bluuebunny/crossref_metadata_2025 huggingface dataset:
“We are no longer using the term BAME:” a qualitative analysis exploring how activists position and mobilize naming of minority ethnic groups in Britain
Authors: Gill Sim
Published: February 2024

In early 2021, the term BAME (Black, Asian, and Minority Ethnic) was commonly used by the government, public bodies, and the mass media to describe minority ethnic groups in Britain. However, this usage faced fierce criticism, particularly due to complex tensions surrounding racial and ethnic identity, solidarity, and history. This article critically evaluates these tensions and the meaning behind BAME through 10 interviews with activists working in the field of British race relations. My principle focus amid this debate revisits the foundations of the term BAME, which, I argue, is rooted in the rise and fall of Political Blackness. Additionally, I examine the broader strategic purposes of BAME as well as emphasize the importance of colorism within our discussions of racialization in Britain. Ultimately, this discussion seeks a richer account of our current climate around ethnic identification that considers both the potential and the limits of the term BAME.
Clinical and histological features of histiocytoid Sweet syndrome associated with VEXAS syndrome
Authors: Lecoeuvre Hortense , Le Gall François , Le Naoures Cécile , Vignon-Pennamen Marie-Dominique , Lamaison Claire , Kammerer-Jacquet Solène-Florence , Lescoat Alain , Oger Emmanuel , Pastoret Cédric , Dupuy Alain
Published: February 2024

Background

VEXAS (Vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is caused by acquired somatic mutations in UBA1. Sweet-syndrome-like skin disorders [and especially histiocytoid Sweet syndrome (HSS)] may be associated with VEXAS syndrome.

Objectives

To characterize the clinical and histopathological features of HSS in patients with VEXAS syndrome.

Methods

Skin biopsies with a histological diagnosis of HSS at Rennes University Medical Center (Rennes, France) between October 2011 and January 2022 were reviewed in this study. Sanger sequencing and digital polymerase chain reaction were used to screen skin, blood and bone marrow samples for UBA1 variants, and thus classify patients as having VEXAS syndrome or not. We evaluated the clinical, histological and molecular (UBA1) characteristics of patients with or without VEXAS syndrome.

Results

We compared 15 skin biopsies from 7 patients found to have VEXAS syndrome and 19 skin biopsies from 15 patients without VEXAS syndrome. Persistent C-reactive protein elevation, macrocytosis, anaemia and haematological malignancies were more prevalent in patients with VEXAS syndrome [6/7 (86%), 6/7 (86%), 7/7 (100%) and 6/7 (86%), respectively] than in patients without [5/14 (36%), 6/15 (40%), 8/15 (53%) and 8/15 (53%), respectively]. These features sometimes appeared after the first skin manifestations, and a UBA1 mutation was found in the skin of five patients with VEXAS syndrome. Dermal infiltration by reniform histiocytoid cells (myeloperoxidase-positive and/or CD163-positive) and a periadnexal distribution were more frequently observed in VEXAS syndrome biopsies [15/15 (100%) and 3/15 (20%), respectively, vs. 11/19 (58%) and 0/19 (0%) in non-VEXAS syndrome biopsies, respectively].

Conclusions

Our findings might help pathologists to consider a diagnosis of VEXAS syndrome and to initiate early genetic testing.
Human papillomavirus detection rates in Bowen disease: correlation with pelvic and digital region involvement and specific p53 immunostaining patterns
Authors: Kim Young Chan , Woo Been , Kim Han-Na , Kim Ko Eun , Jeon Jiehyun , Kim Chungyeul , Baek Yoo Sang
Published: February 2024

Background

The relationship between human papillomavirus (HPV) and Bowen disease (BD) is not fully understood.

Objectives

To investigate the differences in HPV detection rates in BD samples across various body regions and analyse the expression patterns of p53, p16 and Ki-67 in relation to HPV presence.

Methods

Tissue samples from patients diagnosed with BD, confirmed through histopathology, were retrospectively collected. Next-generation sequencing was used for HPV DNA detection. Immunohistochemistry (IHC) for p16, p53 and Ki-67 was performed.

Results

Out of 109 patients with BD, 21 (19.3%) were HPV-positive. All identified types were α-HPVs, with HPV-16 being the most common. The HPV detection rate was significantly higher in the pelvic (9/13, 69%, P < 0.001) and digital (5/10, 50%, P = 0.02) areas compared with those in the other regions. HPV presence was significantly correlated with p53 negativity (P = 0.002), the p53 ‘non-overexpression’ IHC pattern (P < 0.001) and p16–p53 immunostain pattern discordance (P < 0.001). Conversely, there was no notable association between HPV presence and p16 positivity, the p16 IHC pattern or Ki-67 expression.

Conclusions

Our findings suggest the oncogenic role of sexually transmitted and genito-digitally transmitted α-HPVs in the pathogenesis of BD in pelvic and digital regions.

