bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective early adulthood risk factors for vasomotor symptoms in the Coronary Artery Risk Development in Young Adults study
Authors: Kim Catherine , Lane Abbi , Vu Thanh-Huyen T. , Lewis Cora B. , Yin Zhe , Jiang Hui , Auchus Richard J. , Schreiner Pamela J.
Published: January 2024

Objective

Previous studies have assessed potential risk factors for vasomotor symptoms (VMS) beginning in midlife. We examined whether early adulthood risk factors predict VMS trajectories over time.

Methods

We performed a secondary data analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) study, a population-based cohort. We included women who answered questions about VMS at three or more examinations (n = 1,966). We examined whether risk factors at baseline (when participants were aged 18-30 y; average age, 25 y) and the year 15 (Y15) exam (at ages 33-45 y; average age, 40 y) were associated with VMS trajectories from Y15 through Y35. Logistic regression models were used to evaluate the associations with VMS trajectories.

Results

We identified three trajectories of VMS presence: minimal (40%), increasing over time (27%), and persistent (33%). Baseline factors associated with persistent VMS over time included Black race, less than a high school education, depressive symptoms, migraines, cigarette use, and at Y15 hysterectomy. Baseline factors associated with increasing VMS over time included Black race and lower body mass index. Risk factors for bothersome VMS were similar and also included thyroid disease, although thyroid disease was not associated with persistence of VMS over time. Associations were similar among women who had not undergone hysterectomy and in Black and White women.

Conclusions

Risk factors for VMS may be identified in early adulthood. Further examination of risk factors such as migraines and depressive symptoms in early adulthood may be helpful in identifying therapies for VMS.
Changes in endothelial cell density after conventional phacoemulsification and FLACS in eyes with dense cataracts
Authors: Ganesh Sri , Brar Sheetal , Wadhokar Sanjali
Published: January 2024

Purpose:

To compare the safety, effectiveness, and changes in endothelial cell density (ECD) after standard phacoemulsification and femtosecond laser-assisted cataract surgery (FLACS) in dense cataracts (Lens Opacities Classification System III grade 3.0 NO and above).

Setting:

Nethradhama Superspeciality Eye Hospital, Bangalore, India.

Design:

Prospective, randomized, comparative study.

Method:

100 eyes of 100 patients were randomly assigned to either conventional phacoemulsification surgery (CPS) or FLACS (LENSAR Laser System) using predefined patterns of nuclear fragmentations. Measured outcomes included intraoperative phacoemulsification time, irrigation fluid volume, surgical time, and complication rates. ECD was evaluated at baseline, 2 weeks, and 6 months postoperatively.

Results:

The CPS group had significantly higher mean total phacoemulsification time (11.17 ± 6.5 seconds vs 8.03 ± 3.77 seconds), effective phacoemulsification time (6.14 ± 3.62 seconds vs 4.42 ± 2.07 seconds), and total surgical time (8.18 ± 2.36 minutes vs 7.11 ± 1.55 minutes) than the FLACS group (P < .001). Volume of irrigation fluid was comparable between the 2 groups (CPS, 36.7 ± 12.18 mL; FLACS, 38.64 ± 13.73 mL (P = .45). Mean corneal edema score and central corneal thickness values on postoperative day 1 were significantly higher for the CPS group. At 6 months, % ECD loss was significantly higher in the CPS group (16.08%) vs the FLACS group (12.8%) (P < .001). 3 eyes in the CPS group had wound burns of varying severity.

Conclusions:

FLACS with customized nuclear fragmentation patterns resulted in significantly less intraoperative phacoemulsification time, surgical time, and endothelial cell loss compared with conventional phacoemulsification when treating dense cataracts.

Trial Registration Number:

CTRI/2021/12/038887.
Confronting mental health stigma in Haitian Americans suffering from mental health challenges
Authors: Moreau Marie M. , Love Rene A. , Fanfan Dany
Published: January 2024

Background:

Haitian Americans have been disproportionately exposed to risk factors known to play a significant role in the development of mental illness. Yet despite the documented effectiveness of mental health treatment, a high proportion of Haitian Americans with mental health disorders have not received care.

Local problem:

Internalized stigma of mental illness (ISMI) was reported as one of the primary reasons Haitian Americans do not seek help for mental illnesses, resulting in poor long-term outcomes for individuals and families in this community. This quality improvement project characterized ISMI among Haitian Americans, examined associated demographic factors, and tested the impact of a culturally relevant ISMI educational video intervention on willingness to seek mental health treatment.

Methods:

Haitian Americans who self-reported mental illness (N = 20) were recruited from a South Florida clinic. Descriptive statistics, correlations, and thematic analyses were completed to analyze the data.

Interventions:

Participants completed the nine-item ISMI scale, watched an educational video about ISMI, completed a post-intervention survey, and engaged in conversations about mental health and ISMI.

Results:

Sixty-five percent of participants reported mild levels of ISMI. Sex was significantly correlated with ISMI (r = −0.458, p = .042); male participants experienced higher levels of ISMI. The educational video improved participants' knowledge of ISMI, and 85% indicated increased willingness to seek treatment.

Conclusions:

When caring for Haitian Americans with mental illnesses, nurse practitioners should initiate conversations about ISMI, consider gender differences in mental illness beliefs and attitudes, and provide culturally responsive psychoeducational interventions to promote more mental health treatment utilization.
Estimation of Cochlear Implant Insertion Depth Using 2D-3D Registration of Postoperative X-Ray and Preoperative CT Images
Authors: Liu George S. , Cooperman Shayna P. , Neves Caio A. , Blevins Nikolas H.
Published: January 2024

Objective

To improve estimation of cochlear implant (CI) insertion depth in postoperative skull x-rays using synthesized information from preoperative CT scans.

Study Design

Retrospective cohort.

Setting

Tertiary referral center.

