bluuebunny/crossref_metadata_2025 huggingface dataset:
A Single-Institutional Experience with 36 Children Smaller Than 5 Kilograms Supported with the Berlin Heart Ventricular Assist Device (VAD) over 12 Years: Comparison of Patients with Biventricular versus Functionally Univentricular Circulation
Authors: Bleiweis Mark S , Philip Joseph , Peek Giles J , Stukov Yuriy , Janelle Gregory M , Pitkin Andrew D , Sullivan Kevin J , Nixon Connie S , Sharaf Omar M , Neal Dan , Jacobs Jeffrey P
Published: February 2023

Objectives

We reviewed outcomes in all 36 consecutive children <5 kg supported with the Berlin Heart pulsatile ventricular assist device (VAD) at the University of Florida, comparing those with univentricular circulation (n  =  23) to those with biventricular circulation (n  =  13).

Methods

The primary outcome was mortality. Kaplan-Meier methods and log-rank tests were used to assess group differences in long-term survival after VAD insertion. T-tests using estimated survival proportions and standard errors were used to compare groups at specific time points.

Results

Of all 82 patients ever supported with Berlin Heart at our institution, 49 (49/82  =  59.76%) weighed <10 kg and 36 (36/82  =  43.90%) weighed <5 kg. Of these 36 patients who weighed <5 kg, 26 (26/36  =  72.22%) were successfully bridged to transplantation. Of these 36 patients who weighed <5 kg, 13 (13/36  =  36.1%) had biventricular circulation and were supported with 12 biventricular assist devices (BiVADs) and 1 left ventricular assist device (LVAD) (Age [days]: median  =  67, range  =  17–212; Weight [kilograms]: median  =  4.1, range  =  3.1–4.9), while 23 (23/36  =  63.9%) had univentricular circulation and were supported with 23 single ventricle-ventricular assist devices (sVADs) (Age [days]: median  =  25, range  =  4–215; Weight [kilograms]: median  =  3.4, range  =  2.4–4.9). Of 13 biventricular patients who weighed <5 kg, 12 (12/23  =  92.3%) were successfully bridged to cardiac transplantation. Of 23 functionally univentricular patients who weighed <5 kg, 14 (14/23  =  60.87%) were successfully bridged to cardiac transplantation. For all 36 patients who weighed <5 kg: 1-year survival estimate after VAD insertion  =  62.7% (95% confidence interval [CI]  =  48.5%-81.2%) and 5-year survival estimate after VAD insertion  =  58.5% (95% CI  =  43.8%-78.3%). One-year survival after VAD insertion: 84.6% (95% CI  =  67.1%-99.9%) in biventricular patients and 49.7% (95% CI  =  32.3%-76.4%) in univentricular patients, P  =  0.018. Three-year survival after VAD insertion: 84.6% (95% CI  =  67.1%-99.9%) in biventricular patients and 41.4% (95% CI  =  23.6%-72.5%) in univentricular patients, P  =  0.005.

Conclusion

Pulsatile VAD facilitates bridge to transplantation in neonates and infants weighing <5 kg; however, survival after VAD insertion in these small patients is less in those with univentricular circulation in comparison to those with biventricular circulation.
Shifting Episodic Prediction With Online Cognitive Bias Modification: A Randomized Controlled Trial
Authors: Eberle Jeremy W. , Boukhechba Mehdi , Sun Jianhui , Zhang Diheng , Funk Daniel H. , Barnes Laura E. , Teachman Bethany A.
Published: February 2023

Negative future thinking pervades emotional disorders. This hybrid efficacy–effectiveness trial tested a four-session, scalable online cognitive-bias-modification program for training more positive episodic prediction. Nine hundred fifty-eight adults (73.3% female, 86.5% White, 83.4% from United States) were randomly assigned to positive conditions with ambiguous future scenarios that ended positively, 50/50 conditions that ended positively or negatively, or a control condition with neutral scenarios. As hypothesized (preregistration: https://osf.io/jrst6 ), positive-training participants improved more than control participants in negative expectancy bias ( d = −0.58), positive expectancy bias ( d = 0.80), and self-efficacy ( d = 0.29). Positive training was also superior to 50/50 training for expectancy bias and optimism ( d = 0.31). Training gains attenuated yet remained by 1-month follow-up. Unexpectedly, participants across conditions improved comparably in anxiety and depression symptoms and growth mindset. Targeting a transdiagnostic process with a scalable program may improve bias and outlook; however, further validation of outcome measures is required.
Rhetoric and Clinical Science: Maximizing Rationality Within Post-Justificationist Knowledge
Authors: O’Donohue William
Published: February 2023

Scott Lilienfeld wrote about science and metascience and cared deeply about clearly understanding the quality of science. Lilienfeld criticized obscurantist language such as “neurobabble” and poorly defined terms such as “microaggressions.” Science is a social institution that involves communication through language. This article presents a rhetorical analysis of science. The study of the linguistic dimension of science leads to an analysis of science as rhetoric, that is, the multiple methods of persuasion employed by scientists for multiple audiences and consumers. In addition, the failure of justificationist epistemologies to capture what occurs in knowledge generation also leads to the view that science has a rhetorical dimension in which knowledge-generating processes remain rational but nonjustificationist. In this article, I argue that rhetoric provides a rich additional dimension for criticism in clinical psychological science to identify error. Engaging the rhetorical dimension of science can therefore make science more rational, not less. Some major tropes used in psychological journals are identified and criticized.
A Case of Disseminated Histoplasmosis From California, in the Setting of Secondary Hemophagocytic Lymphohistiocytosis: A Diagnostic Challenge
Authors: Govindarajan Ameish , Sous Rowis , Venter Frederick , Torrico Tyler , Karapetians Natalie , Heidari Arash , Cobos Everardo , Petersen Greti
Published: February 2023

