bluuebunny/crossref_metadata_2025 huggingface dataset:
Knowledge of tropical diseases and response capabilities of healthcare providers in Kaduna State, Nigeria
Authors: Adje David U , Dambo Edmund D
Published: April 2023

Background

The public health impact of neglected tropical diseases (NTDs) is quite substantial. The objective of this study was to assess the knowledge and response capability of health professionals regarding NTDs in Kaduna State, Nigeria.

Methods

A pre-tested questionnaire with a Cronbach's α coefficient of 0.716 was administered to 350 health professionals. The questionnaire assessed the knowledge, resource availability and capacity to handle NTD cases.

Results

Only 38 (12.6%) respondents were familiar with the World Health Organization's definition of NTDs. Although self-reported knowledge was highest for physicians (37 [82.2%]), there was no statistically significant knowledge disparity between cadres of health professionals. Only 12 (46.2%) practitioners in private health facilities reported adequate knowledge. The tier of practice was significantly associated with management of NTDs (χ2 = 10.545; df 2; p = 0.005). Only 24 (47.1%) medical laboratory scientists and 18 (40.0%) physicians had adequate clinical resources for management of NTDs. Nearly three-quarters (211 (70.1%)] of respondents had never been trained in the management of NTDs. More than half (177 [58.8%]) of facilities lacked pharmaceuticals or standard operating procedures for management of NTDs.

Conclusions

Self-reported knowledge of NTDs was suboptimal. Physical and clinical resources for the diagnosis and treatment of NTDs were inadequate. Targeted training, increased funding and provision of adequate resources are needed in order to ameliorate the situation.
Worse Itch and Fatigue in Racial and Ethnic Minorities: A Burn Model System Study
Authors: Won Paul , Stoycos Sarah A , Ding Li , McMullen Kara A , Kowalske Karen , Stewart Barclay T , Yenikomshian Haig A
Published: April 2023

Racial and ethnic minority patients experience worse hypertrophic scars after burn injury than White patients. Subsequently, minority patients encounter differences in scar-related recovery domains such as itch and fatigue. This study examines disparities regarding postburn injury itch and fatigue in minority patients to better inform counseling and treatment considerations. From the multicenter National Institute of Disability, Independent Living and Rehabilitation Research Burn Model System Database (2015-2019), outcomes were analyzed at three time-points (discharge from index hospitalization, 6- and 12-months post-injury) using the 5D Itch and PROMIS-29 Fatigue measures. Multilevel linear mixed effects regression modeling analyzed associations between race/ethnicities and outcomes over time. Of 893 total patients, minority patients reported higher/worse itch scores at all time points compared to White patients. Itch scores were significantly higher for Black patients at 6 months (β = 1.42, P = .03) and 12 months (β = 3.36, P < .001) when compared to White patients. Black patients reported higher fatigue scores than White patients at all time points. Fatigue scores were significantly higher for Hispanic/Latino patients at discharge (β = 6.17, P < .001), 6 months (β = 4.49, P < .001), and 12 months (β = 6.27, P < .001) than White patients. This study supports investigation of potential factors leading to increased itch and fatigue such as sociocultural factors, disparities in healthcare access, and psychosocial impacts of these symptoms. In the short-term, minority patients may benefit from additional counseling and focused treatments addressing itch and fatigue after burn injury.
How Should We Determine the Role of Bezlotoxumab for Pediatric Clostridioides difficile Infection?
Authors: Sandora Thomas J
Published: April 2023

The newly published MODIFY III trial established a safe pediatric dose of bezlotoxumab but did not conclusively demonstrate efficacy in decreasing the rate of recurrence of Clostridioides difficile infection in children. This editorial addresses considerations for bezlotoxumab use in pediatrics.
Statins synergize with phosphodiesterase type 5 inhibitors but not with selective estrogen receptor modulators to prevent myofibroblast transformation in an in vitro model of Peyronie’s disease
Authors: Ilg Marcus M , Ralph David J , Cellek Selim
Published: April 2023

Background

Peyronie’s disease (PD) is a fibrotic disorder characterized by plaque formation in the tunica albuginea (TA) of the penis, and we have previously shown that inhibition of transformation of TA-derived fibroblasts to myofibroblasts using a combination phosphodiesterase type 5 (PDE5) inhibitors and selective estrogen receptor modulators (SERMs) is effective in slowing the progression of early PD.

Aim

The study sought to investigate whether combinations of statins with PDE5 inhibitors or SERMs would affect myofibroblast transformation in vitro.

Methods

Primary fibroblasts were isolated from TA of patients with PD and stimulated with transforming growth factor β1 in the absence and presence of a range of concentrations of statins, PDE5 inhibitors, SERMs, and their combinations for 72 hours before quantifying α-smooth muscle actin using in-cell enzyme-linked immunosorbent assay.

Outcomes

The prevention of transforming growth factor β1–induced transformation of TA-derived fibroblasts to myofibroblasts was measured in vitro.

Results

Statins (simvastatin, lovastatin) inhibited myofibroblast transformation in a concentration-dependent manner with half maximal inhibitory concentration values of 0.77 ± 0.07 μM and 0.8 ± 0.13 μM, respectively. Simvastatin inhibited myofibroblast transformation in a synergistic fashion when combined with vardenafil (a PDE5 inhibitor; log alpha >0). Combination of tamoxifen (a SERM) and simvastatin did not show synergy (log alpha <0). When 3 drugs (simvastatin, vardenafil, and tamoxifen) were combined, the effect was not synergistic, but rather was additive.