Graphical Abstract
Formulation and systemic therapy
Authors: Uthayakumar Aarthy K , Patel Neil P
Published: February 2024

This is a Specialty Certificate Examination Case on the systemic therapy of hidradenitis suppurativa.
Recurrent aphthous stomatitis: a rare finding in Evans syndrome
Authors: Lin Alice J , Falcone Lauryn M , Kress Douglas W
Published: February 2024

Recurrent aphthous stomatitis (RAS) is a common condition encountered by dermatologists that is often challenging to diagnose and treat. It has a wide differential diagnosis and has been associated with a variety of risk factors. This article describes a case of Evans syndrome presenting as isolated RAS and demonstrates the need for a broad workup to detect underlying systemic diseases.
Early language dissociation in bilingual minds: magnetoencephalography evidence through a machine learning approach
Authors: Molinaro Nicola , Nara Sanjeev , Carreiras Manuel
Published: February 2024

Does neural activity reveal how balanced bilinguals choose languages? Despite using diverse neuroimaging techniques, prior studies haven’t provided a definitive solution to this problem. Nonetheless, studies involving direct brain stimulation in bilinguals have identified distinct brain regions associated with language production in different languages. In this magnetoencephalography study with 45 proficient Spanish–Basque bilinguals, we investigated language selection during covert picture naming and word reading tasks. Participants were prompted to name line drawings or read words if the color of the stimulus changed to green, in 10% of trials. The task was performed either in Spanish or Basque. Despite similar sensor-level evoked activity for both languages in both tasks, decoding analyses revealed language-specific classification ~100 ms post-stimulus onset. During picture naming, right occipital-temporal sensors predominantly contributed to language decoding, while left occipital-temporal sensors were crucial for decoding during word reading. Cross-task decoding analysis unveiled robust generalization effects from picture naming to word reading. Our methodology involved a fine-grained examination of neural responses using magnetoencephalography, offering insights into the dynamics of language processing in bilinguals. This study refines our understanding of the neural underpinnings of language selection and bridges the gap between non-invasive and invasive experimental evidence in bilingual language production.
Low-temperature catalytic oxidation of glycerol into glyceric acid over Zr@MCM-41-supported Pt catalyst
Authors: Ke Yihu , Xu Huanhuan , Qin Hongyu , Wang Xue , Liu Hai , Yuan Hong
Published: February 2024

A series of mesoporous Zr@MCM-41 zeolites with different Si/Zr molar ratios were prepared using cetyltrimethylammonium bromide as a template. Pt nanoparticles were then successfully loaded onto the Zr@MCM-41 using a colloid-deposition method. These catalysts were evaluated for the catalytic oxidation of glycerol into glyceric acid at low temperature. The results showed that the molar ratios of the Si/Zr affected the oxidization of the primary OH group, in turn affecting the catalytic activity and selectivity. The Pt/Zr@MCM-41-100 catalyst showed the best catalytic activity, with the conversion of glycerol and selectivity for glyceric acid reaching 50.7% and 65.0%, respectively. The characterization result confirmed that the catalytic activity of Pt/Zr@MCM-41-100 was related to the support structure, the dispersion of the Pt nanoparticles, and the interaction between the Pt nanoparticles and the support. Meanwhile, we investigated the stability of the Pt/Zr@MCM-41-100 catalyst and analyzed the deactivation reasons using characterization.
Control of composition and surface area of aluminosilicates by tuning base catalyst concentration
Authors: Hernandez Gaitan Jose A , Sasaki Koki , Miyake Koji , Uchida Yoshiaki , Nishiyama Norikazu
Published: February 2024

Amorphous aluminosilicate nanosheets (a-ASns) consisting of small homogeneous nanoplates were synthesized in a bottom-up approach using the “hydrophilic two-dimensional reactor in amphiphilic phases” (TRAP) method. We found the appropriate operation variable to control the composition of a-ASns: the concentration of base catalysts.
Persistent Gram-negative Bloodstream Infection Increases the Risk of Recurrent Bloodstream Infection With the Same Species
Authors: Ankrah Paa Kwesi , Bock Andrew , Ruffin Felicia , Hanson Blake M , Arias Cesar A , Maskarinec Stacey A , Parsons Joshua , Fowler Vance G , Thaden Joshua T
Published: February 2024

The association between persistent gram-negative bloodstream infection (GN-BSI), or ongoing positive cultures, and recurrent GN-BSI has not been investigated. Among 992 adults, persistent GN-BSI was associated with increased recurrent GN-BSI with the same bacterial species and strain (6% vs 2%; P = .04). Persistent GN-BSI may be a marker of complicated infection.
Seasonality, Clinical Characteristics, and Outcomes of Respiratory Syncytial Virus Disease by Subtype Among Children Aged <5 Years: New Vaccine Surveillance Network, United States, 2016–2020
Authors: Toepfer Ariana P , Amarin Justin Z , Spieker Andrew J , Stewart Laura S , Staat Mary Allen , Schlaudecker Elizabeth P , Weinberg Geoffrey A , Szilagyi Peter G , Englund Janet A , Klein Eileen J , Michaels Marian G , Williams John V , Selvarangan Rangaraj , Harrison Christopher J , Lively Joana Y , Piedra Pedro A , Avadhanula Vasanthi , Rha Brian , Chappell James , McMorrow Meredith , Moline Heidi , Halasa Natasha B
Published: February 2024

Background

Respiratory syncytial virus (RSV) is a leading cause of acute respiratory illnesses in children. RSV can be broadly categorized into 2 major subtypes: A and B. RSV subtypes have been known to cocirculate with variability in different regions of the world. Clinical associations with viral subtype have been studied among children with conflicting findings such that no conclusive relationships between RSV subtype and severity have been established.

Methods

During 2016–2020, children aged <5 years were enrolled in prospective surveillance in the emergency department or inpatient settings at 7 US pediatric medical centers. Surveillance data collection included parent/guardian interviews, chart reviews, and collection of midturbinate nasal plus/minus throat swabs for RSV (RSV-A, RSV-B, and untyped) using reverse transcription polymerase chain reaction.