Patients

Ten adult cochlear implant recipients with preoperative and postoperative temporal bone computed tomography (CT)scans and postoperative skull x-ray imaging.

Interventions

Postoperative x-rays and digitally reconstructed radiographs (DRR) from preoperative CTs were registered using 3D Slicer and MATLAB to enhance localization of the round window and modiolus. Angular insertion depth (AID) was estimated in unmodified and registration-enhanced x-rays and DRRs in the cochlear view. Linear insertion depth (LID) was estimated in registered images by two methods that localized the proximal CI electrode or segmented the cochlea. Ground truth assessments were made in postoperative CTs.

Main Outcome Measure(s)

Errors of insertion depth estimates were calculated relative to ground truth measurements and compared with paired t tests. Pearson correlation coefficient was used to assess inter-rater reliability of two reviewer’s measurements of AID in unmodified x-rays.

Results

In postoperative x-rays, AID estimation errors were similar with and without registration enhancement (−1.3 ± 20.7° and −4.8 ± 24.9°, respectively; mean ± SD; p = 0.6). AID estimation in unmodified x-rays demonstrated strong interrater agreement (ρ = 0.79, p < 0.05) and interrater differences (−15.0 ± 35.3°) comparable to estimate errors. Registering images allowed measurement of AID in the cochlear view with estimation errors of 14.6 ± 30.6° and measurement of LID, with estimate errors that were similar between proximal electrode localization and cochlear segmentation methods (−0.9 ± 2.2 mm and −2.1 ± 2.7 mm, respectively; p = 0.3).

Conclusions

2D-3D image registration allows measurement of AID in the cochlear view and LID using postoperative x-rays and preoperative CT imaging. The use of this technique may reduce the need for postimplantation CT studies to assess these metrics of CI electrode position. Further work is needed to improve the accuracy of AID assessment in the postoperative x-ray view with registered images compared with established methods.
Intracochlear Trauma and Local Ossification Patterns Differ Between Straight and Precurved Cochlear Implant Electrodes
Authors: Geerardyn Alexander , Zhu MengYu , Verhaert Nicolas , Quesnel Alicia M.
Published: January 2024

Hypothesis

Trauma to the osseous spiral lamina (OSL) or spiral ligament (SL) during cochlear implant (CI) insertion segregates with electrode type and induces localized intracochlear ossification and fibrosis.

Background

The goal of atraumatic CI insertion is to preserve intracochlear structures, limit reactive intracochlear tissue formation, and preserve residual hearing. Previous qualitative studies hypothesized a localized effect of trauma on intracochlear tissue formation; however, quantitative studies failed to confirm this.

Methods

Insertional trauma beyond the immediate insertion site was histologically assessed in 21 human temporal bones with a CI. Three-dimensional reconstructions were generated and virtually resectioned perpendicular to the cochlear spiral at high resolution. The cochlear volume occupied by ossification or fibrosis was determined at the midpoint of the trauma and compared with regions proximal and distal to this point.

Results

Seven cases, all implanted with precurved electrodes, showed an OSL fracture beyond the immediate insertion site. Significantly more intracochlear ossification was observed at the midpoint of the OSL fracture, compared with the −26 to −18 degrees proximal and 28 to 56 degrees distal to the center. No such pattern was observed for fibrosis. In the 12 cases with a perforation of the SL (9 straight and 3 precurved electrodes), no localized pattern of ossification or fibrosis was observed around these perforations.

Conclusion

OSL fractures were observed exclusively with precurved electrodes in this study and may serve as a nidus for localized intracochlear ossification. Perforation of the SL, in contrast, predominantly occurred with straight electrodes and was not associated with localized ossification.
Foreign body in lung: a case report
Authors: Tolba Mohamed A. , Farhat Youssef Z. , Mohamad Anwar , Sedkey John A.
Published: January 2024

Introduction:

The presence of a metal foreign body (FB) in the lungs can be a major contributor to pulmonary embolism. FB pulmonary embolism is a rare condition and difficult to diagnose due to its variable clinical presentations.

Case Presentation:

This article presents a case of a 34-year-old male presented to our emergency department after getting injured with a FB fragment entering the upper right thigh. Plain X-ray proved the presence of the FB and patient was admitted to surgical extraction. However, the FB disappeared with the first attempt to reposition the patient. Then, the patient underwent a chest computed tomography (CT) without contrast that revealed the presence of the FB in the heart with a characteristic finding of a starburst appearance. Then the patient was transferred to the Catheter lab. But cardiologists did not find the FB inside the heart. Another chest CT scan was done that showed the FB in the right lower pulmonary artery. Then patient was transferred to the cardio-thoracic surgery department that decided not to remove the FB and just follow-up.

Discussion:

There are many cases of metal FB lodged in the vascular system. In this case, CT scan had been performed to the FB helped to take the appropriate decision before the FB causes damage to any vital organ.

Conclusion:

FB traveling through the vascular system can cause a pulmonary embolism. In our case, the time the FB took to reach the pulmonary arteries was merely few hours. However, appropriate management could help steer the patient away from danger.
Combination of Mifepristone and Misoprostol for First-Trimester Medical Abortion: A Comprehensive Review of the Literature
Authors: Kelesidou Vera , Tsakiridis Ioannis , Virgiliou Andriana , Dagklis Themistoklis , Mamopoulos Apostolos , Athanasiadis Apostolos , Kalogiannidis Ioannis
Published: January 2024

Importance

Several medications have been used to achieve medical abortion in the first trimester of pregnancy. The most commonly used is the combination of mifepristone and misoprostol; however, different doses and routes of administration have been proposed.

Objective

The aim of this study was to summarize published data on the effectiveness, adverse effects, and acceptability of the various combinations of mifepristone and misoprostol in medical abortion protocols in the first trimester of pregnancy.

Evidence Acquisition

This was a comprehensive review, synthesizing the findings of the literature on the current use of mifepristone and misoprostol for first-trimester abortion.