Clinical implications

A combination of a statin with a PDE5 inhibitor might be useful in the clinic to slow the progression of the disease in patients with early PD; however, caution should be taken with such a combination because of the reported myopathy as a side effect.

Strengths and limitations

The use of primary human cells from patients with PD is a strength of this study. The mechanisms by which these drug classes exert synergy when used in combination was not investigated.

Conclusion

This is the first demonstration of an antifibrotic synergy between statins and PDE5 inhibitors.
Blisters and bullae over the skin graft site: a complication of the Coronary Artery Bypass Graft Surgery (CABG)
Authors: Baroudi Ihsan , Sleibi Amjad , Whbi Ibrahim , Khattab Najdat , Douri Thaer
Published: April 2023

Coronary artery bypass grafting is one of the most widely used interventions for patients with ischemic heart disease worldwide. Skin incision blistering after vein harvesting surgery has an estimated incidence rate of 7%. Our case emphasizes the importance of using the right way of applying and removing bandages to minimize incision skin complications.
Boerhaave syndrome following the use of Kambo from the Amazonian Phyllomedusa bicolor tree frog in Australia
Authors: Darlington Christopher R , Copertino Nicolas
Published: April 2023

This case report describes Boerhaave syndrome in an otherwise healthy male after Kambo use in Australia. Kambo is produced from the sections of the Phyllomedusa bicolor (Boddaert, 1772) tree frog. Also known as the giant leaf frog, two-coloured leaf frog, waxy-monkey tree frog and kambô, is native to South America. Its use is part of a traditional cleansing ceremony but has been adopted by the alternative health movement.
Personalized regenerative strategies and molecular diagnosis forin vitrofertilization success: a case report
Authors: Hernández-Melchor Dinorah , Madrazo Iván , Padilla-Viveros América , Camargo Felipe , López-Bayghen Esther
Published: April 2023

Limited options are available for infertility associated with damaged or suboptimal tissues, typically the endometrium or ovaries. The goal of regenerative medicine is to restore function to specific tissues. Here, a 35-year-old female patient underwent two interventions of regenerative medicine: (i) autologous mesenchymal stem cells (MSCs) were applied in the myometrium, and (ii) intraovarian infusion of platelet-rich plasma (PRP). After two failed in vitro fertilization cycles (IVF), in which the endometrium was <5 mm, MSCs were applied, achieving a 7 mm trilaminar lining; however, the embryo quality remained poor. Therefore, intraovarian PRP was utilized for the next IVF cycle; the patient’s response improved, and a euploid embryo developed. After the embryo transfer and a normal 38 weeks of pregnancy, a baby girl was born. Here, we demonstrate two forms of regenerative medicine that can be utilized to improve IVF.
Is There a Wave of Right-Wing Terrorism? A Review Article
Authors: Byman Daniel
Published: April 2023

This review article examines whether right-wing terrorism in the United States and other countries constitutes a long-lasting “wave” comparable to anarchist, jihadist, and other causes that led to extremist violence. Past waves offer many lessons for understanding, and countering, the current right-wing terrorist surge. The various right-wing movement’s uses of technology, fragmentation into numerous groups and individual actors, and potential sources of decline—especially their regular interactions with law enforcement—all have historical parallels with other terrorism eras from which we can learn. However, the media focus on the current manifestations of right-wing violence obscures the deep historical roots of the movement: its violence is hardly new or otherwise unique to today, and thus it is not realistic to expect it to fade over time as movements like anarchism did a century ago. In addition, the international ties of right-wing groups and figures, while quite real, are less extensive and consequential than those of jihadists and many other groups in the past. Perhaps the most important and most difficult issue is the overlap between extreme right-wing violence and legitimate politics. This is a vulnerability but also a tremendous source of potential power, magnifying the influence of violent extremists and making counterterrorism more difficult. Resourcing the fight against far-right violence is vital, as is harnessing the power of technology companies. Finally and most difficult, the political dynamics must change, with politicians of all stripes condemning the violent extreme even as robust, and at times contentious, ideas remain part of the public debate.
A brain structural connectivity biomarker for autism spectrum disorder diagnosis in early childhood
Authors: Jiang Xi , Shou Xiao-Jing , Zhao Zhongbo , Chen Yuzhong , Meng Fan-Chao , Le Jiao , Song Tian-Jia , Xu Xin-Jie , Guo Weitong , Ke Xiaoyan , Cai Xiao-E , Zhao Weihua , Kou Juan , Huo Ran , Liu Ying , Yuan Hui-Shu , Xing Yan , Han Ji-Sheng , Han Song-Ping , Li Yun , Lai Hua , Zhang Lan , Jia Mei-Xiang , Liu Jing , Liu Xuan , Kendrick Keith M , Zhang Rong
Published: April 2023

Background

Autism spectrum disorder (ASD) is associated with altered brain development, but it is unclear which specific structural changes may serve as potential diagnostic markers, particularly in young children at the age when symptoms become fully established. Furthermore, such brain markers need to meet the requirements of precision medicine and be accurate in aiding diagnosis at an individual rather than only a group level.

Objective

This study aimed to identify and model brain-wide differences in structural connectivity using diffusion tensor imaging (DTI) in young ASD and typically developing (TD) children.