Results

Among 6398 RSV-positive children aged <5 years, 3424 (54%) had subtype RSV-A infections, 2602 (41%) had subtype RSV-B infections, and 272 (5%) were not typed, inconclusive, or mixed infections. In both adjusted and unadjusted analyses, RSV-A–positive children were more likely to be hospitalized, as well as when restricted to <1 year. By season, RSV-A and RSV-B cocirculated in varying levels, with 1 subtype dominating proportionally.

Conclusions

Findings indicate that RSV-A and RSV-B may only be marginally clinically distinguishable, but both subtypes are associated with medically attended illness in children aged <5 years. Furthermore, circulation of RSV subtypes varies substantially each year, seasonally and geographically. With introduction of new RSV prevention products, this highlights the importance of continued monitoring of RSV-A and RSV-B subtypes.
‘Who are the capability theorists?’: a tale of the origins and development of the capability approach
Authors: Erasmo Valentina
Published: February 2024

This paper offers a history of the capability approach from its origins to its more recent development. Sen himself refused to be defined as the capability theorist and despite this analysis, we will come to understand that Sen played an essential role in this history because he pioneered the approach, but that his role has probably been overestimated by the available literature. Two further ‘main characters’ provided a relevant contribution to the origins and development of the capability approach, namely Walsh and Nussbaum. Finally, this paper considers the two main groups that have developed since the capability approach, the capability approach centred perspective and the capability approach heuristic value perspective, in order to show how they follow these three main characters in their own development of the capability approach.
Monoallelic pathogenic IFT140 variants are a common cause of autosomal dominant polycystic kidney disease–spectrum phenotype
Authors: Dordoni Chiara , Zeni Letizia , Toso Diego , Mazza Cinzia , Mescia Federica , Cortinovis Roberta , Econimo Laura , Savoldi Gianfranco , Alberici Federico , Scolari Francesco , Izzi Claudia
Published: February 2024

Background

Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disorder, characterized by development and enlargement of kidney cysts, eventually leading to end-stage kidney disease (ESKD). Pathogenic variants in the PKD1 and PKD2 genes are the major cause of ADPKD; additional rare variants in the GANAB, DNAJB11, ALG5 and ALG9 genes have been found in a minority of ADPKD patients. More recently, a significant number of ADPKD families have been linked to monoallelic variants in the IFT140 gene.

Methods

In this retrospective study, we tested the prevalence of the known causative genes of ADPKD-spectrum phenotype, including the PKD1, PKD2, GANAB, DNAJB11, ALG5, ALG and IFT140 genes, in a cohort of 129 ADPKD patients who consecutively underwent genetic testing in a single centre in Italy. Genetic testing utilized a combination of targeted next-generation sequencing, long-range polymerase chain reaction, Sanger sequencing and multiplex ligation-dependent probe amplification. Clinical evaluation was conducted through renal function testing and imaging features, including ultrasonography, computer tomography and magnetic resonance imaging.

Results

Of the 129 enrolled patients, 86 (66.7%) had pathogenic variants in PKD1 and 28 (21.7%) in PKD2, loss of function pathogenic variants in the IFT140 gene were found in 3 unrelated patients (2.3%), no pathogenic variants were found in other ADPKD genes and 12 patients (9.3%) remained genetically unresolved (ADPKD-GUR). Familial clinical and genetic screening of the index patients with ADPKD due to an IFT140 pathogenic variant (ADPKD-IFT140) allowed identification of eight additional affected relatives. In the 11 ADPKD-IFT140 patients, the renal phenotype was characterized by mild and late-onset PKD, with large renal cysts and limited kidney insufficiency. Extrarenal manifestations, including liver cysts, were rarely seen.

Conclusion

Our data suggest the monoallelic pathogenic IFT140 variants are the third most common cause of the ADPKD-spectrum phenotype in Italy, usually associated with a mild and atypical renal cystic disease.
Circulating miR-129-3p in combination with clinical factors predicts vascular calcification in hemodialysis patients
Authors: Jin Jingjing , Cheng Meijuan , Wu Xueying , Zhang Haixia , Zhang Dongxue , Liang Xiangnan , Qian Yuetong , Guo Liping , Zhang Shenglei , Bai Yaling , Xu Jinsheng
Published: February 2024

Background

Vascular calcification (VC) commonly occurs and seriously increases the risk of cardiovascular events and mortality in patients with hemodialysis. For optimizing individual management, we will develop a diagnostic multivariable prediction model for evaluating the probability of VC.

Methods

The study was conducted in four steps. First, identification of miRNAs regulating osteogenic differentiation of vascular smooth muscle cells (VSMCs) in calcified condition. Second, observing the role of miR-129–3p on VC in vitro and the association between circulating miR-129–3p and VC in hemodialysis patients. Third, collecting all indicators related to VC as candidate variables, screening predictors from the candidate variables by Lasso regression, developing the prediction model by logistic regression and showing it as a nomogram in training cohort. Last, verifying predictive performance of the model in validation cohort.

Results

In cell experiments, miR-129–3p was found to attenuate vascular calcification, and in human, serum miR-129–3p exhibited a negative correlation with vascular calcification, suggesting that miR-129–3p could be one of the candidate predictor variables. Regression analysis demonstrated that miR-129–3p, age, dialysis duration and smoking were valid factors to establish the prediction model and nomogram for VC. The area under receiver operating characteristic curve of the model was 0.8698. The calibration curve showed that predicted probability of the model was in good agreement with actual probability and decision curve analysis indicated better net benefit of the model. Furthermore, internal validation through bootstrap process and external validation by another independent cohort confirmed the stability of the model.