Results

The combination of mifepristone and misoprostol seems to be more effective than misoprostol alone. Regarding the dosages and routes, mifepristone is administered orally, and the optimal dose is 200 mg. The route of administration of misoprostol varies; the sublingual and buccal routes are more effective; however, the vaginal route (800 μg) is associated with fewer adverse effects. Finally, the acceptability rates did not differ significantly.

Conclusions

Different schemes for first-trimester medical abortion have been described so far. Future research needs to focus on identifying the method that offers the best trade-off between efficacy and safety in first-trimester medical abortion.

Target Audience

Obstetricians and gynecologists, family physicians

Learning Objectives

After participating in this activity, the learner should be better able to discuss available combinations of mifepristone and misoprostol for first-trimester medical abortion; describe the recommended doses of misoprostol for first-trimester medical abortion; and assess the adverse effects caused by misoprostol when administered by different routes.
Low-Grade Serous Ovarian Cancer: Expert Consensus Report on the State of the Science
Authors: Grisham Rachel N. , Slomovitz Brian M. , Andrews Nicole , Banerjee Susana , Brown Jubilee , Carey Mark S. , Chui Herman , Coleman Robert L. , Fader Amanda N. , Gaillard Stephanie , Gourley Charlie , Sood Anil K. , Monk Bradley J. , Moore Kathleen N. , Ray-Coquard Isabelle , Shih Le-Ming , Westin Shannon N. , Wong Kwang-Kwok , Gershenson David M.
Published: January 2024

(Abstracted from Int J Gynecol Cancer 2023;0:1–14)

Low-grade serous carcinoma represents less than 10% of epithelial ovarian cancers, is often diagnosed in younger women, and is associated with prolonged survival relative to high-grade serous carcinoma. In 2019, a panel of experts gathered to address the unique needs of low-grade serous carcinoma management and published a consensus paper.
Surgical Anatomy of the Clitoris and Surrounding Vulvar Structures
Authors: Tappy Erryn , Corton Marlene
Published: January 2024

(Abstracted from Am J Obstet Gynecol 2023;229(4):460–462)

During periurethral and vulvar procedures, thorough knowledge of clitoral anatomy is imperative to ensure the preservation of the autonomic and somatic nerves. This reduces chances of postoperative clitoral pain, sexual dysfunction, and decreased sensation, as entrapment and compression of these nerves during surgical procedures have been observed to likely cause such dysfunction.
Fetal Heart Rate Responses in Chronic Hypoxaemia With Superimposed Repeated Hypoxaemia Consistent With Early Labour: A Controlled Study in Fetal Sheep
Authors: Lear C. A. , Georgieva A. , Beacom M. J. , Wassink G. , Dhillon S. K. , Lear B. A. , Mills O. J. , Westgate J. A. , Bennet L. , Gunn A. J.
Published: January 2024

(Abstracted from BJOG 2023;130:881–890)

The fetal heart rate is a powerful indicator of overall fetal well-being. In recent years, there has been the development of evaluation approaches of the fetal heart rate tracing such as deceleration area (DA) and capacity (DC).
Immunohistochemical Expression of Epidermal Growth Factor Receptor (EGFR) in Oral Squamous Cell Carcinoma and Oral Potentially Malignant Disorders
Authors: Aamir Razia , Rauf Fozia , Iqbal Fatima , Yousuf Sarah , Rehman Asif , Sheikh Ahmareen K. , Muhammad Sardar
Published: January 2024

Background:

Increased epidermal growth factor receptor (EGFR) expression has been implicated in several tumors and is associated with increased tumor advancement as well as a potential drug target. The objective of the study was to compare the immunohistochemical expression of EGFR in oral squamous cell carcinoma (OSCC) with oral potentially malignant disorders (OPMDs) and their demographic and pathologic parameters.

Methods:

This study was a comparative cross-sectional analytical study. It was conducted at the Department of Pathology, Peshawar Medical College, Riphah International University, Islamabad, Pakistan, from March 2021 to February 2022. The sample size was calculated through G Power. Thirty-eight cases of oral squamous cell carcinoma and 38 cases of oral potentially malignant disorders (OPMDs) were included in the study. Statistical analysis was performed using the Statistical Package for Social Sciences version 20.0. χ2 tests and Fisher exact tests were applied to compare categorical variables.

Results:

Mean age of OSCC was 61.6±13.9, with age range from 26 to 90 years. The male-to-female ratio for OSCC was 2.16:1. Buccal mucosa was the most common site involved (34.2%). The most common histologic type was well-differentiated OSCC (71.05%) followed by poorly differentiated (16%) and moderately differentiated (13.15%). The mean age of OPMDs cases was 59.16 ± 10.81 with a male-to-female ratio of 1:1.2. Buccal mucosa was the common site (55.3%), followed by the tongue (18.4%). The OPMDs with dysplasia were 55.2%, and without dysplasia were 44.8%. A total of 55.7% of cases of OSCC showed positive EGFR expression as compared with 36.9% OPMDs cases. A higher number of low-grade OSCC cases showed increased EGFR positivity (59.3%) as compared with high grade (45.45%). EGFR positivity in OPMD cases without dysplasia was 41.2% as compared with cases with dysplasia (33.3%). The EGFR expression in OPMD cases was higher in the ≤50 age group (P=0.001) and in females (P=0.032), which was statistically significant.

