk’s piano gestures as well as the relationship between saxophonist Charlie Rouse’s improvised solo and Monk’s and bassist John Ore’s accompaniments.
A DNA unwinding equilibrium serves as a checkpoint for CRISPR-Cas12a target discrimination
Authors: Singh Jaideep , Liu Kevin G , Allen Aleique , Jiang Wei , Qin Peter Z
Published: July 2023

CRISPR-associated proteins such as Cas9 and Cas12a are programable RNA-guided nucleases that have emerged as powerful tools for genome manipulation and molecular diagnostics. However, these enzymes are prone to cleaving off-target sequences that contain mismatches between the RNA guide and DNA protospacer. In comparison to Cas9, Cas12a has demonstrated distinct sensitivity to protospacer-adjacent-motif (PAM) distal mismatches, and the molecular basis of Cas12a's enhanced target discrimination is of great interest. In this study, we investigated the mechanism of Cas12a target recognition using a combination of site-directed spin labeling, fluorescent spectroscopy, and enzyme kinetics. With a fully matched RNA guide, the data revealed an inherent equilibrium between a DNA unwound state and a DNA-paired duplex-like state. Experiments with off-target RNA guides and pre-nicked DNA substrates identified the PAM-distal DNA unwinding equilibrium as a mismatch sensing checkpoint prior to the first step of DNA cleavage. The finding sheds light on the distinct targeting mechanism of Cas12a and may better inform CRISPR based biotechnology developments.
On the rules of engagement for microRNAs targeting protein coding regions
Authors: Sapkota Sunil , Pillman Katherine A , Dredge B Kate , Liu Dawei , Bracken Julie M , Kachooei Saba Ataei , Chereda Bradley , Gregory Philip A , Bracken Cameron P , Goodall Gregory J
Published: July 2023

MiRNAs post-transcriptionally repress gene expression by binding to mRNA 3′UTRs, but the extent to which they act through protein coding regions (CDS regions) is less well established. MiRNA interaction studies show a substantial proportion of binding occurs in CDS regions, however sequencing studies show much weaker effects on mRNA levels than from 3′UTR interactions, presumably due to competition from the translating ribosome. Consequently, most target prediction algorithms consider only 3′UTR interactions. However, the consequences of CDS interactions may have been underestimated, with the reporting of a novel mode of miRNA-CDS interaction requiring base pairing of the miRNA 3′ end, but not the canonical seed site, leading to repression of translation with little effect on mRNA turnover. Using extensive reporter, western blotting and bioinformatic analyses, we confirm that miRNAs can indeed suppress genes through CDS-interaction in special circumstances. However, in contrast to that previously reported, we find repression requires extensive base-pairing, including of the canonical seed, but does not strictly require base pairing of the 3′ miRNA terminus and is mediated through reducing mRNA levels. We conclude that suppression of endogenous genes can occur through miRNAs binding to CDS, but the requirement for extensive base-pairing likely limits the regulatory impacts to modest effects on a small subset of targets.
Producing Agreements and Innovations in Collaborative Governance
Authors: Page Stephen B , Thomas Craig , Kern Michael , Murphy Amanda , Page Chris
Published: July 2023

Collaborative governance initiatives often seek innovative solutions to longstanding policy dilemmas, as well as agreements on those solutions among longtime political adversaries. Producing both innovations and agreements in combination is difficult: the diversity among collaborators that enable innovations can complicate their attempts to reach agreements, while unifying factors that support agreements may diminish the prospects for innovation. This article introduces three phases of collaborative agreement and pinpoints drivers of agreements on collaborative innovations. We analyze how each driver connects to the cross-pressure between unity and diversity in collaborative governance and generate propositions that relate each driver to the production of different phases of agreements. Our propositions indicate that collaborators seeking agreements on innovations must strike a balance between factors that support innovations (but may hinder agreements) and factors that support agreements (but may hinder innovations). We recommend ways practitioners can foster and sustain that balance by varying rules governing collaborative participation, information discovery, deliberation, and decisions. We conclude by proposing new research using our conceptual refinements to study whether specific conditions surrounding collaboration are associated with the achievement of different phases of agreement on collaborative innovations.
Carotid artery intima media thickness can predict the response to phosphodiesterase 5 inhibitors in patients with moderate erectile dysfunction
Authors: Kilic Metin , Caglayan Volkan , Sambel Murat , Erdogan Abdullah , Onen Efe , Kurtoglu Unal , Erkan Anıl , Avci Sinan , Ekici Ozgur
Published: July 2023

Background

Increased carotid artery intima-media thickness (CIMT) has been shown to be associated with erectile dysfunction (ED), but studies evaluating the efficacy of CIMT in predicting drug response are lacking in the literature.