Conclusion

We build a diagnostic prediction model and present it as an intuitive tool based on miR-129–3p and clinical indicators to evaluate the probability of VC in hemodialysis patients, facilitating risk stratification and effective decision, which may be of great importance for reducing the risk of serious cardiovascular events.
Propagation characteristics of exposure effect on double-layer weighted social networks
Authors: Hu Simin , Tian Yang , Zhu Xuzhen
Published: February 2024

The information propagation on complex networks has attracted much attention in recent years. We found that there is an exposure effect in social propagation which is often used to describe the psychological phenomenon. The user adoption behaviour in social propagation is also consistent with the exposure effect. According to the exposure effect, people are more likely to accept an object when it is exposed for a longer period. Therefore, we propose the exposure initial threshold, exposure final threshold, and the gate-like adoption probability function to better explain the exposure effect. Then, we construct a social propagation model based on exposure effect utilizing the exposure time and gate-like adoption probability function on a double-layer weighted network. To further understand the mechanism of social propagation, we also provide an edge-based compartmental theory based on the exposure effect. Experiments demonstrate that the exposure initial threshold and exposure duration can affect the propagation range to a certain extent. Next, given the propagation probability and exposure duration, there exists an optimal exposure initial threshold that maximizes the propagation range, which we call the optimal exposure ability. In addition, we explore the effect of the degree heterogeneity of nodes on social propagation under the exposure effect. The numerical simulations support the theoretical hypotheses of this work quite well.
Non-conservative diffusion and its application to social network analysis
Authors: Ghosh Rumi , Lerman Kristina , Surachawala Tawan , Voevodski Konstatin , Teng Shanghua
Published: February 2024

Is the random walk appropriate for modelling and analysing social processes? We argue that many interesting social phenomena, including epidemics and information diffusion, cannot be modelled as a random walk, but instead must be modelled as broadcast-based or non-conservative diffusion. To produce meaningful results, social network analysis algorithms have to take into account differences between these diffusion processes. We formulate conservative (random walk-based) and non-conservative (broadcast-based) diffusion mathematically and show how these are related to well-known metrics: PageRank and Alpha-Centrality, respectively. This formulation allows us to unify two distinct areas of network analysis–centrality and epidemic models–and leads to insights into the relationship between diffusion and network structure, specifically, the existence of an epidemic threshold in non-conservative diffusion. We demonstrate, by ranking nodes in an online social network used for broadcasting news, that non-conservative Alpha-Centrality leads to a better agreement with empirical ranking schemes than conservative PageRank. In addition, we give a scalable approximate algorithm for computing the Alpha-Centrality in a massive graph. We hope that our investigation will inspire further exploration of the applications of non-conservative diffusion in social network analysis.
Hematological and biochemical parameters of giant pandas (Ailuropoda melanoleuca) in captive and semi-natural environments
Authors: Bi Wenlei , Liu Songrui , O’Connor Michael P , Owens Jacob R , Valitutto Marc T , Hou Rong , Qi Dunwu , Hayek Lee-Ann Collins , Wu Fanqi , Ma Rui , Liu Jiabin , Zhou Yanshan , Zhang Long , Callan Ramana , Luo Li , Huang Wenjun , Zhang Zhihe , Spotila James R
Published: February 2024

Physiological indexes like blood parameters have been widely used to monitor the health of free-roaming animals. Attempts to reintroduce one of China’s most endangered species, the giant panda (Ailuropoda melanoleuca), have been hampered by a lack of data on its ecology and physiology. We examined three giant pandas’ hematological and blood chemistry parameters in a soft release program and 30 captive giant pandas as controls and determined the reference intervals (RIs) for those blood parameters in the captive animals. Elevation, captivity status and the interaction of those factors were statistically significant for hematologic measures. Release pandas had significantly higher hemoglobin and hematocrit values after they moved to high elevation locations. We also found significant difference in the enzyme parameters between high and low elevation pandas such as higher aspartate aminotransferase, alanine aminotransferase, creatinine kinase, amylase and lower lactate dehydrogenase and alkaline phosphatase. Release pandas also had higher nutrition parameter values such as higher albumin, globulin and creatinine. The RI for blood parameters in our study provides a baseline to monitor the health of captive animals and forms the basis for assessing the health of free-roaming giant pandas in future reintroduction efforts.
Risk of Primary Gastrointestinal Lymphoma in Patients With Inflammatory Conditions Exposed to Tumor Necrosis Factor Alpha Inhibitors and Immunomodulators: A Case–Control Study
Authors: Braga-Neto Manuel B , Nasser Jason , Wang Xiao Jing , Harmsen William Scott , Raffals Laura E , Camilleri Michael , Chedid Victor
Published: February 2024

Introduction

The aim of this case–control study was to determine if exposure to tumor necrosis factor alpha inhibitors (TNFIs) or immunomodulators (thiopurines or methotrexate) was associated with development of primary gastrointestinal lymphoma (PGIL) in patients with chronic inflammatory conditions.