Conclusions:

EGFR expression by Immunohistochemistry may not be a helpful prognostic marker to determine the risk of OPMDs progressing to higher grades of dysplasia or invasive cancer. However, further studies relating this tumor marker to stage, lymph node metastasis, hematogenous metastasis, survival outcomes, and treatment response may give useful information regarding the utility of this marker.
GAD2 Is a Highly Specific Marker for Neuroendocrine Neoplasms of the Pancreas
Authors: Lennartz Maximilian , Benjamin Dünnebier Nick , Höflmayer Doris , Dwertmann Rico Sebastian , Kind Simon , Reiswich Viktor , Viehweger Florian , Lutz Florian , Fraune Christoph , Gorbokon Natalia , Luebke Andreas M. , Hube-Magg Claudia , Büscheck Franziska , Menz Anne , Uhlig Ria , Krech Till , Hinsch Andrea , Burandt Eike , Sauter Guido , Simon Ronald , Kluth Martina , Steurer Stefan , Marx Andreas H. , Lebok Patrick , Dum David , Minner Sarah , Jacobsen Frank , Clauditz Till S. , Bernreuther Christian
Published: January 2024

Glutamate decarboxylase 2 (GAD2) is the most important inhibitory neurotransmitter and plays a role in insulin-producing β cells of pancreatic islets. The limitation of GAD2 expression to a few normal cell types makes GAD2 a potential immunohistochemical diagnostic marker. To evaluate the diagnostic utility of GAD2 immunohistochemistry, a tissue microarray containing 19,202 samples from 152 different tumor entities and 608 samples of 76 different normal tissue types was analyzed. In normal tissues, GAD2 staining was restricted to brain and pancreatic islet cells. GAD2 staining was seen in 20 (13.2%) of 152 tumor categories, including 5 (3.3%) tumor categories containing at least 1 strongly positive case. GAD2 immunostaining was most commonly seen in neuroendocrine carcinomas (58.3%) and neuroendocrine tumors (63.2%) of the pancreas, followed by granular cell tumors (37.0%) and neuroendocrine tumors of the lung (11.1%). GAD2 was only occasionally (<10% of cases) seen in 16 other tumor entities including paraganglioma, medullary thyroid carcinoma, and small cell neuroendocrine carcinoma of the urinary bladder. Data on GAD2 and progesterone receptor (PR) expression (from a previous study) were available for 95 pancreatic and 380 extrapancreatic neuroendocrine neoplasms. For determining a pancreatic origin of a neuroendocrine neoplasm, the sensitivity of GAD2 was 64.2% and specificity 96.3%, while the sensitivity of PR was 56.8% and specificity 92.6%. The combination of PR and GAD2 increased both sensitivity and specificity. GAD2 immunohistochemistry is a highly useful diagnostic tool for the identification of pancreatic origin in case of neuroendocrine neoplasms with unknown site of origin.
Reliability and Accuracy of the Pediatric Swiss Emergency Triage Scale—the SETSped Study
Authors: Fehlmann Christophe A. , Garcin Sophie , Poncet Antoine , Marti Christophe , Rutschmann Olivier T. , Brandle Gabriel , Faundez Tamara , Simon Josette , Delieutraz Tatiana , Grosgurin Olivier
Published: January 2024

Background and Importance

The Swiss Emergency Triage Scale (SETS) is an adult triage tool used in several emergency departments. It has been recently adapted to the pediatric population but, before advocating for its use, performance assessment of this tool is needed.

Objectives

The purpose of this study was to assess the reliability and the accuracy of the pediatric version of the SETS for the triage of pediatric patients.

Design, Setting, and Participants

This study was a cross-sectional study among a sample of emergency triage nurses (ETNs) exposed to 17 clinical scenarios using a computerized simulator.

Outcome Measures and Analysis

The primary outcome was the reliability of the triage level performed by the ETNs. It was assessed using an intraclass correlation coefficient.

Secondary outcomes included accuracy of triage compared with expert-based triage levels and factors associated with accurate triage.

Main Results

Eighteen ETNs participated in the study and completed the evaluation of all scenarios, for a total of 306 triage decisions. The intraclass correlation coefficient was 0.80 (95% confidence interval, 0.69–0.91), with an agreement by scenario ranging from 61.1% to 100%. The overall accuracy was 85.8%, and nurses were more likely to undertriage (16.0%) than to overtriage (4.3%). No factor for accurate triage was identified.

Conclusions

This simulator-based study showed that the SETS is reliable and accurate among a pediatric population. Future research is needed to confirm these results, compare this triage scale head-to-head with other recognized international tools, and study the SETSped in real-life setting.
Development of a Pharmacy Point-of-Dispensing Toolkit for Anthrax Post-Exposure Prophylaxis for Allegheny County Postal Workers
Authors: Schneider Sarah N. , Nguyen Thai Q. , Hake Kelsey L. , Nightingale Barbara S. , Mangan Thomas P. , Rice Amanda N. , Carroll Joni C.
Published: January 2024

Context:

The Centers for Disease Control and Prevention (CDC) and the US Postal Service (USPS) consider anthrax to be a potential threat to USPS workers. A county health department–owned pharmacy supports local USPS response in the event of an exposure. The pharmacy team identified the need to review and update the local anthrax response plan.

Program/Policy:

A Pharmacy Point-of-Dispensing Toolkit and response plan for initial 10-day post-exposure antibiotic prophylaxis was developed for use by a local health department in the event of a mass anthrax exposure at a US Post Office sorting facility. The pharmacist's role in medical countermeasures planning for anthrax exposure is also discussed to illustrate how pharmacists' medication expertise can be utilized.

Evaluation:

The CDC's Public Health Preparedness Capabilities: National Standards for State and Local Planning framework and inputs from an interprofessional stakeholder team were used to develop a Medical Countermeasures Response Plan and Implementation Toolkit for mass point-of-dispensing (POD) in the event of an anthrax exposure.

Implementation and Dissemination:

Stakeholders attended a USPS Community Partner Training event where additional revisions to the toolkit were made. The toolkit and standing order are now implemented at the local health department to be reviewed and updated on a yearly basis by health department leadership.