Histoplasma capsulatum is a geographically specific dimorphic fungus that can cause a spectrum of diseases. While most cases are asymptomatic pulmonary infections, in severe cases, particularly in immunocompromised patients, disseminated disease can occur. Histoplasmosis in California is limited to only a few case reports. In this article, we describe a rare case of disseminated histoplasmosis in a non-endemic region presenting with diagnostically challenging symptomatology, including altered mental status, status epilepticus, septic shock, and bilateral adrenal masses.
Public Insurance Is Associated With Decreased Rates of Surgical Management for Glenohumeral Instability: An Analysis of the Rhode Island All-Payers Claims Database
Authors: Albright J. Alex , Lemme Nicholas J. , Meghani Ozair , Owens Brett D.
Published: February 2023

Background:

Socioeconomic status has been shown to influence patients’ ability to access health care.

Purpose:

To evaluate the socioeconomic status and/or insurance provider of patients and to determine whether these differences influence the management of shoulder instability.

Study Design:

Descriptive epidemiology study.

Methods:

The Rhode Island All-Payers Claims Database (APCD) was used to identify all patients between the ages of 5 and 64 years who made an insurance claim related to a shoulder instability event between January 1, 2011, and December 31, 2019. Chi-square analysis and multivariate logistic regression were utilized to determine whether insurance status, social deprivation index (SDI), or median income by zip code were significant predictors of treatment methodology and recurrent instability. Kaplan-Meier failure analysis and Cox regression were used to assess for variation in the cumulative rates of surgical intervention and recurrent instability over 20-year age groups (5-24, 25-44, and 45-64 years).

Results:

There were 3310 patients from the APCD query included in the analysis. Bivariate analysis demonstrated significant variation in the rates of surgical stabilization between patients with public and commercial insurance providers ( P < .001). Patients with public insurance received surgery 1.8% of the time compared with 5.8% of the time in patients with commercial insurance. After controlling for recurrent instability, age, instability type (subluxation or dislocation) and directionality, and sex, patients with public insurance were 79% less likely to receive surgery within 30 days ( P = .035) and 64% less likely to receive surgery within 1 year ( P = .002). This disparity was most notable in the 5- to 24-year (hazard ratio [HR] = 0.28; 95% CI, 0.13-0.61) and 25- to 44-year (HR = 0.26; 95% CI, 0.08-0.89) age groups. Neither SDI quartile nor income quartile based on patient primary zip code had a clinically significant influence on rates of surgery or recurrent instability.

Conclusion:

These data demonstrate that patients with public insurance have a decreased likelihood of undergoing surgical stabilization to address glenohumeral instability compared with patients with commercial insurance.
Clinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus Deformity
Authors: Abs Alice , Micicoi Grégoire , Khakha Raghbir , Escudier Jean-Charles , Jacquet Christophe , Ollivier Matthieu
Published: February 2023

Background:

In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity.

Purpose/Hypothesis:

The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student t test.

Results:

A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; P < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; P < .001) and patient satisfaction (2.6 vs 3.9; P < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; P < .001).

Conclusion:

For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.
The Reliability of Acromioclavicular Joint Dislocation Classification Systems: A Comparison Between the Rockwood and Kraus Classifications
Authors: Velasquez Garcia Ausberto , Liendo Rodrigo , Ekdahl Max , Calvo Cristobal , Vidal Catalina
Published: February 2023

Background:

The Rockwood system for the classification of acute acromioclavicular (AC) joint dislocations has been associated with a lack of reliability. A novel system has been proposed (Kraus classification) that is based on dynamic posterior translation of these injuries.

Purpose:

To assess the interobserver and intraobserver reliability of the Rockwood and Kraus classification systems and also to examine the impact of surgeon experience on the assessments.

Study Design:

Cohort study (diagnosis); Level of evidence, 3.

Methods:

Included were 45 patients with acute AC joint injuries who underwent a radiographic examination using standard bilateral AP and modified Alexander views. For interobserver reliability, 6 shoulder surgeons (expert group) and 6 orthopaedic residents (novice group) reviewed the radiographs to classify injuries according to the Rockwood and Kraus classifications; for each categorization, the participants chose between nonoperative management and surgical treatment. The evaluation was repeated 6 weeks later to determine intraobserver reliability. Kappa (κ) coefficients and their 95% CIs were used to compare interobserver and intraobserver reliability for each classification system according to assessor experience. Statistical differences were considered significant when the upper and lower boundaries of the 95% CI did not overlap.