Methods

A discovery cohort including 93 ASD and 26 TD children and two independent validation cohorts including 12 ASD and 9 TD children from three different cities in China were included. Brain-wide (294 regions) structural connectivity was measured using DTI (fractional anisotropy, FA) together with symptom severity and cognitive development. A connection matrix was constructed for each child for comparisons between ASD and TD groups. Pattern classification was performed on the discovery dataset and the resulting model was tested on the two independent validation datasets.

Results

Thirty-three structural connections showed increased FA in ASD compared to TD children and associated with both autistic symptom severity and impaired general cognitive development. The majority (29/33) involved the frontal lobe and comprised five different networks with functional relevance to default mode, motor control, social recognition, language and reward. Overall, classification achieved very high accuracy of 96.77% in the discovery dataset, and 91.67% and 88.89% in the two independent validation datasets.

Conclusions

Identified structural connectivity differences primarily involving the frontal cortex can very accurately distinguish novel individual ASD from TD children and may therefore represent a robust early brain biomarker which can address the requirements of precision medicine.
The Age of Absorptive Roots Impacts Root-Adjacent Microbial Composition in Grapevines
Authors: Persico Meredith J. , Fleishman Suzanne M. , Eissenstat David M. , Bell Terrence H. , Centinari Michela
Published: April 2023

In grapevine, metabolic activity of absorptive roots changes rapidly as roots age but it is unclear whether nearby microbial assemblages shift as well. Here, we investigated whether first-order root age affects bacterial and fungal variation adjacent to the root surface, and whether root age should be integrated into future studies on root functional traits and associated microbes. We hypothesized that microbial diversity and composition would differ between young (≤11 days old) and old (11.5 to 40 days old) first-order roots due to expected differences in metabolism over the root lifespan (i.e., higher metabolism in young roots). Overall, we found that microbial composition was distinct between young and old absorptive roots, with stronger evidence at the phylum and amplicon sequence variant (ASV) taxonomic levels for fungi ( P = 0.003 and P = 0.038, respectively) than bacteria ( P = 0.082 and P = 0.129, respectively). Furthermore, we identified differentially abundant fungal and bacterial ASVs in young and old roots that related to expected differences in root function, including instances of microbes previously described as copiotrophs more abundant adjacent to young roots and microbes described as oligotrophs and saprotrophs more abundant adjacent to old roots. In contrast to the distinct shifts in microbial composition, there was little evidence of shifts in α diversity (i.e., observed ASVs and Shannon diversity) between young and old roots. Our study suggests that future work on the impacts of root functional traits on localized microbial composition may improve results interpretation and reduce some variation by accounting for root age at sampling.
A formula for predicting postoperative functional decline using routine medical data in elderly patients after hip fracture surgery
Authors: Fukuda Taeko , Imai Shinobu , Maruo Kazushi , Horiguchi Hiromasa
Published: April 2023

Background:

If functional decline after hip surgery can be predicted without special assessment, the effects of new treatments and rehabilitation practices can be easily compared with previous cases or those in other countries. The purpose of this study was to develop and examine a formula for such prediction.

Methods:

Data of 3,120 patients older than 65 yr with hip fracture were analyzed. The Barthel Index was used for evaluating activities of daily living (ADL). Low ADL was defined as patients with a lower score at discharge than the score at admission and patients with complete dependence at admission that did not change until discharge. Three models were developed in a training sample: Basic, Comorbidity, and Laboratory & Vital Signs models were created by inputting basic patient data, the basic data plus comorbidities, the basic data and comorbidities plus 8 laboratory test results and 5 vital signs, respectively. All potential variables with statistical significance < 0.2 on univariate analyses and some variables that may be clinically meaningful were included in multivariable models. The final model was developed by stepwise logistic regression.

Results:

The c-statistic of the Laboratory & Vital Signs formula was 0.701 and the predictive value was 76.9%. The c-statistics of the Basic and Comorbidity formulas were 0.643 and 0.664, respectively. Applying the Laboratory & Vital Signs formula to the validation sample, the c-statistic was 0.663.

Conclusions:

The formula developed from the medical data collected routinely before surgery could predict low ADL following hip fracture surgery in elderly patients.

Level of Evidence:

IVb
Newborn Screening Conditions: Early Intervention and Probability of Developmental Delay
Authors: Reynolds Elizabeth , Blanchard Sheresa , Jalazo Elizabeth , Chakraborty Pranesh , Bailey Donald B.
Published: April 2023

Objectives:

The purpose of this study is to explore which newborn screening (NBS) conditions are automatically eligible for early intervention (EI) across states and to determine the extent to which each disorder should automatically qualify for EI because of a high probability of developmental delay.

Methods:

We examined each state's EI eligibility policy and reviewed the literature documenting developmental outcomes for each NBS condition. Using a novel matrix, we assessed the risk of developmental delay, medical complexity, and risk of episodic decompensation, revising the matrix iteratively until reaching consensus. Three NBS conditions (biotinidase deficiency, severe combined immunodeficiency, and propionic acidemia) are presented in detail as examples.

Results:

Most states (88%) had Established Conditions lists to autoqualify children to EI. The average number of NBS conditions listed was 7.8 (range 0–34). Each condition appeared on average in 11.7 Established Conditions lists (range 2–29). After the literature review and consensus process, 29 conditions were likely to meet national criteria for an Established Condition.