Methods

Patients with PGIL and controls evaluated at a tertiary care center over 20 years were matched 1:3 using a medical record informatics search engine based on their chronic inflammatory condition (Crohn’s disease [CD], ulcerative colitis [UC], rheumatoid arthritis, ankylosing spondylitis, and psoriatic arthritis) and duration of follow-up. Patients who started on TNFI within 3 months of PGIL diagnosis were excluded. We extracted demographics, medical history, and medications used. Univariate models using conditional logistic regression were used due to the small number of matched pairs.

Results

Twenty PGIL cases matched with 60 controls were followed for a mean 9.9 ± 6.9 and 9.7 ± 8.6 years, respectively. Mean age at time of PGIL diagnosis was 47.5 ± 22.0 (standard deviation) years and the majority (75%) were males. The most common inflammatory diagnosis was inflammatory bowel disease (80% of cases; 45% with UC and 35% with CD). Development of PGIL was not associated with TNFI (odds ratio [OR] = 2.6; 95% confidence interval [CI] 0.69–11.01; P = .18), but with use of TNFI in combination with thiopurines (OR = 8.93; 95% CI 1.43–80.25; P = .014). Risk of PGIL increased with every additional TNFI (2.277 (1.002–5.713); P = .0494). All cases exposed to multiple TNFI were also exposed to thiopurines. Use of thiopurines (alone or in combination) was the greatest risk factor (OR = 6.32; 95% CI 1.55–37.05; P = 0.006) to develop PGIL.

Conclusions

TNFI therapy was not associated with increased risk for PGIL unless used in combination with thiopurines and with every switch to a different TNFI.
Restoration of blood vessel regeneration in the era of combination SGLT2i and GLP-1RA therapy for diabetes and obesity
Authors: Terenzi Daniella C , Bakbak Ehab , Teoh Hwee , Krishnaraj Aishwarya , Puar Pankaj , Rotstein Ori D , Cosentino Francesco , Goldenberg Ronald M , Verma Subodh , Hess David A
Published: February 2024

Ischaemic cardiovascular diseases, including peripheral and coronary artery disease, myocardial infarction, and stroke, remain major comorbidities for individuals with type 2 diabetes (T2D) and obesity. During cardiometabolic chronic disease (CMCD), hyperglycaemia and excess adiposity elevate oxidative stress and promote endothelial damage, alongside an imbalance in circulating pro-vascular progenitor cells that mediate vascular repair. Individuals with CMCD demonstrate pro-vascular ‘regenerative cell exhaustion’ (RCE) characterized by excess pro-inflammatory granulocyte precursor mobilization into the circulation, monocyte polarization towards pro-inflammatory vs. anti-inflammatory phenotype, and decreased pro-vascular progenitor cell content, impairing the capacity for vessel repair. Remarkably, targeted treatment with the sodium-glucose cotransporter-2 inhibitor (SGLT2i) empagliflozin in subjects with T2D and coronary artery disease, and gastric bypass surgery in subjects with severe obesity, has been shown to partially reverse these RCE phenotypes. SGLT2is and glucagon-like peptide-1 receptor agonists (GLP-1RAs) have reshaped the management of individuals with T2D and comorbid obesity. In addition to glucose-lowering action, both drug classes have been shown to induce weight loss and reduce mortality and adverse cardiovascular outcomes in landmark clinical trials. Furthermore, both drug families also act to reduce systemic oxidative stress through altered activity of overlapping oxidase and antioxidant pathways, providing a putative mechanism to augment circulating pro-vascular progenitor cell content. As SGLT2i and GLP-1RA combination therapies are emerging as a novel therapeutic opportunity for individuals with poorly controlled hyperglycaemia, potential additive effects in the reduction of oxidative stress may also enhance vascular repair and further reduce the ischaemic cardiovascular comorbidities associated with T2D and obesity.
Impact of early enteral feed composition on the rate of chyle leak post-esophagectomy
Authors: Pan Sally , Cheah Lilyanne , Bushra Raisa , Ribbits Alexander , Grimes Samantha ,   Cambridge Oesophagogastric Group, Bennett John , Safranek Peter , Sujendran Vijay , Hindmarsh Andrew , Gourgiotis Stavros , Hardwick Richard , Lamb Claire , Cockburn Linsey , Mason Bridget , Chinyama Nyarai , Smith Ben , Lee Natalie , Joshi Simple , O’Neill J Robert
Published: February 2024

Patients undergoing esophagectomy are at risk of malnutrition and benefit from perioperative enteral feeding. Esophagectomy carries a risk of chyle leak, and this risk may be influenced by early enteral feed composition. We evaluated the impact of early enteral medium-chain triglyceride-rich feed on the prevalence and severity of chyle leak post-esophagectomy, length of stay, and postoperative weight change. This retrospective study included consecutive patients undergoing esophagectomy at a single center between January 2015 and December 2022. Patients received enteral feed on postoperative days 1–5 with Nutrison Energy or Protein Plus Energy (‘standard’) (January 2015– June 2021) or Nutrison Peptisorb Plus High Energy High Protein (‘HEHP’) enteral feed (June 2021 to December 2022). All patients transitioned to ‘standard’ supplemental jejunal feeding on postoperative day 6 onwards and were discharged on oral IDDSI level 4 diet. Patients who did not commence early enteral feeding were excluded from analysis. A total of 329 patients were included. Patients who received early HEHP feed had fewer chyle leaks (5/52; 9.6%) compared with patients who received standard feed (68/277; 24.5%, P = 0.017). The HEHP group had a shorter total length of hospital stay (P = 0.011). Weight change from preoperative baseline was equivalent in both groups at 6 weeks (P = 0.066) and 3 months (P = 0.400). In the context of routine jejunostomy use and early enteral feeding post-esophagectomy, HEHP feed on postoperative days 1–5 was associated with significantly fewer chyle leaks and shorter length of stay compared with standard feed. No difference was noted in postoperative weight change between groups.
Efficacy and Safety of Filgotinib for the Treatment of Perianal Fistulising Crohn’s Disease [DIVERGENCE 2]: A Phase 2, Randomised, Placebo-controlled Trial
Authors: Reinisch Walter , Colombel Jean-Frederic , D’Haens Geert R , Rimola Jordi , Masior Tomasz , McKevitt Matt , Ren Xuehan , Serone Adrian , Schwartz David A , Gecse Krisztina B
Published: February 2024