Results:

The overall interobserver agreement for diagnosis (both novice and expert groups) was moderate (κ = 0.52 [95% CI, 0.51-0.54]) for the Rockwood classification and substantial (κ = 0.62 [95% CI, 0.53-0.65]) for the Kraus classification; however, no significant differences were observed between the κ values. The overall interobserver agreement for treatment selection was substantial when using both the Rockwood (κ = 0.78 [95% CI, 0.72-0.81]) and Kraus (κ = 0.77 [95% CI, 0.66-0.87]) classifications. The overall intraobserver agreement for diagnosis was substantial using both the Rockwood (κ = 0.65 [95% CI, 0.61-0.67]) and Kraus (κ = 0.73 [95% CI, 0.69-0.75]) classifications. There were no significant differences between the novice and expert groups on any of the evaluations.

Conclusion:

The Kraus system was slightly more reliable than the Rockwood system for classifying AC joint injuries both between assessor groups and overall. The level of surgeon experience had no impact on the evaluations.
Saphenous Nerve Schwannoma: A Rare Differential Diagnosis of Knee Pain in Children
Authors: Cherraqi Amine , El Haddad Siham , Messaoud Ola , Andour Hajar , Tbouda Mohammed , El Ansari Naoual , KILI Amina , Hessissen Laila , Allali Nazik , Chat Latifa
Published: February 2023

Schwannomas are uncommon benign tumors of the peripheral nerves with a low risk of malignant transformation. They rarely affect children, can affect any part of the body but rarely occur in the lower extremity and typically present with a palpable mass, pain or neurological signs. Imaging helps to orient the diagnosis and anatomopathological examination helps to confirm it. We report a case of a 12-year-old girl who presented with left knee pain with subcutaneous mass overlying the tibial tuberosity medially. Clinical examination revealed a positive Tinel’s sign. Magnetic resonance imaging (MRI) of the knee was performed, which revealed an encapsulated subcutaneous soft tissue mass overlying the tibial tuberosity medially, eccentric to the course of the infrapatellar branch of the saphenous nerve. The patient was operated with total intracapsular excision of the lesion and the anatomopathological study of the surgical specimen came back in favor of a schwannoma. Postoperatively, the patient showed a good recovery with disappearance of pain and swelling.
Effects of Two Different Doses of Ursodeoxycholic Acid on Indirect Hyperbilirubinemia in Neonates with Glucose-6-phosphate Dehydrogenase Deficiency Treated with Phototherapy: A Randomized Controlled Trial
Authors: Farhadi Roya , Keyhanian Elham , Naderisorki Mohammad , Nadi Ghara Aliasghar
Published: February 2023

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is one of the causes of severe hyperbilirubinemia, prolonged jaundice, and bilirubin-induced encephalopathy in neonates. In a randomized controlled trial, we evaluated the effect of oral ursodeoxycholic acid (UDCA) on indirect hyperbilirubinemia in G6PD-deficient neonates requiring phototherapy. Intervention group I (N = 45; received phototherapy and 10 mg/kg/day UDCA), Intervention group II (N = 40; received phototherapy and 20 mg/kg/day UDCA), and a control group (N = 49; received phototherapy and placebo). Levels of total serum bilirubin (TSB) in all 3 groups decreased significantly over time ( P = .001) but the level of TSB at different hours after admission and the duration of phototherapy did not differ significantly between the 3 groups. After discharge, the 2 intervention groups had a significantly lower rate of readmission than the control group ( P = .001). No significant difference was observed between the 10 and 20 mg/kg/day groups. Further evaluation is recommended, especially in terms of the pharmacokinetics of UDCA in neonates.

Trial registration number: IRCT20091201002801N4, prospectively registered on 2019-06-1
Argentopolybasite, Ag16Sb2S11, a new member of the polybasite group
Authors: Števko Martin , Mikuš Tomáš , Sejkora Jiří , Plášil Jakub , Makovicky Emil , Vlasáč Jozef , Kasatkin Anatoly
Published: February 2023