Discussion:

Pharmacists can use their medication expertise and experience with patient education to design emergency response plans focused on increasing patient safety and medication adherence. Pharmacists should be involved in emergency response and medical countermeasures planning that involve medications.
Mother-to-Child Transmission of HBV Infection by Preventive Interventions in Southern Vietnam's Hospitals
Authors: Hoang Quoc Cuong , Nguyen Minh Ngoc , Nguyen Thi Thu Huong , Nguyen Mong Hoai Thu , Ha Thi Bich Ngoc , Nguyen Viet Thinh , Nguyen Thuong Vu , Tran Ngoc Huu
Published: January 2024

Introduction:

The World Health Organization (WHO) recommends tenofovir disoproxil fumarate (TDF) for pregnant women with hepatitis B virus (HBV) presenting with HBV DNA levels of 106 copies/mL or more to hinder mother-to-child transmission (MTCT). Moreover, it is suggested that neonates of HBV-infected mothers receive an HBV vaccine birth dose within 24 hours of birth to mitigate transmission risk.

Methodology:

The study included 661 HBV-infected pregnant women and 316 infants from 3 hospitals in Southern Vietnam between October 2019 and November 2020. Infants were classified on the basis of their mothers' TDF prophylaxis into I-TDF (+) group (107 infants) whose mothers received TDF; I-TDF (−) group (56 infants) whose mothers missed TDF; and I-NTDF group (153 infants) whose mothers did not necessitate TDF. Almost all infants received an HBV vaccine birth dose with HBIG administered on the basis of parents' financial standing.

Results:

MTCT was found in 2.2% of the cases. The respective MTCT rates for I-TDF (+), I-TDF (−), and I-NTDF groups were 2.8%, 5.4%, and 0.7%. Immune response rates to the HBV vaccination in the total cohort, I-TDF (+), I-TDF (−), and I-NTDF groups, were 88.6%, 87.9%, 85.7%, and 90.2%, respectively. Vaccinated infants exhibited a statistically lower risk of HBV infection postbirth (aRR = 0.1; 95% confidence interval, 0.0-0.6; P = .01).

Conclusion:

TDF can equate the MTCT risk in pregnant women with HBV DNA levels of 106 copies/mL or more to those with lower levels. Early administration of the HBV vaccine postbirth also effectively curtails MTCT. Thus, expanding TDF prophylaxis and vaccine coverage is pivotal to impede MTCT.
Maternal and Fetal Radiation-Induced Cancer Risk From Computed Tomography Pulmonary Angiography During Pregnancy: A Retrospective Cohort Study Across a Multihospital Integrated Health Care Network
Authors: Cohen Stuart L. , Feizullayeva Chinara , Wang Jason J. , Chan Nicholas , McCandlish John Austin , Cronin Paul P. , Barish Matthew A. , O'Connell William , Sanelli Pina C.
Published: January 2024

Objective

Computed tomography pulmonary angiogram (CTPA) is important to evaluate suspected pulmonary embolism in pregnancy but has maternal/fetal radiation risks. The objective of this study was to estimate maternal and fetal radiation-induced cancer risk from CTPA during pregnancy.

Methods

Simulation modeling via the National Cancer Institute's Radiation Risk Assessment Tool was used to estimate excess cancer risks from 17 organ doses from CTPA during pregnancy, with doses determined by a radiation dose indexing monitoring system. Organ doses were obtained from a radiation dose indexing monitoring system. Maternal and fetal cancer risks per 100,000 were calculated for male and female fetuses and several maternal ages.

Results

The 534 CTPA examinations had top 3 maternal organ doses to the breast, lung, and stomach of 17.34, 15.53, and 9.43 mSv, respectively, with a mean uterine dose of 0.21 mSv. The total maternal excess risks of developing cancer per 100,000 were 181, 151, 121, 107, 94.5, 84, and 74.4, respectively, for a 20-, 25-, 30-, 35-, 40-, 45-, and 50-year-old woman undergoing CTPA, compared with baseline cancer risks of 41,408 for 20-year-old patients. The total fetal excess risks of developing cancer per 100,000 were 12.3 and 7.3 for female and male fetuses, respectively, when compared with baseline cancer risks of 41,227 and 48,291.

Discussion

Excess risk of developing cancer from CTPA was small relative to baseline cancer risk for pregnant patients and fetuses, decreased for pregnant patients with increasing maternal age, and was greater for female fetuses than male fetuses.
Noninvasive Isocitrate Dehydrogenase 1 Status Prediction in Grade II/III Glioma Based on Magnetic Resonance Images: A Transfer Learning Strategy
Authors: Zhang Jin , Wang Yuyao , Yang Yang , Han Yu , Yu Ying , Hu Yuchuan , Liang Shouheng , Sun Qian , Shang Danting , Bi Jiajun , Cui Guangbin , Yan Linfeng
Published: January 2024

Objective

The aim of this study was to evaluate transfer learning combined with various convolutional neural networks (TL-CNNs) in predicting isocitrate dehydrogenase 1 (IDH1) status of grade II/III gliomas.

Methods

Grade II/III glioma patients diagnosed at the Tangdu Hospital (August 2009 to May 2017) were retrospectively enrolled, including 54 patients with IDH1 mutant and 56 patients with wild-type IDH1. Convolutional neural networks, AlexNet, GoogLeNet, ResNet, and VGGNet were fine-tuned with T2-weighted imaging (T2WI), fluid attenuation inversion recovery (FLAIR), and contrast-enhanced T1-weighted imaging (T1CE) images. The single-modal networks were integrated with averaged sigmoid probabilities, logistic regression, and support vector machine. FLAIR-T1CE-fusion (FC-fusion), T2WI-T1CE-fusion (TC-fusion), and FLAIR-T2WI-T1CE-fusion (FTC-fusion) were used for fine-tuning TL-CNNs.