Conclusion:

Despite benefiting from NBS and timely treatment, many children diagnosed with NBS conditions are at risk for developmental delays and significant medical complexity. The results demonstrate a need for more clarity and guidance regarding which children should qualify for EI. We suggest that most NBS conditions should automatically qualify based on the probability of resulting in a developmental delay. These findings suggest a future opportunity for collaboration between NBS and EI programs to create a consistent set of Established Conditions, potentially expediate referrals of eligible children, and streamline children's access to EI services.
A Model of Ischaemia-Induced Renal Interstitial Fibrosis in Mice with Established Diabetes
Authors: Ma Frank Y , Tesch Greg H , Grynberg Keren , Ozols Elyce , Mulley William R , Nikolic-Paterson David J
Published: April 2023

Background:

Diabetes is a well-established clinical risk factor for the development of acute kidney injury (AKI) following an episode of renal ischaemia. However, we lack a robust animal model to investigate the pathological mechanisms underpinning the increased susceptibility of the diabetic kidney to ischaemia-induced AKI and the transition to chronic kidney disease. The aim of this study was to develop a mouse model in which renal ischaemia induces renal interstitial fibrosis in diabetic mice, but not in control mice.

Methods:

C57BL6/J mice were made diabetic via 5 low dose streptozotocin injections. 8 weeks later, diabetic mice underwent 12 min of bilateral renal ischaemia and were killed on days 1, 7 or 28 after reperfusion. For comparison, groups of age-matched non-diabetic mice underwent the same renal ischaemia/reperfusion injury (IRI) protocol.

Results:

Non-diabetic mice developed AKI on day 1 which showed a virtually complete recovery of structure and function by day 7. By contrast, diabetic mice exhibited a state of chronic renal inflammation and developed a much more severe AKI on day 1 after IRI. Diabetic mice showed a marked delay in the repair response on day 7, and exhibited chronic tubular damage, inflammation and robust interstitial fibrosis on day 28.

Conclusion:

We have developed a mouse model suitable for the dissection of the mechanisms by which diabetes makes the kidney highly susceptible to an ischaemic insult and the transition to chronic kidney disease.
Antidepressive Effectiveness of Amisulpride, Aripiprazole, and Olanzapine in Patients With Schizophrenia Spectrum Disorders
Authors: Kjelby Eirik , Gjestad Rolf , Fathian Farivar , Sinkeviciute Igne , Alisauskiene Renata , Anda Liss , Løberg Else-Marie , Reitan Solveig Klæbo , Joa Inge , Larsen Tor Ketil , Rettenbacher Maria , Berle Jan Øystein , Fasmer Ole Bernt , Kroken Rune Andreas , Johnsen Erik
Published: April 2023

Background

Depressive symptoms are frequent in schizophrenia and associated with a poorer outcome. Currently, the optimal treatment for depressive symptoms in schizophrenia remains undetermined. Amisulpride, aripiprazole, and olanzapine all have antidepressive pharmacodynamic properties, ranging from serotonergic affinities to limbic dopaminergic selectivity. Consequently, in a 12-month pragmatic, randomized clinical trial, we aimed to investigate differences in antidepressive effectiveness among amisulpride, aripiprazole, and olanzapine as a secondary outcome, measured by change in the Calgary Depression Scale for Schizophrenia sum score in patients within the schizophrenia spectrum.

Methods

Psychotic patients within the schizophrenia spectrum were included, and effectiveness was analyzed with latent growth curve modeling.

Results

Of the 144 patients, 51 (35%) were women, the mean age was 31.7 (SD 12.7), and 39% were antipsychotic naive. At inclusion, 68 (47%) participants had a Calgary Depression Scale for Schizophrenia sum score >6, indicating severe depressive symptoms. Across the 12-month follow-up, there was a depressive symptom reduction in all medication groups, but no statistically significant differences between the study drugs. Separate analyses of the subcohort with elevated depressive symptoms at inclusion also failed to find differences in depressive symptom reduction between study drugs. The reduction in depressive symptoms mainly occurred within 6 weeks after randomization.

Conclusions

There was a reduction in depressive symptoms under treatment with amisulpride, aripiprazole, and olanzapine in acutely psychotic patients with schizophrenia spectrum disorder, but no differences between the drugs.
Standard Versus Restrictive Transfusion Strategy for Pediatric Cardiac ECLS Patients: Single Center Retrospective Cohort Study
Authors: Garcia Guerra Andres , Ryerson Lindsay , Garros Daniel , Nahirniak Susan , Granoski Don , Calisin Olivia , Sheppard Cathy , Lequier Laurance , Garcia Guerra Gonzalo
Published: April 2023

This retrospective cohort study aimed to compare blood component transfusion before and after the implementation of a restrictive transfusion strategy (RTS) in pediatric cardiac Extracorporeal Life Support (ECLS) patients. The study included children admitted to the pediatric cardiac intensive care unit (PCICU) at the Stollery Children’s Hospital who received ECLS between 2012 and 2020. Children on ECLS between 2012 and 2016 were treated with standard transfusion strategy (STS), while those on ECLS between 2016 and 2020 were treated with RTS. During the study, 203 children received ECLS. Daily median (interquartile range [IQR]) packed red blood cell (PRBC) transfusion volume was significantly lower in the RTS group; 26.0 (14.4–41.5) vs. 41.5 (26.6–64.4) ml/kg/day, p value <0.001. The implementation of a RTS led to a median reduction of PRBC transfusion of 14.5 (95% CI: 6.70–21.0) ml/kg/day. Similarly, the RTS group received less platelets: median (IQR) 8.4 (4.50–15.0) vs. 17.5 (9.40–29.0) ml/kg/day, p value <0.001. The implementation of a RTS resulted in a median reduction of platelet transfusion of 9.2 (95% CI: 5.45–13.1) ml/kg/day. The RTS resulted in less median (IQR) fluid accumulation in the first 48 hours: 56.7 (2.30–121.0) vs. 140.4 (33.8–346.2) ml/kg, p value = 0.001. There were no significant differences in mechanical ventilation days, PCICU/hospital days, or survival. The use of RTS resulted in lower blood transfusion volumes, with similar clinical outcomes.
Improved 3 Year Heart Transplant Survival in Black Recipients Following the Affordable Care Act
Authors: Brandes Rachel A. , Liang Caroline J. , Suerig Brigette , Chen Frederick Y. , Couper Gregory S. , Kawabori Masashi
Published: April 2023