The new mineral argentopolybasite, ideally Ag16Sb2S11, was found at the Kremnica Au–Ag epithermal deposit, Žiar nad Hronom Co., Banská Bystrica Region, Slovakia (type locality), Šibeničný vrch near Nová Baňa, Žarnovica Co., Banská Bystrica Region, Slovakia (cotype locality) and the Arykevaam epithermal Au–Ag deposit, Anadyr’ District, Chukotka Autonomous Okrug, Russian Federation (cotype locality). At the Kremnica deposit argentopolybasite was found as discrete, well-developed (pseudo)hexagonal tabular crystals up to 4 mm in size or as complex crystalline aggregates and groups up to 5 mm in size in cavities of quartz. It is associated with pyrargyrite, polybasite, stephanite, miargyrite, rozhdestvenskayaite-(Zn), argentotetrahedrite-(Zn), naumannite, gold and pyrite. Argentopolybasite is dark grey to black, with a black streak and metallic to opaque lustre. The Mohs hardness is ~3. It is brittle with no observable cleavage and with a conchoidal fracture. The calculated density is 6.403 g⋅cm–3. In reflected light, argentopolybasite is grey, with no observable bireflectance and very weak pleochroism. It shows moderate anisotropy in crossed polarisers with weak greenish and green–blue tints. The reflectance values for wavelengths recommended by the Commission on Ore Mineralogy of the IMA are (Rmin/Rmax, %): 30.3/31.0 (470 nm), 28.8/29.3 (546 nm), 28.1/28.6 (589 nm) and 27.4/27.8 (650 nm). The empirical formulae (based on 29 apfu) are, Kremnica: (Ag15.94Cu0.18)Σ16.12(Sb1.40As0.61)Σ2.01(S10.60Se0.25Cl0.03)Σ10.88, Nová Baňa: Ag16.30(Sb1.74As0.22)Σ1.96(S10.69Cl0.04)Σ10.73and Arykevaam: (Ag15.54Cu0.38)Σ15.92(Sb1.56As0.51)Σ2.07S11.01. The ideal end-member formula for argentopolybasite is Ag16Sb2S11. Argentopolybasite is trigonal, space groupP321,a= 15.0646(5) Å,c= 12.2552(5) Å,V= 2408.61(15) Å3andZ= 2. The seven strongest powder X-ray diffraction lines are [dobsin Å, (I),hkl]: 12.169, (40), 001; 3.162, (100), 041; 3.045, (54), 004; 2.881, (45), 042; and 2.4256, (28), 421. The crystal structure of argentopolybasite from Kremnica, refined toRobs= 0.0741 for 2804 observed reflections, confirmed that the atomic arrangement is isotypic to that of the other members of the polybasite group and it is isostructural with argentopearceite.
A global study for acute myeloid leukemia with RARG rearrangement
Authors: Zhu Hong-Hu , Qin Ya-Zhen , Zhang Zhang-Lin , Liu Yong-Jing , Wen Li-Jun , You M. James , Zhang Cheng , Such Esperanza , Luo Hong , Yuan Hong-Jian , Zhou Hong-Sheng , Liu Hong-Xing , Xu Reng , Li Ji , Li Jian-Hu , Hao Jian-Ping , Jin Jie , Yu Liang , Zhang Jing-Ying , Liu Li-Ping , Zhang Le-Ping , Huang Rui-Bin , Shen Shu-Hong , Gao Su-Jun , Wang Wei , Yan Xiao-Jing , Zhang Xin-You , Du Xin , Chu Xiao-Xia , Yu Yan-Fang , Wang Yi , Mi Ying-Chang , Lu Ying , Cai Zhen , Su Zhan , Taussig David Christopher , MacMahon Suzanne , Ball Edward D. , Wang Huan-You , Welch John S. , Yin C. Cameron , Borthakur Gautam , Sanz Miguel A. , Kantarjian Hagop M. , Huang Jin-Yan , Hu Jiong , Chen Su-Ning
Published: February 2023

Acute myeloid leukemia (AML) with retinoic acid receptor γ (RARG) rearrangement has clinical, morphologic, and immunophenotypic features similar to classic acute promyelocytic leukemia. However, AML with RARG rearrangement is insensitive to alltrans retinoic acid (ATRA) and arsenic trioxide (ATO) and carries a poor prognosis. We initiated a global cooperative study to define the clinicopathological features, genomic and transcriptomic landscape, and outcomes of AML with RARG rearrangements collected from 29 study groups/institutions worldwide. Thirty-four patients with AML with RARG rearrangements were identified. Bleeding or ecchymosis was present in 18 (54.5%) patients. Morphology diagnosed as M3 and M3v accounted for 73.5% and 26.5% of the cases, respectively. Immunophenotyping showed the following characteristics: positive for CD33, CD13, and MPO but negative for CD38, CD11b, CD34, and HLA-DR. Cytogenetics showed normal karyotype in 38% and t(11;12) in 26% of patients. The partner genes of RARG were diverse and included CPSF6, NUP98, HNRNPc, HNRNPm, PML, and NPM1. WT1- and NRAS/KRAS-mutations were common comutations. None of the 34 patients responded to ATRA and/or ATO. Death within 45 days from diagnosis occurred in 10 patients (∼29%). At the last follow-up, 23 patients had died, and the estimated 2-year cumulative incidence of relapse, event-free survival, and overall survival were 68.7%, 26.7%, and 33.5%, respectively. Unsupervised hierarchical clustering using RNA sequencing data from 201 patients with AML showed that 81.8% of the RARG fusion samples clustered together, suggesting a new molecular subtype. RARG rearrangement is a novel entity of AML that confers a poor prognosis. This study is registered with the Chinese Clinical Trial Registry (ChiCTR2200055810).
Explainable machine learning model reveals its decision-making process in identifying patients with paroxysmal atrial fibrillation at high risk for recurrence after catheter ablation
Authors: Ma Yibo , Zhang Dong , Xu Jian , Pang Huani , Hu Miaoyang , Li Jie , Zhou Shiqiang , Guo Lanyan , Yi Fu
Published: February 2023

Background

A number of models have been reported for predicting atrial fibrillation (AF) recurrence after catheter ablation. Although many machine learning (ML) models were developed among them, black-box effect existed widely. It was always difficult to explain how variables affect model output. We sought to implement an explainable ML model and then reveal its decision-making process in identifying patients with paroxysmal AF at high risk for recurrence after catheter ablation.

Methods

Between January 2018 and December 2020, 471 consecutive patients with paroxysmal AF who had their first catheter ablation procedure were retrospectively enrolled. Patients were randomly assigned into training cohort (70%) and testing cohort (30%). The explainable ML model based on Random Forest (RF) algorithm was developed and modified on training cohort, and tested on testing cohort. In order to gain insight into the association between observed values and model output, Shapley additive explanations (SHAP) analysis was used to visualize the ML model.