Results

IDH1-mutant prediction accuracies using AlexNet, GoogLeNet, ResNet, and VGGNet achieved 70.0% (AUC = 0.660), 65.0% (AUC = 0.600), 70.0% (AUC = 0.700), and 80.0% (AUC = 0.730) for T2WI images, 70.0% (AUC = 0.660), 70.0% (AUC = 0.620), 70.0% (AUC = 0.710), and 80.0% (AUC = 0.720) for FLAIR images, and 73.7% (AUC = 0.744), 73.7% (AUC = 0.656), 73.7% (AUC = 0.633), and 73.7% (AUC = 0.700) for T1CE images, respectively. The highest AUC (0.800) was achieved using VGGNet and FC-fusion images.

Conclusions

TL-CNNs (especially VGGNet) had a potential predictive value for IDH1-mutant status of grade II/III gliomas.
Medial Patellar Plica Thickness as a Morphologic Predictor of the Medial Patellar Plica Syndrome
Authors: Kim Dong Kyu , Lee Kyu-Chong , Yoon Do Won , Kim Taeho
Published: January 2024

Objective

The aim of this study was to evaluate the association between medial patellar plica (MPP) syndrome and the morphological features of the MPP, including length, width, and thickness, on knee magnetic resonance imaging (MRI).

Materials and Methods

From 2018 to 2022, 167 patients diagnosed with isolated MPP syndrome based on both MRI and arthroscopic findings were included in the “study group” and 226 patients without knee pathology on both MRI and physical examination were included in the “control group.” Finally, 393 patients (mean age, 38.9 ± 5.7 years) with 405 knee MRI examinations were included. Morphological MR features of MPP were assessed, including width, length, and thickness. Multivariate regression and receiver operating characteristic analyses were performed to identify the factors associated with MPP syndrome.

Results

The mean thickness of MPP was significantly higher in the study group than control group (2.3 ± 0.5 mm vs 1.0 ± 0.8 mm, P < 0.001). Moreover, on multivariate analysis, MPP thickness was the only significant factor associated with MPP syndrome (odds ratio, 6.452; 95% confidence interval, 0.816–15.073; P = 0.002). On receiver operating characteristic analysis, thickness ≥1.8 mm was estimated as the optimal cutoff for predicting MPP syndrome with sensitivity of 75.9%, specificity of 65.4%, and area under the curve of 0.727 (95% confidence interval, 0.667–0.788; P < 0.001).

Conclusions

Measurement of MPP thickness on MRI could be a morphological predictor of MPP syndrome.
Radiosensitizing Favors Response to Peptide Receptor Radionuclide Therapy in Patients With Highly Proliferative Neuroendocrine Malignancies
Authors: Trautwein Nils Florian , Hinterleitner Clemens , Kiefer Lena Sophie , Singer Stephan , Mattern Sven , Schwenck Johannes , Reischl Gerald , Sipos Bence , Lauer Ulrich M. , Dittmann Helmut , Zender Lars , la Fougère Christian , Hinterleitner Martina
Published: January 2024

Aim/Introduction

Peptide receptor radionuclide therapy (PRRT) represents a cornerstone of treatment regimens for patients with low proliferative neuroendocrine tumors (NETs). However, in patients experiencing somatostatin receptor–positive NET with higher proliferation rates, a value and potential therapeutic benefit of PRRT as part of multimodal treatment approaches and potentially with addition of radiosensitizing agents has not yet been established.

Patients and Methods

In this study, 20 patients with histologically confirmed gastroenteropancreatic (GEP) NET with proliferation rates (Ki67) between 15% and 55% were treated either with PRRT only (n = 10) or with a combination therapy (n = 10) comprising PRRT and capecitabine/temozolomide (CAP/TEM) for at least 2 consecutive cycles.

Results

Disease control rate in patients treated with PRRT alone was 60% (40% stable disease and 20% partial response). Strikingly, in patients treated with PRRT in combination with radiosensitization (CAP/TEM), the disease control rate was 90% (20% stable disease and 70% partial response). The median progression-free survival in the PRRT only group was 12 months, whereas the median progression-free survival in the PRRT + CAP/TEM group was 26 months and has not been yet reached for all patients in the group during the observation period. The median disease-specific survival for patients with PRRT alone was 51 months, whereas this end point was not yet reached in the PRRT + CAP/TEM group. Moreover, the PRRT + CAP/TEM group showed a significantly higher reduction of SSTR-PET–based metabolic tumor volume and chromogranin A levels compared with the PRRT only group. Importantly, adverse events of all grades did not differ between both groups.

Conclusions

PRRT + CAP/TEM represents a highly promising and well-tolerated therapeutic regimen for patients experiencing somatostatin receptor–positive NET with higher (Ki67 ≥ 15%) proliferation rate. Prospective randomized clinical trials are warranted.
Continuous Renal Replacement Therapy During Long-term Normothermic Machine Perfusion of Human Donor Livers for up to 7 D
Authors: Lascaris Bianca , Hoffmann Roland F. , Nijsten Maarten W.N. , Porte Robert J. , de Meijer Vincent E.
Published: January 2024

Background.

Normothermic machine perfusion (NMP) is used to preserve and test donor livers before transplantation. During NMP, the liver is metabolically active and produces waste products, which are released into the perfusate. In this study, we describe our simplified and inexpensive setup that integrates continuous renal replacement therapy (CRRT) with NMP for up to 7 d. We also investigated if the ultrafiltrate could be used for monitoring perfusate concentrations of small molecules such as glucose and lactate.

Methods.

Perfusate composition (urea, osmolarity, sodium, potassium, chloride, calcium, magnesium, phosphate, glucose, and lactate) was analyzed from 56 human NMP procedures without CRRT. Next, in 6 discarded human donor livers, CRRT was performed during NMP by integrating a small dialysis filter (0.2 m2) into the circuit to achieve continuous ultrafiltration combined with continuous fluid substitution for up to 7 d.

Results.