To improve healthcare access, the US government implemented the Affordable Care Act (ACA) in 2014. Previous studies investigating its impact on healthcare inequities showed significant improvement in Black transplant recipient outcomes. Our objective is to determine the ACA’s impact on Black heart transplant (HTx) recipients. Using the United Network for Organ Sharing database, we analyzed 3,462 Black HTx recipients pre- and post-ACA (January 2009 to December 2012, and January 2014 to December 2017). Black recipient numbers and rates of overall HTx, insurance effects on survival, geographic changes in HTx, and post-HTx survival were compared pre- and post-ACA. Black recipients increased from 1,046 (15.3%) to 2,056 (22.2%) post-ACA (p < 0.001). Three year survival increased among Black recipients (85.8–91.9%, p = 0.01; 79.4–87.7%, p < 0.01; 78.3–84.6%, p < 0.01). Affordable Care Act implementation was protective for survival (hazard ratio [HR] = 0.64 [95% confidence interval [CI], 0.51–0.81], p < 0.01). Publicly insured patient survival increased post-ACA to match that of privately insured (87.3–91.8%, p = 0.001). United Network for Organ Sharing (UNOS) Regions 2, 8, and 11 experienced improved survival post-ACA (p = 0.047, p = 0.02, and p < 0.01, respectively). The post-ACA era showed improved HTx access and survival in Black recipients, indicating that national medical policy may play a strong role in eliminating racial disparities. Further attention is required to improve inequities in medical care.

http://links.lww.com/ASAIO/B2
The impact of hospital-family integrated continuation nursing based on information technology on patients unhealthy mood, family function and sexual function after cervical cancer surgery
Authors: Li Li-Ping , Rao Dan-Feng , Chen Xiang-Xiang , Qi Xiu-Yun , Chen Xiao-Xue , Wang Xiao-Qing , Li Jing
Published: April 2023

The objective of this study was to explore the impact on hospital-family integrated continuation care based on information technology on the negative emotions, family function, and sexual function of patients after cervical cancer surgery. The clinical case data onto 114 postoperative cervical cancer patients who were nursing in our hospital from July 2019 to July 2021 were selected and were divided into a control group and an observation group. The control group used routine nursing care, and on this basis, the observation group used information technology as the basis for hospital-family integrated continuation care, and we observed and compared the differences in the 2 groups of patients bad mood, family function, and sexual function. The score of anxiety (P= .017), depression (P= .009), fatigue rating (P= .012), and anger (P< .001) in the observation group after care were significantly lower than those in the control group. Problem solving, role, emotional response, emotional involvement, and family function total score in the observation group after care was significantly lower than those in the control group (P< .05). Sexual desire score, sexual arousal score, vaginal lubrication score, orgasm score, sexual satisfaction score, dyspareunia score, and Female Sexual Function Inventory total scores in the observation and control groups after care were significantly higher than those before care (P< .05). The sexual function scores in the observation group after care was significantly higher than those in the control group (P< .05). The hospital-family integrated continuation care based on information technology is more effective than conventional nursing care for patients after cervical cancer surgery.
A nomogram to predict the risk of sarcopenia in older people
Authors: Yin Guangjiao , Qin Juanjuan , Wang Ziwei , Lv Fang , Ye Xujun
Published: April 2023

The burden of sarcopenia is increasing worldwide. However, most cases of sarcopenia are undiagnosed due to the lack of simple screening tools. This study aimed to develop and validate an individualized and simple nomogram for predicting sarcopenia in older adults. A total of 180 medical examination populations aged ≥60 years were enrolled in this study. Sarcopenia was diagnosed according to the Asian Working Group for Sarcopenia 2019 consensus. The primary data were randomly divided into training and validation sets. Univariate logistic regression analysis was performed to select the risk factors of sarcopenia, which were subjected to the least absolute shrinkage and selection operator for feature selection. A nomogram was established using multivariate logistic regression analysis by incorporating the features selected in the least absolute shrinkage and selection operator regression model. The discrimination and calibration of the predictive model were verified by the concordance index, receiver operating characteristic curve, and calibration curve. In this study, 55 cases of sarcopenia were available. Risk predictors included age, albumin, blood urea nitrogen, grip strength, and calf circumference. The model had good discrimination and calibration capabilities. concordance index was 0.92 (95% confidence interval: 0.84–1.00), and the area under the receiver operating characteristic curve was 0.92 (95% confidence interval: 0.83–1.00) in the validation set. The Hosmer-Lemeshow test had aPvalue of .94. The predictive model in this study will be a clinically useful tool for predicting the risk of sarcopenia, and it will facilitate earlier detection and therapeutic intervention for sarcopenia.
The mechanism of peach kernel and safflower herb-pair for the treatment of liver fibrosis based on network pharmacology and molecular docking technology: A review
Authors: Huang Long , Yu Qingsheng , Peng Hui , Zhen Zhou
Published: April 2023