Results

In this cohort, 135 patients experienced tachycardias recurrences. With hyperparameters adjusted, the ML model predicted AF recurrence with an area under the curve of 66.7% in the testing cohort. Summary plots listed the top 15 features in descending order and preliminary showed the association between features and outcome prediction. Early recurrence of AF showed the most positive impact on model output. Dependence plots combined with force plots showed the impact of single feature on model output, and helped determine high risk cut-off points. The thresholds of CHA2DS2-VASc score, systolic blood pressure, AF duration, HAS-BLED score, left atrial diameter and age were 2, 130 mmHg, 48 months, 2, 40 mm and 70 years, respectively. Decision plot recognized significant outliers.

Conclusion

An explainable ML model effectively revealed its decision-making process in identifying patients with paroxysmal atrial fibrillation at high risk for recurrence after catheter ablation by listing important features, showing the impact of every feature on model output, determining appropriate thresholds and identifying significant outliers. Physicians can combine model output, visualization of model and clinical experience to make better decision.
Analysis of risk characteristics for metachronous metastasis in different period of nasopharyngeal carcinoma
Authors: Fei Zhaodong , Hong Huiling , Xu Ting , Xu Yiying , Chen Jiawei , Qiu Xiufang , Ding Jianming , Feng Ye , Huang Chaoxiong , Li Li , Li Mengying , Chen Chuanben
Published: February 2023

Objective

To identify the main risk factors for metachronous metastatic nasopharyngeal carcinoma (NPC) in different periods after radiotherapy and estimate the weight of various factors in the early or late metachronous metastasis (EMM/LMM) groups.

Methods

This retrospective registry consists of 4434 patients with newly diagnosed NPC. Cox regression analysis was used to assess the independent significance of various risk factors. The Interactive Risk Attributable Program (IRAP) was used to calculate the attributable risks (ARs) for metastatic patients during different periods.

Results

Among 514 metastatic patients, 346 (67.32%) patients diagnosed with metastasis within 2 years after treatment were classified into the EMM group, while other 168 patients were classified into the LMM group. The ARs of T-stage, N-stage, pre-Epstein-Barr virus (EBV) DNA, post-EBV DNA, age, sex, pre-neutrophil-to-lymphocyte ratio, pre-platelet-to-lymphocyte ratio, pre-hemoglobin (HB), and post-HB were 20.19, 67.25, 2.81, 14.28, 18.50, - 11.17%, 14.54, 9.60, 3.74% and - 9.79%, respectively, in the EMM group. In the LMM group, the corresponding ARs were 3.68, 49.11, - 18.04%, 2.19, 6.11, 0.36, 4.62, 19.77, 9.57 and 7.76%, respectively. After multivariable adjustment, the total AR for tumor-related factors was 78.19%, and that for patient-related factors was 26.07% in the EMM group. In the LMM group, the total AR of tumor-related factors was 43.85%, while the weights of patient-related factors was 39.97%. In addition, except for these identified tumor- and patient-related factors, other unevaluated factors played a more important role in patients with late metastasis, with the weight increasing by 15.77%, from 17.76% in the EMM group to 33.53% in the LMM group.

Conclusion

Most metachronous metastatic NPC cases occurred in the first 2 years after treatment. Early metastasis was mainly affected by tumor-related factors, which accounted for a declining percentage in the LMM group.
Phenotypic screening platform identifies statins as enhancers of immune cell-induced cancer cell death
Authors: Selvin Tove , Berglund Malin , Lenhammar Lena , Jarvius Malin , Nygren Peter , Fryknäs Mårten , Larsson Rolf , Andersson Claes R
Published: February 2023

Background

High-throughput screening (HTS) of small molecule drug libraries has greatly facilitated the discovery of new cancer drugs. However, most phenotypic screening platforms used in the field of oncology are based solely on cancer cell populations and do not allow for the identification of immunomodulatory agents.

Methods

We developed a phenotypic screening platform based on a miniaturized co-culture system with human colorectal cancer- and immune cells, providing a model that recapitulates part of the tumor immune microenvironment (TIME) complexity while simultaneously being compatible with a simple image-based readout. Using this platform, we screened 1,280 small molecule drugs, all approved by the Food and Drug Administration (FDA), and identified statins as enhancers of immune cell-induced cancer cell death.

Results

The lipophilic statin pitavastatin had the most potent anti-cancer effect. Further analysis demonstrated that pitavastatin treatment induced a pro-inflammatory cytokine profile as well as an overall pro-inflammatory gene expression profile in our tumor-immune model.

Conclusion

Our study provides an in vitro phenotypic screening approach for the identification of immunomodulatory agents and thus addresses a critical gap in the field of immuno-oncology. Our pilot screen identified statins, a drug family gaining increasing interest as repurposing candidates for cancer treatment, as enhancers of immune cell-induced cancer cell death. We speculate that the clinical benefits described for cancer patients receiving statins are not simply caused by a direct effect on the cancer cells but rather are dependent on the combined effect exerted on both cancer and immune cells.
Awareness and diagnosis for intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) in neonatal (NICU) and pediatric intensive care units (PICU) – a follow-up multicenter survey
Authors: Wiegandt Paul , Jack Thomas , von Gise Alexander , Seidemann Kathrin , Boehne Martin , Koeditz Harald , Beerbaum Philipp , Sasse Michael , Kaussen Torsten
Published: February 2023

Background

Constantly elevated intra-abdominal pressure (IAH) can lead to abdominal compartment syndrome (ACS), which is associated with organ dysfunction and even multiorgan failure. Our 2010 survey revealed an inconsistent acceptance of definitions and guidelines among pediatric intensivists regarding the diagnosis and treatment of IAH and ACS in Germany. This is the first survey to assess the impact of the updated guidelines on neonatal/pediatric intensive care units (NICU/PICU) in German-speaking countries after WSACS published those in 2013.