Aim

We aimed to evaluate the efficacy of CIMT in predicting the response to phosphodiesterase-5 inhibitors (PDE5-I).

Methods

A total of 274 subjects were divided into two groups: ED patients (n = 150) and controls (n = 124). The patients in the ED group were further divided into the subgroups of severe, moderate, mild–moderate, and mild ED. Blood tests, carotid ultrasonography, and the International Index of Erectile Function-5 (IIEF-5) diagnostic tool were applied to all subjects. Tadalafil was administered to each patient. The patients were re-evaluated using the IIEF-5 questionnaire after 2 months of treatment. According to their response to medication, the patients were evaluated as responders or nonresponders.

Outcomes

Increased CIMT was significantly associated with the failure of PDE5-I therapy, especially in patients with moderate/mild-moderate ED.

Results

Fasting blood glucose, body mass index, and CIMT were significantly higher in the ED group compared to the control group (P = .021, P = .006, and P < .001, respectively). The IIEF-5 score was significantly lower in the ED group (P < .001). CIMT was significantly correlated with the IIEF-5 score. When the total patient group was evaluated, the CIMT value of the responders was significantly lower than that of the nonresponders (P = .001). CIMT was significantly higher among the nonresponders with moderate/mild-moderate ED compared to the responders (P = .004 and .008, respectively), while there was no significant difference in CIMT between the responders and nonresponders with severe or mild ED. A receiver operating characteristic (ROC) analysis of CIMT was performed for discrimination between nonresponders and responders with moderate/mild-moderate ED. The area under the ROC curve was 0.801 (0.682–0.921) (P = .001), and the cutoff value was determined to be 0.825 mm, at which CIMT predicted the response to treatment with 65% sensitivity and 89% specificity.

Clinical Implications

Using a validated CIMT cutoff value can help the physician inform the patient about the possibility of drug failure and avoid attempting second-line therapy too soon.

Strengths and Limitations

There are three main limitations to our study. First, the number of participants was low. Second, ultrasound is a relatively subjective method, and third, all measurements were made by the same radiologist.

Conclusion

CIMT can be used as a predictor of response to PDE5-I therapies in patients with moderate/mild–moderate ED.
Aging Workforce, Productivity, and Wages in Japan
Authors: Jiang Mingyu , Kazekami Sachiko , Yasuda Hiroki , Yugami Kazufumi
Published: July 2023

We use a panel data set of Japanese firms from 2005 to 2019 to examine how a firm’s employee age structure affects its productivity and wages. The pooled ordinary-least-squares (OLS) results indicate a negative relationship between the proportion of older employees and labor productivity. However, the effects disappear after applying a fixed effects (FE) model and the generalized method of moments to consider the unobserved heterogeneity among firms. Moreover, the proportion of older employees does not significantly affect firms’ wages. We further examine firm heterogeneity as a factor that contributes to the difference between the pooled OLS and FE estimates. The results suggest that differences in corporate stakeholder characteristics and corporate governance, such as the presence of labor unions and proportion of foreign ownership, may be related to the ratio of older workers and corporate performance.
Impact of Soil Type and Placement of Xyway LFR Fungicide on Germination and Growth of Corn Seedlings Under a Controlled Setting
Authors: Kleczewski Nathan M.
Published: July 2023

Xyway LFR was released for use in corn as an in-furrow fungicide during 2020. Producers have raised concerns of reduced emergence and growth in corn plantings. Here, I assessed the impact of Xyway LFR placement in relation to the seed for impacts on seedling emergence and growth in two contrasting soil types (sand versus topsoil) under controlled conditions. Soil was added to containers, and five corn seeds were placed in a row in a furrow within each container. Xyway LFR was applied in a band at labelled rates at 0 (directly on seed), 1.27, 2.54, or 5.08 cm away from the seed. Containers were maintained under a light bank, and germination over time, as well as seedling biomass, was assessed. Statistical analysis indicated that plants in topsoil had greater germination rates and dry masses than plants in sand. Total plant dry masses were reduced relative to controls when Xyway LFR was placed 0 cm from the seed. However, when placed 2.54 or 5.08 cm from the seed, this impact was not evident. Potential phytotoxic effects may be mitigated by placing the product in a band at least 2.54 cm from the seed furrow.
Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education
Authors: Quay Catherine , Ramakrishnan Arun
Published: July 2023