Within a few hours of NMP without CRRT, a linear increase in osmolarity and concentrations of urea and phosphate to supraphysiological levels was observed. After integration of CRRT into the NMP circuit, the composition of the perfusate was corrected to physiological values within 12 h, and this homeostasis was maintained during NMP for up to 7 d. Glucose and lactate levels, as measured in the CRRT ultrafiltrate, were strongly correlated with perfusate levels (r = 0.997, P < 0.001 and r = 0.999, P < 0.001, respectively).

Conclusions.

The integration of CRRT into the NMP system corrected the composition of the perfusate to near-physiological values, which could be maintained for up to 7 d. The ultrafiltrate can serve as an alternative to the perfusate to monitor concentrations of small molecules without potentially compromising sterility.
Microbiota of healthy dogs demonstrate a significant decrease in richness and changes in specific bacterial groups in response to supplementation with different dietary fibers in a randomized cross-over trial.
Authors: Salavati Schmitz Silke , Salgado Jorge Perez-Accino , Glendinning Laura
Published: January 2024

Even though dietary fibers are often used as prebiotic supplements in dogs, the effect of individual types of fibers on canine microbiota composition is unknown. The objective of this study was to assess changes in fecal microbiota richness, diversity and taxonomic abundance with 3 different fiber supplements in dogs. These were psyllium husk, resistant starch from banana flour and methylcellulose. They were administered to 17 healthy dogs in a cross-over trial after transition to the same complete feed. Fecal scores and clinical activity indices were recorded, and fecal samples collected before and at the end of supplementation, as well as 2 weeks after each supplement (washout). Illumina NovaSeq paired-end 16S rRNA gene sequencing was performed on all samples. After quality control and chimera removal, alpha diversity indices were calculated with QIIME. Differences in specific taxa between groups were identified using Metastats. Methylcellulose significantly increased fecal scores but had no effect on microbiota. Psyllium resulted in minor changes of specific taxa abundance, but with questionable biological significance. Resistant starch reduced microbiota richness and resulted in the most abundant changes in taxa, mostly a reduction in short-chain fatty acid producing genera of the Bacillota phylum, with an increase in genera within the Bacteroidota, Pseudomonadota, Actinomycetota and Saccharibacteria. In conclusion, while psyllium and methylcellulose led to few changes in the microbiota composition, the taxonomic changes seen with resistant starch may indicate a less favorable composition. Based on this, the type of resistant starch used here cannot be recommended as a prebiotic in dogs.
Elucidating the biological characteristics and pathogenicity of the highly virulent G2a porcine epidemic diarrhea virus
Authors: Li Chang , Wu Qiong , Song Haofei , Lu Hongyu , Yang Keli , Liu Zewen , Liu Wei , Gao Ting , Yuan Fangyan , Zhu Jiajia , Guo Rui , Tian Yongxiang , Zhou Danna
Published: January 2024

Since the large-scale outbreak of porcine epidemic diarrhoea (PED) in 2010, caused by the genotype 2 (G2) variant of the porcine epidemic diarrhoea virus (PEDV), pig farms in China, even those vaccinated with the G2b vaccine, have experienced infections from the G2a variant, leading to significant economic losses. This study successfully isolated the G2a strain DY2020 from positive small intestine contents (SICs) by blind passage on Vero cells for four generations. The SICs were taken from Daye, Hubei Province, China. The biological characteristics were identified by indirect immunofluorescence assay (IFA) and transmission electron microscopy (TEM). The growth kinetics of the strain on Vero cells were detected by TCID50, and the virus titre could reach 107.35 TCID50 ml−1 (SD: 5.07×106). The pathogenicity towards colostrum-deprived piglets was conducted by assessing faecal viral shedding, morphometric analysis of intestinal lesions, and immunohistochemical staining. The results showed that DY2020 was highly virulent to colostrum-deprived piglets, with severe watery diarrhoea and other clinical symptoms appeared at 6 h post-infection (h p.i.), and all died within 30 h. Pathological tissue examination results showed that the lesions mainly occurred in the intestines of piglets, causing pathological changes such as shortening of intestinal villi. In summary, the discovery of the G2a strain DY2020 in this study is of great significance for understanding Hubei PEDV and provides an important theoretical basis for the development of new efficient PEDV vaccines.
Strain features of pneumococcal isolates in the pre- and post-PCV10 era in Pakistan
Authors: Javaid Nida , Lo Stephanie W. , Nisar Muhammad Imran , Basharat Asma , Jaleel Hadiqa , Rasool Karam , Sultana Qamar , Kabir Furqan , Hotwani Aneeta , Breiman Robert F. , Bentley Stephen D. , Shakoor Sadia , Mirza Shaper
Published: January 2024

Pakistan is amongst the four countries with the highest number of pneumococcal deaths. While the PCV10 vaccine was introduced in Pakistan in October 2012, data regarding the impact of the vaccine on the population dynamics of