Methods

We conducted a follow-up survey and sent 473 questionnaires to all 328 German-speaking pediatric hospitals. We compared our findings regarding awareness, diagnostics and therapy of IAH and ACS with the results of our 2010 survey.

Results

The response rate was 48% (n = 156). The majority of respondents was from Germany (86%) and working in PICUs with mostly neonatal patients (53%).

The number of participants who stated that IAH and ACS play a role in their clinical practice rose from 44% in 2010 to 56% in 2016. Similar to the 2010 investigations, only a few neonatal/pediatric intensivists knew the correct WSACS definition of an IAH (4% vs 6%). Different from the previous study, the number of participants who correctly defined an ACS increased from 18 to 58% (p < 0,001). The number of respondents measuring intra-abdominal pressure (IAP) increased from 20 to 43% (p < 0,001). Decompressive laparotomies (DLs) were performed more frequently than in 2010 (36% vs. 19%, p < 0,001), and the reported survival rate was higher when a DL was used (85% ± 17% vs. 40 ± 34%).

Conclusions

Our follow-up survey of neonatal/pediatric intensivists showed an improvement in the awareness and knowledge of valid definitions of ACS. Moreover, there has been an increase in the number of physicians measuring IAP in patients. However, a significant number has still never diagnosed IAH/ACS, and more than half of the respondents have never measured IAP. This reinforces the suspicion that IAH and ACS are only slowly coming into the focus of neonatal/pediatric intensivists in German-speaking pediatric hospitals. The goal should be to raise awareness of IAH and ACS through education and training and to establish diagnostic algorithms, especially for pediatric patients.

The increased survival rate after conducting a prompt DL consolidates the impression that the probability of survival can be increased by timely surgical decompression in the case of full-blown ACS.
A population-based study to assess two convolutional neural networks for dental age estimation
Authors: Wang Jian , Dou Jiawei , Han Jiaxuan , Li Guoqiang , Tao Jiang
Published: February 2023

Background

Dental age (DA) estimation using two convolutional neural networks (CNNs), VGG16 and ResNet101, remains unexplored. In this study, we aimed to investigate the possibility of using artificial intelligence-based methods in an eastern Chinese population.

Methods

A total of 9586 orthopantomograms (OPGs) (4054 boys and 5532 girls) of the Chinese Han population aged from 6 to 20 years were collected. DAs were automatically calculated using the two CNN model strategies. Accuracy, recall, precision, and F1 score of the models were used to evaluate VGG16 and ResNet101 for age estimation. An age threshold was also employed to evaluate the two CNN models.

Results

The VGG16 network outperformed the ResNet101 network in terms of prediction performance. However, the model effect of VGG16 was less favorable than that in other age ranges in the 15–17 age group. The VGG16 network model prediction results for the younger age groups were acceptable. In the 6-to 8-year-old group, the accuracy of the VGG16 model can reach up to 93.63%, which was higher than the 88.73% accuracy of the ResNet101 network. The age threshold also implies that VGG16 has a smaller age-difference error.

Conclusions

This study demonstrated that VGG16 performed better when dealing with DA estimation via OPGs than the ResNet101 network on a wholescale. CNNs such as VGG16 hold great promise for future use in clinical practice and forensic sciences.
The effect of zingiber officinale on prooxidant-antioxidant balance and glycemic control in diabetic patients with ESRD undergoing hemodialysis: a double-blind randomized control trial
Authors: Rostamkhani Helya , Veisi Parisa , Niknafs Bahram , Jafarabadi Mohammad Asghari , Ghoreishi Zohreh
Published: February 2023

Background

Diabetes management in hemodialysis patients with end-stage renal disease needs precision to avoid complications. The study aimed to investigate the effect of ginger supplementation on prooxidant-antioxidant balance, glycemic management, and renal function in diabetic hemodialysis patients.

Trial design and methods

Forty-four patients were randomly allocated to either the ginger or the placebo group in this randomized, double blind, placebo-controlled study. Patients in the ginger group received 2000 mg/d ginger for eight weeks, whereas those in the placebo group received equivalent placebos. After a 12- to 14-h fast, serum levels of fasting blood glucose (FBG), insulin, urea, creatinine, and prooxidant-antioxidant balance (PAB) were measured at baseline and at the end of the study. The homeostatic model evaluation of insulin resistance was used to determine insulin resistance (HOMA-IR).

Results

Serum levels of FBG (p = 0.001), HOMA-IR (p = 0.001), and urea (p = 0.017) were considerably lower in the ginger group compared to baseline, and the difference was significant when compared to the placebo group (p < 0.05). Moreover, ginger supplementation decreased serum levels of creatinine (p = 0.034) and PAB (p = 0.013) within the group, but the effect was insignificant between groups(p > 0.05). On the other hand, insulin levels did not vary significantly across and among the groups(p > 0.05).