Innovative educational interventions that dispel aging myths and promote empathy toward older adults can be used to reduce age bias and health care disparities. Virtual reality (VR) is one intervention that has shown promise in this area. This one-group, pretest-posttest design pilot study examined the effect of a VR experience on empathy with a sample of 121 second-degree, prelicensure nursing students. A significant improvement in empathy was observed. This study adds to the limited evidence that examines the use of VR for immersive storytelling and facilitation of empathy toward older adults in nursing students.
Cerebral Autoregulation-guided Management of Adult and Pediatric Traumatic Brain Injury
Authors: Lele Abhijit V. , Vavilala Monica S.
Published: July 2023

Cerebral autoregulation (CA) plays a vital role in maintaining cerebral blood flow in response to changes in systemic blood pressure. Impairment of CA following traumatic brain injury (TBI) may exacerbate the injury, potentially impacting patient outcomes. This focused review addresses 4 key questions regarding the measurement, natural history of CA after TBI, and potential clinical implications of CA status and CA-guided management in adults and children with TBI. We examine the feasibility and safety of CA assessment, its association with clinical outcomes, and the potential for reversing deranged CA following TBI. Finally, we discuss how the knowledge of CA status may affect TBI management and outcomes.
Non-invasive imaging of pathological scars using a portable handheld two-photon microscope
Authors: Han Yang , Sun Yuxuan , Yang Feili , Liu Qingwu , Fei Wenmin , Qiu Wenzhuo , Wang Junjie , Li Linshuang , Zhang Xuejun , Wang Aimin , Cui Yong
Published: July 2023

Background:

Pathological scars are a disorder that can lead to various cosmetic, psychological, and functional problems, and no effective assessment methods are currently available. Assessment and treatment of pathological scars are based on cutaneous manifestations. A two-photon microscope (TPM) with the potential for real-time non-invasive assessment may help determine the under-surface pathophysiological conditions in vivo. This study used a portable handheld TPM to image epidermal cells and dermal collagen structures in pathological scars and normal skin in vivo to evaluate the effectiveness of treatment in scar patients.

Methods:

Fifteen patients with pathological scars and three healthy controls were recruited. Imaging was performed using a portable handheld TPM. Five indexes were extracted from two dimensional (2D) and three dimensional (3D) perspectives, including collagen depth, dermo-epidermal junction (DEJ) contour ratio, thickness, orientation, and occupation (proportion of collagen fibers in the field of view) of collagen. Two depth-dependent indexes were computed through the 3D second harmonic generation image and three morphology-related indexes from the 2D images. We assessed index differences between scar and normal skin and changes before and after treatment.

Results:

Pathological scars and normal skin differed markedly regarding the epidermal morphological structure and the spectral characteristics of collagen fibers. Five indexes were employed to distinguish between normal skin and scar tissue. Statistically significant differences were found in average depth (t = 9.917, P <0.001), thickness (t = 4.037, P <0.001), occupation (t = 2.169, P <0.050), orientation of collagen (t = 3.669, P <0.001), and the DEJ contour ratio (t = 5.105, P <0.001).

Conclusions:

Use of portable handheld TPM can distinguish collagen from skin tissues; thus, it is more suitable for scar imaging than reflectance confocal microscopy. Thus, a TPM may be an auxiliary tool for scar treatment selection and assessing treatment efficacy.
Clinical Outcomes of First-line Therapies for Advanced Non–Small Cell Lung Cancer
Authors: García-Fumero Ricardo , Fernández-López Cristina , Calleja-Hernández Miguel Ángel , Expósito-Ruiz Manuela , Espín Jaime , Expósito-Hernández José
Published: July 2023

Objectives:

To analyze the evolution of clinical outcomes derived from clinical trials on first-line therapies for advanced or metastatic non–small cell lung cancer (NSCLC) published between 2010 and 2020, focusing on how these outcomes impact survival rates and management of patients.