Peach kernel and safflower herb-pair (PKSH) are widely used in traditional Chinese medicine for the treatment of liver fibrosis. Therefore, network pharmacology was performed to explore potential therapeutic targets and pharmacological mechanisms of PKSH. The active components of PKSH from the Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform database and potential targets of liver fibrosis from the Online Mendelian Inheritance in Man, Pharmacogenetics and Pharmacogenomics Knowledge Base, GeneCards, and DrugBank Database were identified. The protein-protein interaction network was constructed using Cytoscape (v3.8.0). Gene Ontology and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed for the treatment of liver fibrosis, and molecular docking was carried out to verify the results of network pharmacology analysis. After screening disease-related genes, 179 intersection genes overlapped between 196 target proteins of the active compound and 9189 potential disease targets. Furthermore, we obtained 15 hub nodes and 146 edges to establish a related network diagram using CytoNCA. 2559 Gene Ontology biological processes underlying PKSH have been explored for the treatment of liver fibrosis, in which the response to oxidative stress plays a vital role. Furthermore, Kyoto Encyclopedia of Genes and Genomes enrichment analysis revealed that PKSH might play a role in inhibiting liver fibrosis, mainly through the PI3K-Akt signaling pathway. PKSH can regulate the response to oxidative stress through the PI3K-Akt signaling pathway for the treatment of liver fibrosis. The main bioactive components in PKSH, including quercetin and luteolin, can activate the PI3K-Akt signaling pathway by binding with the hub targets of the disease, which may provide insights into drug development for liver fibrosis.
Trough Concentration Response in Infliximab and Adalimumab Treated Children With Inflammatory Bowel Disease Following Treatment Adjustment: A Pharmacokinetic Model
Authors: Levy Rachel , Matar Manar , Zvuloni Maya , Shamir Raanan , Assa Amit
Published: April 2023

Objectives:

In patients with inflammatory bowel diseases (IBD), data on trough concentration (TC) response to adjustments of anti-tumor necrosis factor (TNFα) are scarce.

Methods:

We included pediatric patients with IBD who were treated with anti-TNFα agents and had sequential monitoring of TC pre- and post-adjustment. Patients with positive anti-drug-antibodies or with concomitant change in immunomodulatory treatment were excluded.

Results:

For the entire cohort (86 patients), median age at diagnosis was 13.2 (interquartile range, 10.7–14.9) years [females, 48%; Crohn disease (CD), 72%]. For infliximab, 58 patients had 201 interval changes and 26 had dose increase. Increase in TC following dose increase could not be predicted due to significant variability (P = 0.9). For every 10% decrease in interval, TC was increased by 1.6 µg/mL or by 57.2% (P = 0.014). Perianal disease was associated with attenuated response. For every 10% increase in interval, TC was decreased by 0.66 µg/mL or by 4.2%. The diagnosis of CD was associated with reduced response to interval increase. For adalimumab, 28 patients had 31 and 12 events of interval decrease or increase, respectively. Interval decrease resulted in increased median TC from 4.5 (3.5–5.3) µg/mL to 8.1 (6.5–10.5) µg/mL (X1.8) while interval increase resulted in TC change from 15.5 (12.8–18.6) µg/mL to 9.7 (6.5–14.6) µg/mL (:1.6) (P < 0.001 for both). Increase in delta TC was associated with younger age, and with absence of perianal disease (P = 0.001).

Conclusion:

Changes in TC following treatment adjustment can be almost linearly predicted for adalimumab while response to infliximab adjustment are more variable.
Impact of organizational climate on the self-efficacy of operating room personnel
Authors: Amiri Fardin , Baghbani Mina , Hannani Sedigheh , Azadi Namam Ali
Published: April 2023

Introduction:

Organizational climate is a set of characteristics of the work environment that are perceived directly and indirectly by employees and influence the behaviour of the organization’s employees. An appropriate organizational climate can be effective in motivating employees, improving morale and the staff’s participation in decision-making. So, it can be effective in increasing the staff’s creativity and innovation as well as productivity and self-efficacy of them. Therefore, the present study aimed to determine the association of organizational climate with the job self-efficacy of the operating room staff in the medical training centres of IUMS in 2020–2021.

Methods:

This study is descriptive and analytical research conducted in 2020–2021. The participants of this study include all the operating room. The research sample included 220 people. The data collection tools in this study are demographic characteristics form, questionnaire on organizational climate and Lyle Sussman and a job self-efficacy questionnaire by Riggs and Knight. Data analysis was performed using SPSS software through statistics of Spearman’s correlation, multiple regression model and Mann–Whitney.

Results:

More than half of the participants (50.5%) had a good organizational climate and high self-efficacy (58.2%). The results of Spearman’s rank correlation coefficient indicated that there was a significant relationship between organizational climate and self-efficacy (P<0.0001).