Background and Aims

There is an unmet need in the treatment of perianal fistulising Crohn’s disease [PFCD]. This study evaluated the efficacy and safety of the Janus kinase 1 preferential inhibitor, filgotinib, for the treatment of PFCD.

Methods

This phase 2, double-blind, multicentre trial enrolled adults with PFCD and prior treatment failure. Participants were randomised [2:2:1] to receive filgotinib 200 mg, filgotinib 100 mg, or placebo, once daily orally for up to 24 weeks. The primary endpoint was combined fistula response (reduction from baseline of at least one draining external opening determined by physical assessment, and no fluid collections >1 cm on pelvic magnetic resonance imaging [MRI]) at Week 24.

Results

Between April 2017 and July 2020, 106 individuals were screened and 57 were randomised. Discontinuations were lowest in the filgotinib 200 mg group (3/17 [17.6%] versus 13/25 [52.0%] for filgotinib 100 mg and 9/15 [60.0%] for placebo). The proportion of participants who achieved a combined fistula response at Week 24 was 47.1% (8/17; 90% confidence interval [CI] 26.0, 68.9%) in the filgotinib 200 mg group, 29.2% [7/24; 90% CI 14.6, 47.9%] in the filgotinib 100 mg group, and 25.0% [3/12; 90% CI 7.2, 52.7%] in the placebo group. Serious adverse events occurred more frequently with filgotinib 200 mg (5/17 [29.4%]) than with placebo (1/15 [6.7%]). There were no treatment-related serious adverse events or deaths.

Conclusions

Filgotinib 200 mg was associated with numerical reductions in the number of draining perianal fistulas based on combined clinical and MRI findings compared with placebo, and was generally well tolerated [NCT03077412].
Rate of cardiovascular events up to 8 years after uncomplicated myocarditis: a nationwide cohort study
Authors: Schelldorfer Andreas , Gregoriano Claudia , Hauser Stephanie , Fuchs Tobias A , Mueller Beat , Schuetz Philipp , Kutz Alexander
Published: February 2024

Aims

While prognosis of acute myocarditis with uncomplicated presentation is perceived as benign, data on long-term outcomes are scarce. We evaluated rates of myocarditis-associated cardiovascular events after a first-time hospitalization with uncomplicated acute myocarditis in patients without known heart disease.

Methods and results

In this retrospective nationwide population-based cohort study from 2013 to 2020, hospitalized patients with uncomplicated acute myocarditis but without known heart disease were 1:1 propensity score-matched with surgical controls hospitalized for laparoscopic appendectomy. As assessed in time-to-event analyses, the primary outcome was a composite of rehospitalization for myocarditis, pericardial disease, heart failure and its complications, arrhythmias, implantation of cardiac devices, and heart transplant. After matching, we identified 1439 patients with uncomplicated acute myocarditis (median age of 35 years, 74.0% male) and 1439 surgical controls (median age of 36 years, 74.4% male). Over a median follow-up of 39 months, compared with surgical controls, the hazard ratio for the primary composite outcome was 42.3 [95% confidence interval (CI) 17.4–102.8], corresponding to an incidence rate of 43.7 vs. 0.9 per 1000 patient-years (py) and an incidence rate difference of 42.7 (95% CI 36.7–48.8) per 1000 py.

Conclusion

Patients hospitalized with uncomplicated acute myocarditis and no known prior heart disease were associated with substantial risk for cardiovascular events over a follow-up of up to 8 years. This calls for a more efficient therapeutic management of this population of patients.
Surgical management of calcific valvular and coronary disease in a patient with alkaptonuria: a case report
Authors: Boyd Riley M , Bharadwaj Sandeep N , Fagan Andrew , Mehta Christopher K
Published: February 2024

Background

Alkaptonuria is a rare metabolic disease that causes an increase in homogentisic acid (HGA) due to a lack of enzymatic activity. Commonly, accumulation of HGA presents with dark discoloration of skin and other tissues, also known as ochronosis. Additionally, alkaptonuria can result in other clinical manifestations, including arthritis and cardiac disease. This case highlights alkaptonuria-related cardiac disease and challenges that cardiac surgery teams may face when treating this patient population.

Case summary

A 62-year-old male with a history of alkaptonuria, Hodgkin’s lymphoma treated with chemoradiation, hypertension, and hyperlipidaemia originally presented with shortness of breath in the setting of known cardiac disease. Cardiac work-up demonstrated aortic stenosis, mitral stenosis, and multivessel coronary artery disease requiring aortic valve replacement, mitral valve replacement, and coronary artery bypass grafting. During the operation, significant discoloration of tissue was observed. This correlated with areas of severe calcification, which was noted throughout both valves. Extensive debridement was required prior to proceeding to valve replacements. Additionally, near-infrared spectroscopy failed to provide accurate measurements of cerebral oxygenation.