Methods:

A systematic review of phase III and pivotal phase II clinical trials was conducted by a structured search on Medline and Embase. A comprehensive set of variables was collected to assess their influence on survival rates. We also estimated the clinical benefit by applying the ESMO-MCBS v1.1 and extracted the authors’ conclusions.

Results:

Sixty-six studies involving 34,951 patients were included. Best survival outcomes were found for nonsquamous non–small cell lung cancer (OS and progression-free survival medians: 19.4 and 10.2 mo) and for those expressing molecular targets (OS and progression-free survival medians: 23.8 and 11.0 mo). No significant influence on survival rates was observed for industry funding and disease stage (IIIB/IV vs. IV). ESMO-MCBS v1.1 was applied in 45 positive studies and resulted in a meaningful clinical benefit score in 37.8%. Quality of life (QoL) was reported in 57.6% of the original publications and showed statistical significance favoring the experimental arm in 33.3%. Positive authors’ conclusions (75.7% of trials) were based on OS and/or QoL in 34% and on surrogate endpoints in 66%.

Conclusions:

Extended survival times and a steady improvement in QoL have been observed. However, there were more than twice as many studies reporting positive authors’ conclusions as studies meeting the ESMO threshold for meaningful clinical benefit.
Clinical considerations and pathophysiological associations among obesity, weight loss, heart failure, and hypertension
Authors: Barillas-Lara Maria Irene , Faaborg-Andersen Christian C. , Quintana Raymundo A. , Loro-Ferrer Juan Francisco , Mandras Stacy A. , daSilva-deAbreu Adrian
Published: July 2023

Purpose of review

To describe the relationship between three pandemics: hypertension, obesity, and heart failure. From pathophysiology to treatment, understanding how these disease entities are linked can lead to breakthroughs in their prevention and treatment. The relevance of this review lies in its discussion of novel pharmacological and surgical treatment strategies for obesity and hypertension, and their role in the prevention and treatment of heart failure.

Recent findings

Novel medications such as GLP-1 agonists have demonstrated sustained weight loss in patients with obesity, and concurrent improvements in their cardiometabolic profile, and possibly also reductions in hypertension-related comorbidities including heart failure. Surgical therapies including laparoscopic bariatric surgery represent an important treatment strategy in obese patients, and recent studies describe their use even in patients with advanced heart failure, including those with ventricular assist devices.

These developments have deep implications on our efforts to understand, mitigate, and ultimately prevent the three pandemics, and offer promising improvements to quality of life, survival, and the cost burden of these diseases.
The Prevalence of Optical Coherence Tomography Artifacts in High Myopia and its Influence on Glaucoma Diagnosis
Authors: Poon Linda Yi-Chieh , Wang Chi-Hsun , Lin Pei-Wen , Wu Pei-Chang
Published: July 2023

Précis:

Optical coherence tomography (OCT) artifacts occur much more frequently in highly myopic eyes compared with non-highly myopic eyes. A longer axial length is predictive of having OCT artifacts.

Purpose:

To investigate the types and prevalence of artifacts on OCT scans in patients with and without high myopia.

Materials and Methods:

Patients were divided into 4 groups based on whether they had glaucoma and/or high myopia. All peripapillary retinal nerve fiber layer (RNFL) scan images were individually inspected for the presence of artifacts.

Results:

Two hundred twenty-six patients were enrolled. The prevalence of OCT artifacts was 18.6% in non-high myopes and 51.9% in high myopes (P<0.001). Outer RNFL border misidentification was the most common type of artifact for non-high myopes, whereas retinal pathology-related artifact was the most common in high myopes. Univariable regression analysis showed that a longer axial length [odds ratio (OR) 1.815, P<0.001], a higher pattern standard deviation (OR 1.194, P<0.001), and thinner RNFL (OR 0.947, P<0.001) were predictive factors for the presence of OCT artifacts. The diagnostic capability of global RNFL thickness before and after manual correction of segmentation errors did not differ for both non-high myopes [area under the receiver operating curve 0.915–0.913 (P=0.955)] and high myopes [area under the receiver operating curve 0.906–0.917 (P=0.806)].