Streptococcus pneumoniae

in Pakistan remain obscure. Using whole genome sequencing of 190 isolates (nasopharyngeal carriage=75, disease=113, unknown sites=2) collected between 2002 and 2020, this study presents characteristics of pneumococcal strains in Pakistan in the pre- and post-vaccine era. The isolates were characterized on the basis of serotype distribution, genetic lineages (or Global Pneumococcal Sequence Cluster, GPSC) and antibiotic resistance. A high level of diversity in serotype and genetic lineages of pneumococci was observed in Pakistan. Among 190 isolates, we identified 54 serotypes, 67 GPSCs and 116 sequence types (STs) including 23 new STs. The most prevalent GPSCs and their associated serotypes in nasopharyngeal carriage were GPSC54 (expressing serotype 9V), GPSC5 (15A and 7B, and serogroup 24), GPSC25 (15B/15C), GPSC67 (18C) and GPSC376 (6A and 6D). Similarly, among 113 disease-causing isolates, the most prevalent GPSC/serotype combinations were GPSC2 (serotype 1), GPSC10 (serotypes 14, 10A, 19A and 19F), GPSC43 (serotypes 13, 11A, 23B, 35A and 9V), GPSC67 (serotypes 18A and 18C) and GPSC642 (serotype 11A). Of the 190 isolates, the highest levels of resistance were observed against penicillin (58.9 %, n=122), erythromycin (29.5 %, n=56), clindamycin (13.2 %, n=25), co-trimoxazole (94.2 %, n=179) and tetracycline/doxycycline (53.2 %, n=101). A higher proportion of disease-causing isolates were multidrug resistant as compared to carriage isolates (54 % vs 25 %). Our data suggest limited coverage of PCV10 in nasopharyngeal (21.6 %, 16/74) as well as disease-causing (38.1 %, 16/42) isolates among children ≤5 years old; however, higher valent vaccine PCV13 would increase the coverage rates to 33.8 % in nasopharyngeal and 54.8 % in disease-causing isolates, whereas PCV24/25 would offer the highest coverage rates. Owing to the diversity of serotypes observed during the post-vaccine period, the suggested inclusion of serotype in future vaccine formulations will require investigations with larger data sets with an extended temporal window. This article contains data hosted by Microreact.
Sociodemographic Factors Associated with Antenatal Steroid Exposure among Late Preterm Births
Authors: Clapp Mark A. , Cohen Jessica L. , Gyamfi-Bannerman Cynthia , Kaimal Anjali J. , Lorch Scott A , Wright Jason D. , Melamed Alexander
Published: January 2024

As the risk of preterm birth is known to vary widely, we aimed to determine if antenatal steroid exposure among LPBs varied based on sociodemographic characteristics. We hypothesized that sociodemographic factors may influence a provider ‘s clinical judgment of a patient ‘s likelihood of preterm birth and, therefore, also be associated with antenatal steroid use. This cross-sectional analysis used the 2021 US natality data and included non-anomalous, liveborn, hospital-based singleton births at ≥34 weeks of gestation to mothers without diabetes, a cohort similar to those in the ALPS Trial. The following sociodemographic factors were compared among those who received vs. did not receive steroids using chi-square tests: age, race (as designated and categorized on the birth certificate), ethnicity, primary pay for the delivery, marital status, and education. In 2021, 237,025 late preterm births met eligibility criteria, of which 17.3% were exposed to antenatal steroids. Among the following sociodemographic factors, the odds of antenatal steroid receipt were lower compared to the reference majority population: 1) Black (adjusted odds ratio (aOR) 0.88 (95% CI 0.81, 0.96)) and Native Hawaiian or Other Pacific Islander (NHOPI) (aOR 0.58 (95% CI 0.43, 0.79) compared to White race; 2) less than high school education (aOR 0.76 (95% CI 0.72, 0.81)) or high school education (Aor 0.87 (95% CI 0.83, 0.91)) compared to post-secondary education; and 3) public (aOR 0.83 (95% CI 0.78, 0.87)) or no insurance (aOR 0.68 (95% CI 0.61, 0.77)) compared to private insurance. Age and marital status were not associated with steroid receipt. Despite no known differential treatment effects of antenatal steroids by sociodemographic factors, steroid exposure among LBPs varied significantly among races, ethnicities, payers, and education levels in the US.
The Menstrual Practice Needs Scale Short Form (MPNS-SF) and Rapid (MPNS-R): Development in Khulna, Bangladesh, and validation in cross-sectional surveys from Bangladesh and Uganda
Authors: Hennegan Julie , Hasan Md. Tanvir , Jalil Tasfiyah , Hunter Erin C , Head Alexandra , Jabbar Abdul , Mohosin Arifa Bente , Zoha Nigar Sultana , Alam Muhammad Khairul , Dunstan Laura , Akter Sabina , Zaman Afreen , Kaiser Adrita , Smith Calum , Bagala Lillian , Azzopardi Peter S
Published: January 2024

Objectives

Develop and validate short and rapid forms of the 36-item Menstrual Practice Needs Scale (MPNS-36).

Design

Item reduction prioritised content validity and was informed by cognitive interviews with schoolgirls in Bangladesh, performance of scale items in past research, and stakeholder feedback. The original MPNS-36 was revalidated, and short and rapid forms tested in a cross-sectional survey. This was followed by further tests of dimensionality, internal consistency, and validity in multiple cross-sectional surveys.

Setting and participants

Short form (MPNS-SF) and rapid form (MPNS-R) measures were developed in a survey of 313 menstruating girls (mean age=13.51) in Khulna, Bangladesh. They were further tested in the baseline survey of the Adolescent Menstrual Experiences and Health Cohort, in Khulna, Bangladesh (891 menstruating girls, mean age=12.40); and the dataset from the MPNS-36 development in Soroti, Uganda (538 menstruating girls, mean age=14.49).

Results

The 18-item short form reflects the six original subscales, with the four core subscales demonstrating good fit in all three samples (Khulna pilot: RMSEA=0.064 90%CI 0.043-0.084, CFI=.94, TLI=.92. Cohort baseline: RMSEA=0.050 90%CI 0.039-0.062, CFI=.96, TLI=.95. Uganda: RMSEA=0.039 90%CI 0.028-0.050, CFI=.95, TLI=.94). The 9-item rapid form captures diverse needs. A two-factor structure was the most appropriate but fell short of adequate fit (Khulna pilot: RMSEA=0.092 90%CI 0.000-0.158, CFI=.93, TLI=.89). Hypothesised associations between the MPNS scores and other constructs were comparable between the MPNS-36 and MPNS-SF in all populations, and replicated, with attenuation, in the MPNS-R. Internal consistency remained acceptable.

Conclusions

The MPNS-SF offers a reliable and valid measure of adolescent girls’ menstrual hygiene experience while reducing participant burden, to support implementation and improve measurement in menstrual health research. The MPNS-R provides a brief measure with poorer structural validity, suited to including menstrual health within broader water, sanitation and hygiene or sexual and reproductive health research.