Conclusion

In summary, this study indicated that in diabetic hemodialysis patients, ginger could result to lower blood glucose levels, enhanced insulin sensitivity, and lower serum urea levels. Further studies with a more extended intervention period and various doses and forms of ginger are needed.

Trial registration

IRCT20191109045382N2. (06/07/2020), Retrospectively registered,https://www.irct.ir/trial/48467
Preparedness of primary health care facilities on implementation of essential non-communicable disease interventions in Osun State South-West Nigeria: a rural–urban comparative study
Authors: Akinwumi Adebowale Femi , Esimai Olapeju Adefunke , Arije Olujide , Ojo Temitope Olumuyiwa , Esan Oluwaseun Taiwo
Published: February 2023

Background

Global response to the growing burden of non-communicable diseases (NCDs) in developing countries includes the development of WHO Package of Essential Non-communicable Disease Interventions (WHO PEN) for Primary Health Care (PHC). The study assessed the level of preparedness of PHC facilities on implementation of essential NCD interventions in rural and urban Local Government Areas (LGAs) of Osun State, Nigeria.

Methods

The study was a comparative cross-sectional survey. Information was collected from heads of 33 rural and 33 urban PHC facilities and through direct observation on the domains of staff training, basic equipment, diagnostics and essential medicines for cardiovascular diseases, diabetes and chronic respiratory diseases (CRDs) using a semi-structured interviewer administered questionnaire.

Results

Manual sphygmomanometer was found in similar proportions (84.8%) of PHC facilities in rural and urban LGAs. Glucometer was available in 45.5% of the PHC facilities in urban and 33.3% of the PHC facilities in the rural LGAs, the difference was not statistically significant (χ2 = 1.015; p = 0.314). Basic equipment for CRDs were not available in majority of PHC facilities in both locations. Moduretic tablets were the most reported essential NCD medicines, available in 15% of PHC facilities in rural LGAs and none in urban LGAs. The anti-diabetic medicines were not available in any of the PHC facilities in both locations. More than 90% (≥ 30) of the PHC facilities in both locations were not prepared to implement essential interventions for each NCD across domains of staff training and essential medicines. Overall, 97.0% of the PHC facilities in the rural LGAs and all the PHC facilities in urban LGAs were not prepared on implementation of essential interventions for the three NCDs.

Conclusion

The level of preparedness of the PHC facilities on implementation of essential NCD interventions in the rural and urban LGAs of Osun State is very low. Government needs to strengthen the PHC system by providing needed essential medicines, basic diagnostics, equipment, and training of clinical health care workers for implementation of essential NCD interventions in the state.
Fecal microbiota transplantation attenuates Escherichia coli infected outgrowth by modulating the intestinal microbiome
Authors: Wang Yaping , He Yuanyuan , Liang Ying , Liu Han , Chen Xiushuang , Kulyar Muhammad Fakhar-e-Alam , Shahzad Asim , Wei Kunhua , Li Kun
Published: February 2023

Background

Given the crucial role of gut microbiota in animal and human health, studies on modulating the intestinal microbiome for therapeutic purposes have grasped a significant attention, of which the role of fecal microbiota transplantation (FMT) has been emphasized.

Methods

In the current study, we evaluated the effect of FMT on gut functions in Escherichia coli (E. coli) infection by using mice model. Moreover, we also investigated the subsequently dependent variables of infection, i.e., body weight, mortality, intestinal histopathology, and the expression changes in tight junction proteins (TJPs).

Results

The FMT effectively decreased weight loss and mortality to a certain extent with the restoration of intestinal villi that resulted in high histological scores for jejunum tissue damage (p < 0.05). The effect of FMT on alleviating the reduction of intestinal TJPs was also proved by immunohistochemistry analysis and mRNA expression levels. Moreover, the abundance of health-threatening bacteria, belonging to phylum Proteobacteria, family Enterobacteriaceae and Tannerellaceae, genus Escherichia-Shigella, Sphingomonas, Collinsella, etc., were significantly increased, whereas beneficial bacteria, belonging to phylum Firmicutes, family Lactobacillaceae, genus Lactobacillus were decreased in the gut of infected mice. Furthermore, we sought to investigate the association of clinical symptoms with FMT treatment with modulation in gut microbiota. According to beta diversity, the microbial community of gut microbiota results reflected the similarities between non-infected and FMT groups. The improvement of the intestinal microbiota in FMT group was characterized by the significant high level of beneficial microorganisms with the synergistic decrease of Escherichia-Shigella, Acinetobacter, and other taxa.