Conclusion:

The prevalence of OCT artifacts was the highest in patients with both high myopia and glaucoma. The most common type of OCT artifact is different for non-high myopes and high myopes. Physicians need to be aware of a higher likelihood of OCT artifacts, particularly in those with a longer axial length, worse visual field, and thinner RNFL thickness.
Codetection of Plasmodium falciparum in Children Hospitalized With Dengue Fever in the Dominican Republic
Authors: Teoh Zheyi , Simpson Brittany N. , Howard Thad , McElhinney Kathryn , Ware Russell , Mena Rafael , Schlaudecker Elizabeth P.
Published: July 2023

Background:

Cases of malaria and dengue in the Dominican Republic both spiked in 2019, but their rates of codetection are poorly characterized, especially in children.

Methods:

We performed a prospective, observational study in January to December 2019 at the Hospital Infantil Robert Reid Cabral, in the Dominican Republic, enrolling hospitalized children with a clinical suspicion of dengue fever. Participants with a positive plasma dengue IgM antibodies were included in this study. Clinical and hospital data were abstracted, and dried blood spot samples were collected from participants and tested with quantitative polymerase chain reaction to detect the presence of Plasmodium falciparum DNA.

Results:

A total of 429 children with serological evidence of acute dengue were included in this study, of whom 1.4% (n = 6/429) had codetection of dengue and malaria. There were no significant differences in fever duration or presence of vomiting, abdominal pain and rash between both groups. Children with dengue and malaria codetection were numerically more often admitted to the pediatric intensive care unit, despite no differences found in overall clinical severity.

Conclusions:

The codetection of malaria and dengue in children was overall uncommon in our Dominican Republic cohort despite the rise in cases in 2019 but may be associated with a more severe hospital course. Further epidemiological and cohort studies to characterize the risk of both pathogens as case numbers fluctuate will be important to better understand the dynamics of coinfections.
Validation of the Korean Version of the Assessment of Strategies in Families-Effectiveness Scale
Authors: CHOI Hanna , PARK Byungsun
Published: July 2023

Background

Family health significantly affects society and the country. Health problems have been identified as the most important cause of family anxiety and conflict in South Korea. Because valid instruments to measure this concept are limited, using the Assessment of Strategies in Families-Effectiveness scale may provide precious insight into family health and nursing practice.

Purpose

This study was designed to translate and validate the Korean version of the Assessment of Strategies in Families-Effectiveness (K-ASF-E) scale. This scale was developed based on the framework of systemic organization for assessment and intervention use in the context of family nursing in South Korea.

Methods

A methodological approach was used to verify the validity and reliability of the K-ASF-E. To determine validity, we first invited four experts to evaluate content validity. Next, we collected data from 1,028 participants using stratified random sampling that considered the background of each participant in terms of region, age, and gender. On the basis of the collected data, we determined the construct validity of the scale using exploratory factor analysis and confirmatory factor analysis. Finally, we used Cronbach's alpha and intraclass correlation coefficient analyses to assess scale reliability.

Results

The K-ASF-E showed item-level content validity index and scale-level content validity index values of 1.00, as assessed by four experts. Using the principal component analysis method with varimax rotation, the exploratory factor analysis verified the validity of a K-ASF-E scale comprising four dimensions and 20 items, including system maintenance (seven items), system change (four items), coherence (six items), and individuation (three items). For confirmatory factor analysis, the fit indices of the factor structure of K-ASF-E indicate appropriate model fitness. The Cronbach's alpha coefficients for each of the subfactors centered on the target were .59–.86, and the intraclass correlation coefficient (range) was .56–.85.

Conclusions/Implications for Practice

The K-ASF-E scale is the first attempt to develop a reliable and valid measurement tool for family effectiveness in South Korea. Initial testing was validated using a large number of stratified randomized clusters. The K-ASF-E scale accurately measures family effectiveness and may be used for family-related research, intervention, and training programs in community and clinical settings.
Sarcoidosis and frailty: recognizing factors that foster holistic resilience
Authors: Saketkoo Lesley Ann , Russell Anne-Marie , Patterson Karen C. , Obi Ogugua Ndili , Drent Marjolein
Published: July 2023

Purpose of review

Sarcoidosis is a multiorgan system disease exerting significant impact on biophysical, social, psychological and emotional well-being. Mortality and disability correlate to accessible, timely, expert care for sarcoidosis and its related complications. Across health conditions, positive healthcare interactions and interventions can rehabilitate unfavourable factors tied to concepts of ‘frailty’. Here, we set out to introduce concepts related tofrailtyand their impact in the context of sarcoidosis.