Discussion

Alkaptonuria is correlated with cardiovascular disease, particularly valvular disease. Intraoperatively, these patients may exhibit noticeable discoloration and severe calcification of various tissues. Additionally, traditional infrared-based methods of cerebral oxygenation monitoring may not be reliable; however, other options of cerebral monitoring may be feasible. With proper pre-operative planning, however, patients with alkaptonuria may safely undergo cardiac surgery.
Epistemic Blind Spots, Misconceptions and Stereotypes: The Home Birth Jurisprudence of the European Court of Human Rights
Authors: van Leeuwen Fleur
Published: February 2024

This article offers a critical feminist reading of the home birth jurisprudence of the European Court of Human Rights. The aim is to shed light on the gender sensitivity of the Court in its legal reasoning and knowledge production. Since its first decision on the permissibility of a blanket de facto home birth ban in the case of Ternovszky v. Hungary in 2010, the Court has given five judgments on the matter, including a Grand Chamber decision in the case of Dubska and Krejzova v. Czech Republic. The author finds that the Court applies an overtly restrictive obstetric narrative of childbirth without situating its controversial epistemic basis. In doing so, the Court reinforces a rationale that is linked to loss of agency and disempowerment of persons in childbirth and reproduces harmful stereotypes. The article highlights bias in knowledge formation and (re)production at the Court in addressing cases of home birth. The findings in this article add to feminist inquiries of international human rights adjudication, specifically in regard to knowledge formation, knowledge production and stereotyping as well as to literature on the Court’s gender sensitivity.
Booster vaccination with SARS-CoV-2 mRNA vaccines and myocarditis in adolescents and young adults: a Nordic cohort study
Authors: Hviid Anders , Nieminen Tuomo A , Pihlström Nicklas , Gunnes Nina , Dahl Jesper , Karlstad Øystein , Gulseth Hanne Løvdal , Sundström Anders , Husby Anders , Hansen Jørgen Vinsløv , Ljung Rickard , Hovi Petteri
Published: February 2024

Background and Aims

The SARS-CoV-2 mRNA vaccines are associated with an increased risk of myocarditis. This association appears to be strongest in male adolescents and younger males and after the second dose. The aim was to evaluate the risk of myocarditis following SARS-CoV-2 mRNA booster vaccination in 12-to-39-year-olds.

Methods

A multinational cohort study was conducted using nationwide register data in Denmark, Finland, Norway, and Sweden and comprising all 8.9 million individuals residing in each of the four countries. Participants were followed for an inpatient diagnosis of myocarditis. In each of the four countries, Poisson regression was used to estimate adjusted incidence rate ratios (IRRs) of myocarditis comparing vaccination schedules, with associated 95% confidence intervals (CIs). Country-specific results were combined in meta-analyses.

Results

A total of 8.9 million residents were followed for 12 271 861 person-years and 1533 cases of myocarditis were identified. In 12-to-39-year-old males, the 28-day acute risk period following the third dose of BNT162b2 or mRNA-1273 was associated with an increased incidence rate of myocarditis compared to the post-acute risk period 28 days or more after the second dose [IRR 2.08 (95% CI 1.31–3.33) and 8.89 (2.26–35.03), respectively]. For females, the corresponding IRR was only estimable for BNT162b2, 3.99 (0.41–38.64). The corresponding absolute risks following the third dose of BNT162b2 and mRNA-1273 in males were 0.86 (95% CI 0.53–1.32) and 1.95 (0.53–4.99) myocarditis events within 28 days per 100 000 individuals vaccinated, respectively. In females, the corresponding absolute risks following the third dose of BNT162b2 were 0.15 (0.04–0.39) events per 100 000 individuals vaccinated. No deaths occurred within 30 days of vaccine-related cases.

Conclusions

The results suggest that a booster dose is associated with increased myocarditis risk in adolescents and young adults. However, the absolute risk of myocarditis following booster vaccination is low.
Device innovation in cardiovascular medicine: a report from the European Society of Cardiology Cardiovascular Round Table
Authors: Windecker Stephan , Gilard Martine , Achenbach Stephan , Cribier Alain , Delgado Victoria , Deych Nataliya , Drossart Inga , Eltchaninoff Hélène , Fraser Alan G , Goncalves Alexandra , Hindricks Gerhard , Holborow Richard , Kappetein Arie Pieter , Kilmartin John , Kurucova Jana , Lüscher Thomas F , Mehran Roxana , O’Connor Donal B , Perkins Mark , Samset Eigil , von Bardeleben Ralph Stephan , Weidinger Franz
Published: February 2024