Conclusion:

Considering that there was a significant association between the organizational climate and self-efficacy, it is recommended that the officials of medical training centres improve the job self-efficacy and organizational climate of the operating room staff based on the conditions and rules governing the operating room by considering the following factors; knowing the organizational climate and personal characteristics of operating room staff, knowing the causes of various conflicts and knowing the ambiguities and challenges in the work environment.
A rare presentation of osteochondroma at the spinous process of the cervical spine: a case report
Authors: Librianto Didik , Saleh Ifran , Ipang Fachrisal , Aprilya Dina , Yafidy Muhammad , Yasmine Medisya
Published: April 2023

Osteochondroma is a benign cartilaginous tumor that usually arises from the growth plate of the long bones. Its presentation in flat bones is uncommon. Spinal osteochondroma is a rare case, with only a 4% incidence compared to all spinal neoplasms. We report an unusual case of osteochondroma at the spinous process of the C4 spine of a 15-year-old patient with the chief complaint of neck discomfort on movement. The patient has previously been diagnosed and treated for multiple hereditary exostoses of other bones. The patient underwent surgery for the current lesion with complete excision to the base of the lesion. Histopathology revealed a benign osteochondroma with a thin layer of cartilaginous cap. The patient was healed uneventfully and had no recurrence of the lesion on the same site at the 1-year follow-up. Surgical resection remains the mainstay treatment of osteochondroma and has proved to the low recurrence. In the case of cervical osteochondroma, surgery is advisable, particularly in symptomatic patients, to prevent complications.
Can Pyridoxine Successfully Reduce Behavioral Side Effects from Levetiracetam?
Authors: Chhabra Nikita , Vanood Aimen , Hoerth Matthew T. , Sanchez Cristina Valencia , O’Carroll Cumara B.
Published: April 2023

Background:

Levetiracetam is a commonly used anti-seizure medication, with the development of neuropsychiatric symptoms being the most common side effect. Preliminary literature describes the improvement of these symptoms with pyridoxine, mostly within the pediatric population. However, randomized control trial data investigating this relationship is sparse.

Objective:

The objective of this study was to critically assess evidence regarding the role of pyridoxine in the treatment of neuropsychiatric symptoms from levetiracetam.

Methods:

The objective was addressed through the development of a structured, critically appraised topic. This included a clinical scenario with a clinical question, literature search strategy, critical appraisal, results, evidence summary, commentary, and bottom-line conclusions. Participants included consultant and resident neurologists, medical librarians, clinical epidemiologists, and content experts in the field of epilepsy.

Results:

A randomized, placebo-controlled clinical trial was selected for critical appraisal. This trial compared pyridoxine versus placebo for the treatment of neuropsychiatric symptoms from levetiracetam in a pediatric population and included 105 patients (46/105 received pyridoxine, 59/105 received placebo). It found that both groups had a significant reduction in behavioral symptoms at the 2-,4-and 6-week time points (P<0.05). However, the authors noted that the pyridoxine group had almost double the relative reduction when compared with the placebo group at all time points: 1.9 at 2 weeks, 2.0 at 4 weeks, and 1.8 at 6 weeks (P=0.001).

Conclusions:

This study suggests that pyridoxine for the treatment of levetiracetam-induced behavioral side effects may result in modest improvement, although many limitations prevent conclusive results. There remains a need for a double-blinded, randomized control trial in both the adult and pediatric populations.
New Onset of Tuberculosis Complicating FDG PET/CT Evaluation in Patient With Recent Chimeric Antigen Receptor T-Cell Therapy
Authors: Wang Guanyun , Yang Xu , Wang Hongrong , Wang Wei , Yang Jigang
Published: April 2023

A 16-year-old adolescent girl with CD19 chimeric antigen receptor (CAR) T-cell therapy for acute lymphoblastic leukemia experienced new onset of the fever.18F-FDG PET/CT studies acquired at 1 and 2 months, respectively, after CAR-T, showed foci of abnormal activity in the mediastinal lymph nodes not seen on the study before therapy. However, these foci of abnormal activity were later proven due to newly developed tuberculosis after CAR T-cell therapy.
Coronary Collateral Circulation: A New Predictor of Mortality in Heart Transplant Recipients With Allograft Vasculopathy
Authors: Civieri Giovanni , Masiero Giulia , Osto Elena , Gambino Antonio , Angelini Annalisa , Fraiese Angela , Fedrigo Marny , Toscano Giuseppe , Bottio Tomaso , Perazzolo Marra Martina , Iliceto Sabino , Gerosa Gino , Tona Francesco
Published: April 2023

Background.

Coronary collateral arteries (CCAs) are anastomotic channels between vessels; although beneficial in atherosclerosis, their role in heart transplantation (HT) recipients is underinvestigated. CCAs initially develop as microcirculation and cardiac allograft vasculopathy (CAV), promoting immune-dependent proliferative angiogenic response, and play a role in their development. In our hypothesis, ischemia induced by coronary microvascular dysfunction (CMD) triggers the development of CCAs, which are, in turn, less functional as affected by CAV themselves.

Methods.

One hundred twenty-one patients receiving HT at our institution were retrospectively evaluated and were included if transthoracic echocardiography with coronary flow velocity reserve (CFVR) assessment and coronary angiography were performed. CMD was defined as CFVR of ≤2.5. Patients with CAV were enrolled, and their angiograms were reviewed to evaluate the presence of CCAs. Cardiovascular mortality was assessed as the main clinical outcome.

Results.