Recent findings

Studies examining frailty across other multiorgan and single organ-based diseases that mirror organ involvement in sarcoidosis demonstrate findings that bear relevance in sarcoidosis. Namely, factors predisposing a person to frailty are a multifactorial phenomenon which are also reflected in the lived experience of sarcoidosis; and that early diagnosis, intervention and prevention may alter a course towards more favourable health outcomes.

Factors predisposing to frailty in other health conditions may also signal a risk in sarcoidosis. In turn, proactive health preservation – regardless of age – may lead to improved biopsychosocial reserve and health-related quality of life. Fortifying holistic resilience in sarcoidosis is anticipated to reduce risk of the occurrence and prolongation of health-related complications, and facilitate swifter recovery from biophysical complications as well as from psychosocial and emotional stressors.
Artificial intelligence in digestive endoscopy: recent advances
Authors: Rey Jean-Francois
Published: July 2023

Purpose of review

With the incessant advances in information technology and its implications in all domains of our life, artificial intelligence (AI) started to emerge as a need for better machine performance. How it can help endoscopists and what are the areas of interest in improving both diagnostic and therapeutic endoscopy in each part of the gastrointestinal (GI) tract. What are the recent benefits and clinical usefulness of this new technology in daily endoscopic practice.

Recent Findings

The two main AI systems categories are computer-assisted detection ‘CADe’ for lesion detection and computer-assisted diagnosis ‘CADx’ for optical biopsy and lesion characterization. Multiple softwares are now implemented in endoscopy practice. Other AI systems offer therapeutic assistance such as lesion delineation for complete endoscopic resection or prediction of possible lymphanode after endoscopic treatment. Quality assurance is the coming step with complete monitoring of high-quality colonoscopy. In all cases it is a computer-aid endoscopy as the overall result rely on the physician. Video capsule endoscopy is the unique example were the computer conduct the device, store multiple images, and perform accurate diagnosis.

AI is a breakthrough in digestive endoscopy. Screening gastric and colonic cancer detection should be improved especially outside of expert's centers. Prospective and multicenter trials are mandatory before introducing new software in clinical practice.
Facial nerve schwannoma and other benign neoplastic facial nerve lesions
Authors: Kitama Tsubasa , Hosoya Makoto , Oishi Naoki
Published: July 2023

Purpose of review

Several neoplastic lesions may originate from facial nerves, including facial nerve schwannomas. These neoplastic lesions can cause various symptoms, such as facial nerve paralysis, and decrease the quality of life of patients. Therefore, knowledge of how to manage these diseases is important for otologists. However, the incidence of these diseases is extremely low, and universal management methods have not yet been established. This review summarizes recent advances in knowledge regarding these neoplastic lesions, especially facial nerve schwannomas.

Recent findings

Recent advances and the accumulation of knowledge regarding these benign facial nerve lesions have provided several preferable treatments and management methods, especially for facial nerve schwannomas. However, this still depends on the patient's symptoms and tumor localization.

This review presents the optimal treatment protocol and differential diagnosis of benign facial nerve lesions. This may be useful for pretreatment differentiation and treatment decision-making.
DUPAN-2 as a Risk Factor of Early Recurrence After Curative Pancreatectomy for Patients With Pancreatic Ductal Adenocarcinoma
Authors: Sasaki Atsushi , Sakata Kazuhito , Nakano Koji , Tsutsumi Satoshi , Fujishima Hajime , Futsukaichi Takuro , Terashi Takahiro , Ikebe Masahiko , Bandoh Toshio , Utsunomiya Tohru
Published: July 2023

Objectives

Several patients with pancreatic ductal adenocarcinoma (PDAC) experience postoperative early recurrence (ER). We evaluated PDAC patients to identify the risk factors for postoperative ER (≤6 months), including preoperative serum DUPAN-2 level.

Methods

We retrospectively evaluated 74 PDAC patients who underwent pancreatectomy with curative intent. Clinicopathological factors including age, sex, body mass index, postoperative complications, pathological factors, preoperative C-reactive protein/albumin ratio, neutrophil/lymphocyte ratio, modified Glasgow prognostic score, preoperative tumor markers (carcinoembryonic antigen, carbohydrate antigen 19-9, SPAN-1, and DUPAN-2), and history of adjuvant chemotherapy were investigated. Early recurrence risk factors were determined using multivariate logistic regression analysis.