Conclusion

The findings suggest a beneficial host-microbiome correlation following fecal microbiota transplanatation for controlling gut infections and pathogens-associated diseases.
Structural violence and the uncertainty of viral undetectability for African, Caribbean and Black people living with HIV in Canada: an institutional ethnography
Authors: Odhiambo Apondi J. , O’Campo Patricia , Nelson La Ron E. , Forman Lisa , Grace Daniel
Published: February 2023

Biomedical advances in healthcare and antiretroviral treatment or therapy (ART) have transformed HIV/AIDS from a death sentence to a manageable chronic disease. Studies demonstrate that people living with HIV who adhere to antiretroviral therapy can achieve viral suppression or undetectability, which is fundamental for optimizing health outcomes, decreasing HIV-related mortality and morbidity, and preventing HIV transmission. African, Caribbean, and Black (ACB) communities in Canada remain structurally disadvantaged and bear a disproportionate burden of HIV despite biomedical advancements in HIV treatment and prevention. This institutional ethnography orients to the concept of ‘structural violence’ to illuminate how inequities shape the daily experiences of ACB people living with HIV across the HIV care cascade. We conducted textual analysis and in-depth interviews with ACB people living with HIV (n = 20) and health professionals including healthcare providers, social workers, frontline workers, and health policy actors (n = 15). Study findings produce a cumulative understanding that biomedical HIV discourses and practices ignore structural violence embedded in Canada’s social fabric, including legislation, policies and institutional practices that produce inequities and shape the social world of Black communities. Findings show that inequities in structural and social determinants of health such as food insecurity, financial and housing instability, homelessness, precarious immigration status, stigma, racial discrimination, anti-Black racism, criminalization of HIV non-disclosure, health systems barriers and privacy concerns intersect to constrain engagement and retention in HIV healthcare and ART adherence, contributing to the uncertainty of achieving and maintaining undetectability and violating their right to health. Biomedical discourses and practices, and inequities reduce Black people to a stigmatized, pathologized, and impoverished detectable viral underclass. Black people perceived as nonadherent to ART and maintain detectable viral loads are considered “bad” patients while privileged individuals who achieve undetectability are considered “good” patients. An effective response to ending HIV/AIDS requires implementing policies and institutional practices that address inequities in structural and social determinants of health among ACB people.
Formate-induced CO tolerance and methanogenesis inhibition in fermentation of syngas and plant biomass for carboxylate production
Authors: Baleeiro Flávio C. F. , Varchmin Lukas , Kleinsteuber Sabine , Sträuber Heike , Neumann Anke
Published: February 2023

Background

Production of monocarboxylates using microbial communities is highly dependent on local and degradable biomass feedstocks. Syngas or different mixtures of H2, CO, and CO2can be sourced from biomass gasification, excess renewable electricity, industrial off-gases, and carbon capture plants and co-fed to a fermenter to alleviate dependence on local biomass. To understand the effects of adding these gases during anaerobic fermentation of plant biomass, a series of batch experiments was carried out with different syngas compositions and corn silage (pH 6.0, 32 °C).

Results

Co-fermentation of syngas with corn silage increased the overall carboxylate yield per gram of volatile solids (VS) by up to 29% (0.47 ± 0.07 g gVS−1; in comparison to 0.37 ± 0.02 g gVS−1with a N2/CO2headspace), despite slowing down biomass degradation. Ethylene and CO exerted a synergistic effect in preventing methanogenesis, leading to net carbon fixation. Less than 12% of the electrons were misrouted to CH4when either 15 kPa CO or 5 kPa CO + 1.5 kPa ethylene was used. CO increased the selectivity to acetate and propionate, which accounted for 85% (electron equivalents) of all products at 49 kPa CO, by favoring lactic acid bacteria and actinobacteria overn-butyrate andn-caproate producers. Inhibition ofn-butyrate andn-caproate production by CO happened even when an inoculum preacclimatized to syngas and lactate was used. Intriguingly, the effect of CO onn-butyrate andn-caproate production was reversed when formate was present in the broth.

Conclusions

The concept of co-fermenting syngas and plant biomass shows promise in three aspects: by making anaerobic fermentation a carbon-fixing process, by increasing the yields of short-chain carboxylates (propionate and acetate), and by minimizing electron losses to CH4. Moreover, a model was proposed for how formate can alleviate CO inhibition in certain acidogenic bacteria. Testing the fermentation of syngas and plant biomass in a continuous process could potentially improve selectivity ton-butyrate andn-caproate by enriching chain-elongating bacteria adapted to CO and complex biomass.
Inadvertent intrathecal drug injection while treating low back pain: a case report and review of the literature
Authors: Ferrieri Alessandro , Bosco Donatella , Polilli Ennio , Ciulli Raffaella , Visocchi Lina , Mincione Lucrezia , Iacoe Rosa , Zocaro Rosamaria , Frattari Antonella
Published: February 2023

Background

Undesired intrathecal injections represent an important subset of medical errors, albeit rare. Clinical effects depend on the type and concentration of drug(s) injected. Here we report on the case of a healthy woman with persistent low back pain, treated with a paravertebral injection of lidocaine, thiocolchicoside, and l-acetylcarnitine at an orthopedic practice.

Case report

A 42-year-old Caucasian woman, with no relevant past medical history, received a lumbar paravertebral injection of lidocaine, thiocolchicoside, and l-acetylcarnitine for persistent low back pain. Approximately 30 minutes after injection, she experienced quick neurological worsening. Upon arrival at the Emergency Department, she was comatose, with fixed bilateral mydriasis, trismus, and mixed acidosis; seizures ensued in the first hours; slow progressive amelioration was observed by day 6; retrograde amnesia was the only clinical relevant remaining symptom by 6 months.

Conclusions

To our knowledge, this is the first reported case of inadvertent intrathecal thiocolchicoside injection in an adult patient, as well as the first in the neurosurgical literature. Our experience suggests that injection therapy for low back pain should be administered in adequate settings, where possible complications may be promptly treated.