Forty patients were found to have CCAs. Patients with CCAs have lower CFVR than those without CCAs (2.22 ± 0.72 versus 2.69 ± 0.92;P = 0.003), reflecting in different rates of CMD in the 2 groups (72.5% versus 37%; P < 0.001). CMD is associated with higher CAV grades (P < 0.001), which are also associated with CCAs (P < 0.001). Patients with poorly developed CCAs have lower CFVR (P < 0.001). At multivariable analysis, CMD (P = 0.008) and higher CAV grades (P = 0.005) are independent predictors of CCAs. During the median follow-up time of 10.2 (6.6-13.3) y, patients with CCAs have been found to have higher mortality than those without CCAs (57.5% versus 32.1%; P = 0.007). CCAs are associated with a lower probability of survival also in patients with CMD (P < 0.001) and are independent predictors of mortality (P < 0.001).

Conclusions.

Our results demonstrate an interplay between CAV, CMD, and CCAs. We confirm that CAV is associated with CMD, and we show, for the first time, that CMD is associated with CCAs. CCAs are pathophysiologically associated with more severe graft vasculopathy and independently predict mortality after HT.
The Association Between Kidney Donor Profile Index and 1-y Graft Function
Authors: Foresto Renato Demarchi , Hazin Maria Amelia Aguiar , Cassão Bianca Cristina , de Morais Ana Paula Aquino , Felipe Claudia Rosso , Requião-Moura Lucio R. , Medina Pestana José , Tedesco-Silva Helio
Published: April 2023

Background.

The association between Kidney Donor Profile Index (KDPI) and 1-y estimated glomerular filtration rate (eGFR) with long-term kidney graft survival is well known. Yet, the association between KDPI and 1-y eGFR remains uncertain considering the several concurrent competing risk factors.

Methods.

This single-center, retrospective cohort study analyzed data from 3059 consecutive deceased donor kidney transplant recipients with a 1-y follow-up from January 2013 to December 2017. The aim was to determine the association between the KDPI strata (0%–35%, 36%–50%, 51%–85%, 86%–100%) and 1-y eGFR estimated by the CKD-EPI equation.

Results.

The incidence of delayed graft function (50.6% versus 59.3% versus 62.7% versus 62.0%; P < 0.001) and cytomegalovirus infection (36.7% versus 36.6% versus 43.3% versus 57.8%; P < 0.001) increased with increasing KDPI strata but not biopsy-proven acute rejection (9.1% versus 9.8% versus 8.4% versus 9.1%; P = 0.736). The median 1-y eGFR decreased with increasing KDPI strata (64.8 versus 53.5 versus 46.9 versus 39.1 mL/min/1.73 m2; P < 0.001). In the Cox regression, the higher the KDPI was, the lower the probability of a lower 1-y eGFR was. Assuming the 0%–35% strata as the reference, the likelihood of eGFR <50 mL/min/1.73 m2 was increased by 76.6% (hazard ratio [HR] = 1.767, 95% confidence interval [CI] = 1.406–2.220), 2.24- and 2.87-fold higher for KDPI higher >35%–50% (HR = 2.239, 95% CI = 1.862–2.691), and >51%–85% (HR = 2.871, 95% CI = 2.361–3.491), respectively. Other variables associated with a lower graft function were donor sex (HR male versus female = 0.896, 95% CI = 0.813–0.989) and cold ischemia time (HR for each hour = 1.011, 95% CI = 1.004–1.019). This association was sustained after the Poisson mediation analysis, including delayed graft function, cytomegalovirus, and acute rejection as mediators.

Conclusions.

In this cohort of deceased donor kidney recipients, KDPI, and cold ischemia time were the major independent risk factors associated with lower 1-y kidney function.
Alloreactive T cells to Assess Acute Rejection Risk in Kidney Transplant Recipients
Authors: Mendoza Rojas Aleixandra , Verhoeven Jeroen G.H.P. , de Kuiper Ronella , Clahsen-van Groningen Marian C. , Boer Karin , Hesselink Dennis A. , van Gelder Teun , van Besouw Nicole M. , Baan Carla C.
Published: April 2023

Background.

Memory T cells are important mediators of transplant rejection but are not routinely measured before or after kidney transplantation. The aims of this study were as follows: (1) validate whether pretransplant donor-reactive memory T cells are reliable predictors of acute rejection (AR) (2) determine whether donor-reactive memory T cells can distinguish AR from other causes of transplant dysfunction.

Methods.

Samples from 103 consecutive kidney transplant recipients (2018–2019) were obtained pretransplantation and at time of for-cause biopsy sampling within 6 mo of transplantation. The number of donor-reactive interferon gamma (IFN-γ) and interleukin (IL)-21-producing memory T cells was analyzed by enzyme-linked immunosorbent spot (ELISPOT) assay.

Results.

Of the 63 patients who underwent a biopsy, 25 had a biopsy-proven acute rejection (BPAR; 22 aTCMR and 3 aAMR), 19 had a presumed rejection, and 19 had no rejection. Receiver operating characteristic analysis showed that the pretransplant IFN-γ ELISPOT assay distinguished between patients who later developed BPAR and patients who remained rejection-free (area under the curve [AUC] 0.73; sensitivity 96% and specificity 41%). Both the IFN-γ and IL-21 assays were able to discriminate BPAR from other causes of transplant dysfunction (AUC 0.81; sensitivity 87% and specificity 76% and AUC 0.81; sensitivity 93% and specificity 68%, respectively).

Conclusions.

This study validates that a high number of donor-reactive memory T cells before transplantation is associated with the development of AR after transplantation. Furthermore, it demonstrates that the IFN-γ and IL-21 ELISPOT assays are able to discriminate between patients with AR and patients without AR at the time of biopsy sampling.