Results

Recurrence and ER occurred in 52 (70.3%) and 23 (31.1%) patients, respectively. Univariate analysis revealed that postoperative complications, C-reactive protein/albumin ratio ≥0.02, neutrophil/lymphocyte ratio ≥3.01, carbohydrate antigen 19-9 ≥ 92.3 U/mL, SPAN-1 ≥ 69 U/mL, DUPAN-2 ≥ 200 U/mL, and absence of adjuvant chemotherapy were significant risk factors for ER. In multivariate analysis, DUPAN-2 ≥ 200 U/mL (P = 0.04) and absence of adjuvant chemotherapy (P = 0.02) were identified as independent risk factors for ER.

Conclusions

A higher level of preoperative DUPAN-2 was an independent risk factor for ER. For patients with high DUPAN-2 level, neoadjuvant therapies might be required to avoid ER.
Solid Pseudopapillary Neoplasm of the Pancreas
Authors: Sun Gen , Fang Kang , Fu Xiaowei , Peng Long , Shu Jiaming , Tu Yi , Li Yong , Xiao Weidong
Published: July 2023

Objectives

The aim of the study is to summary the clinicopathological characteristics and surgical outcomes of solid pseudopapillary neoplasm (SPN) of the pancreas.

Methods

In this retrospective study, the information of 118 patients with SPN from 3 hospitals were analyzed.

Results

A total of 118 patients. The mean age was 30.8 (standard deviation, 14.7) years and the majority were female (n = 95, 80.5%). Sixty-seven patients (56.8%) had clinical symptoms, of which the most common symptom was abdominal pain (49.6%). The mean tumor size was 5.9 (standard deviation, 2.9) cm. Pseudopapillary architecture was the commonest histologic feature, and β-catenin, CD56, vimentin, neuron-specific enolase, CD10, a1-antitrypsin, cytokeratins showed different degrees of positive expression in immunohistochemical staining. Fourteen patients (11.9%) presented aggressive pathologic behavior, which was correlated to the incomplete tumor capsule. At a median follow-up of 59.2 months, the recurrence rate was 1.8% and the overall 5-year survival rate was 97.7%.

Conclusions

Solid pseudopapillary neoplasm of the pancreas is a potentially low-grade malignant tumor that most frequently found in young females. Its clinical manifestations are nonspecific and the diagnosis mostly depends on pathological examination. Surgical resection is the first choice of treatment for SPN with a good prognosis.
Stability of Symptom Clusters in Children With Acute Lymphoblastic Leukemia Undergoing Chemotherapy
Authors: Li Rongrong , Shen Xinyi , Yang Qi , Zhang Lin , Li Huiling , Yao Wenying , Chan Yuying
Published: July 2023

Background

Children with acute lymphoblastic leukemia (ALL) experience multiple symptoms during chemotherapy. Assessing how symptoms cluster together and how these symptom clusters (SCs) change over time may lay a foundation for future research in SC management and the pathophysiological mechanisms of SCs.

Objectives

This study aimed to assess the stability of SCs in children with ALL during chemotherapy.

Methods

A longitudinal investigation was carried out. The Chinese version of the Memorial Symptom Assessment Scale 10 to 18 was used to assess the occurrence, severity, and distress of symptoms in 134 children with ALL (8–16 years old) at the following 4 separate points: before chemotherapy (T1), start of post–induction therapy (T2), 4 months post–induction therapy (T3), and start of maintenance therapy (T4). Exploratory factor analyses were used to extract SCs.

Results

Six SCs were identified. Emotional and somatic clusters were identified across all dimensions and time points. Gastrointestinal cluster was all identified except for occurrence at T1. Neurological cluster was identified at T2 and T3 for all dimensions and at T4 for severity and distress. Self-image disorder cluster was all identified except at T1. Skin mucosa cluster was identified at T2 and T3 for all dimensions. Emotional cluster exhibited common symptoms across dimensions and time points.

Conclusion

The number and types of SCs determined by scoring the occurrence, severity, and distress are different, but some SCs are relatively stable.

Implications for Practice

Clinicians should not only focus on the common trajectory of symptoms and SCs, but also assess each child individually.