Research performed in Europe has driven cardiovascular device innovation. This includes, but is not limited to, percutaneous coronary intervention, cardiac imaging, transcatheter heart valve implantation, and device therapy of cardiac arrhythmias and heart failure. An important part of future medical progress involves the evolution of medical technology and the ongoing development of artificial intelligence and machine learning. There is a need to foster an environment conducive to medical technology development and validation so that Europe can continue to play a major role in device innovation while providing high standards of safety. This paper summarizes viewpoints on the topic of device innovation in cardiovascular medicine at the European Society of Cardiology Cardiovascular Round Table, a strategic forum for high-level dialogue to discuss issues related to the future of cardiovascular health in Europe. Devices are developed and improved through an iterative process throughout their lifecycle. Early feasibility studies demonstrate proof of concept and help to optimize the design of a device. If successful, this should ideally be followed by randomized clinical trials comparing novel devices vs. accepted standards of care when available and the collection of post-market real-world evidence through registries. Unfortunately, standardized procedures for feasibility studies across various device categories have not yet been implemented in Europe. Cardiovascular imaging can be used to diagnose and characterize patients for interventions to improve procedural results and to monitor devices long term after implantation. Randomized clinical trials often use cardiac imaging-based inclusion criteria, while less frequently trials randomize patients to compare the diagnostic or prognostic value of different modalities. Applications using machine learning are increasingly important, but specific regulatory standards and pathways remain in development in both Europe and the USA. Standards are also needed for smart devices and digital technologies that support device-driven biomonitoring. Changes in device regulation introduced by the European Union aim to improve clinical evidence, transparency, and safety, but they may impact the speed of innovation, access, and availability. Device development programmes including dialogue on unmet needs and advice on study designs must be driven by a community of physicians, trialists, patients, regulators, payers, and industry to ensure that patients have access to innovative care.
Cardiovascular benefit of statin use against air pollutant exposure in older adults
Authors: Kim Kyuwoong , Jeong Seogsong , Choi Seulggie , Chang Jooyoung , Choi Daein , Lee Gyeongsil , Kim Seong Rae , Park Sang Min
Published: February 2024

Aims

Little is known about the cardiovascular benefit of statin use against ambient air pollution among older adults who are at higher risk of cardiovascular disease (CVD) potentially owing to age-related declines in cardiovascular functions along with other risk factors.

Methods and results

This retrospective, population-based cohort study consisted of adults aged 60 years and older free of CVD at baseline identified from the National Health Insurance Service database linked to the National Ambient Air Monitoring Information System for average daily exposure to PM10 and PM2.5 in 2015 in the major metropolitan areas in the Republic of Korea. The follow-up period began on 1 January 2016 and lasted until 31 December 2021. The Cox proportional hazards model was used to evaluate the association of cardiovascular benefit with statin use against different levels of air pollutant exposure. Of 1 229 444 participants aged 60 years and older (mean age, 67.4; 37.7% male), 377 076 (30.7%) were identified as statin users. During 11 963 322 person-years (PYs) of follow-up, a total of 86 018 incident stroke events occurred (719.0 events per 100 000 PYs). Compared to statin non-users exposed to high levels of PM10 (>50 µg/m3) and PM2.5 (>25 µg/m3), statin users had 20% [adjusted hazard ratio (HR), 0.80; 95% confidence intervals (CI), 0.75–0.85] and 17% (adjusted HR, 0.80; 95% CI, 0.80–0.86) lower adjusted risk of incident stroke for PM10 and PM2.5, respectively. A similar risk reduction for incident CVD was also found among statin users exposed to low or moderate levels of PM10 (≤50 µg/m3) and PM2.5 (≤25 µg/m3) exposure.

Conclusion

Among adults aged 60 years and older with high and low or moderate levels of exposure to PM10 and PM2.5, statin use was associated with a significantly lower risk of stroke.
Non-stenotic fibro-calcific aortic valve as a predictor of myocardial infarction recurrence
Authors: Myasoedova Veronika A , Chiesa Mattia , Cosentino Nicola , Bonomi Alice , Ludergnani Monica , Bozzi Michele , Valerio Vincenza , Moschetta Donato , Massaiu Ilaria , Mantegazza Valentina , Marenzi Giancarlo , Poggio Paolo
Published: February 2024

Aims

Patients with acute myocardial infarction (AMI) are at increased risk of recurrent cardiovascular events. Non-stenotic aortic valve fibro-calcific remodelling (called aortic valve sclerosis; AVSc), reflecting systemic damage, may serve as a new marker of risk. This study aims to stratify subgroups of AMI patients with specific probabilities of recurrent AMI and to evaluate the importance of AVSc in this setting.

Methods and results

Consecutive AMI patients (n = 2530) were admitted at Centro Cardiologico Monzino (2010–19) and followed up for 5 years. Patients were divided into study (n = 1070) and test (n = 966) cohorts. Topological data analysis (TDA) was used to stratify patient subgroups, while Kaplan–Meier and Cox regression analyses were used to evaluate the significance of baseline characteristics. Topological data analysis identified 11 subgroups of AMI patients with specific baseline characteristics. Two subgroups showed the highest rate of re-infarction after 5 years from the indexed AMI with a combined hazard ratio (HR) of 3.8 [95% confidence interval (CI): 2.7–5.4] compared with the other subgroups. This was confirmed in the test cohort (HR = 3.1; 95% CI: 2.2–4.3). These two subgroups were mostly men, with hypertension and dyslipidaemia, who exhibit a higher prevalence of AVSc, higher levels of high-sensitive C-reactive protein and creatinine. In the year-by-year analysis, AVSc, adjusted for all confounders, showed an independent association with the increased risk of re-infarction (odds ratio of ∼2 at all time points), in both the study and the test cohorts (all P < 0.01).

Conclusion

AVSc is a crucial variable for identifying AMI patients at high risk of recurrent AMI and its presence should be considered when assessing the management of AMI patients. The inclusion of AVSc in risk stratification models may improve the accuracy of predicting the likelihood of recurrent AMI, leading to more personalized treatment decisions.