bluuebunny/crossref_metadata_2025 huggingface dataset:
Congenital syphilis as the cause of multiple bone fractures in a young infant case report
Authors: Koliou Maria , Chatzicharalampous Elpida , Charalambous Myria , Aristeidou Kyriakos
Published: December 2022

Background

The differential diagnosis of multiple unexplained bone fractures in a young infant usually includes child abuse or bone disease such as osteogenesis imperfecta. Bone abnormalities can occur in 60–80% of cases with congenital syphilis and may be the sole manifestation. However, this frequent manifestation of this rare disease such as congenital syphilis is frequently disregarded. We describe a case of a young infant with multiple long bone fractures diagnosed with congenital syphilis.

Case presentation

This 2-month-old male patient was referred to our hospital because of fractures of the ulna and distal radius bilaterally and noisy breathing with the suspicion of osteogenesis imperfecta. After thorough examination, the infant had anemia and a palpable spleen. We performed a screen for congenital infections among other investigations, which revealed positive non-treponemal and treponemal antibodies for syphilis. Hence the diagnosis for Congenital Syphilis was made.

We performed a lumbar puncture (LP) which showed mild pleocytosis. The patient was treated with intravenous aqueous penicillin G 200 000 UI/KG per day for 10 days. In addition, a single dose of intramuscular penicillin G benzathine 50 000 UI/KG was given due to the abnormal result of CSF.

On follow up admission 6 months later, the new syphilis serology had much improved and the new LP revealed no abnormal findings.

Conclusions

We present this case report in order to remind of a common manifestation of congenital syphilis, a rare disease which needs to be included in the differential diagnosis of multiple unexplained fractures in early infancy. In our case the fractures were symmetric and bilateral and they were accompanied by anemia and mild hepatosplenomegaly which led to the investigation of congenital syphilis as a possible cause. However, two thirds of infants with congenital syphilis are asymptomatic at birth. All women should have a proper syphilis screening during pregnancy.
A hybrid machine learning model of depression estimation in home-based older adults: a 7-year follow-up study
Authors: Lin Shaowu , Wu Yafei , Fang Ya
Published: December 2022

Background

Our aim was to explore whether a two-step hybrid machine learning model has the potential to discover the onset of depression in home-based older adults.

Methods

Depression data (collected in the year 2011, 2013, 2015 and 2018) of home-based older Chinese (n = 2,548) recruited in the China Health and Retirement Longitudinal Study were included in the current analysis. The long short-term memory network (LSTM) was applied to identify the risk factors of participants in 2015 utilizing the first 2 waves of data. Based on the identified predictors, three ML classification algorithms (i.e., gradient boosting decision tree, support vector machine and random forest) were evaluated with a 10-fold cross-validation procedure and a metric of the area under the receiver operating characteristic curve (AUROC) to estimate the depressive outcome.

Results

Time-varying predictors of the depression were successfully identified by LSTM (mean squared error =0.8). The mean AUCs of the three predictive models had a range from 0.703 to 0.749. Among the prediction variables, self-reported health status, cognition, sleep time, self-reported memory and ADL (activities of daily living) disorder were the top five important variables.

Conclusions

A two-step hybrid model based on “LSTM+ML” framework can be robust in predicting depression over a 5-year period with easily accessible sociodemographic and health information.
A prospective observational study for a Federated Artificial Intelligence solution for moniToring mental Health status after cancer treatment (FAITH): study protocol
Authors: Lemos Raquel , Areias-Marques Sofia , Ferreira Pedro , O’Brien Philip , Beltrán-Jaunsarás María Eugenia , Ribeiro Gabriela , Martín Miguel , del Monte-Millán María , López-Tarruella Sara , Massarrah Tatiana , Luís-Ferreira Fernando , Frau Giuseppe , Venios Stefanos , McManus Gary , Oliveira-Maia Albino J.
Published: December 2022

Background

Depression is a common condition among cancer patients, across several points in the disease trajectory. Although presenting higher prevalence rates than the general population, it is often not reported or remains unnoticed. Moreover, somatic symptoms of depression are common in the oncological context and should not be dismissed as a general symptom of cancer. It becomes even more challenging to track psychological distress in the period after the treatment, where connection with the healthcare system typically becomes sporadic. The main goal of the FAITH project is to remotely identify and predict depressive symptoms in cancer survivors, based on a federated machine learning (ML) approach, towards optimization of privacy.

Methods

FAITH will remotely analyse depression markers, predicting their negative trends. These markers will be treated in distinct categories, namely nutrition, sleep, activity and voice, assessed in part through wearable technologies. The study will include 300 patients who have had a previous diagnosis of breast or lung cancer and will be recruited 1 to 5 years after the end of primary cancer. The study will be organized as a 12-month longitudinal prospective observational cohort study, with monthly assessments to evaluate depression symptoms and quality of life among cancer survivors. The primary endpoint is the severity of depressive symptoms as measured by the Hamilton Depression Rating Scale (Ham-D) at months 3, 6, 9 and 12. Secondary outcomes include self-reported anxiety and depression symptoms (HADS scale), and perceived quality of life (EORTC questionnaires), at baseline and monthly. Based on the predictive models gathered during the study, FAITH will also aim at further developing a conceptual federated learning framework, enabling to build machine learning models for the prediction and monitoring of depression without direct access to user’s personal data.

Discussion

Improvements in the objectivity of psychiatric assessment are necessary. Wearable technologies can provide potential indicators of depression and anxiety and be used for biofeedback. If the FAITH application is effective, it will provide healthcare systems with a novel and innovative method to screen depressive symptoms in oncological settings.

Trial registration

Trial ID: ISRCTN10423782. Date registered: 21/03/2022.
Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia
Authors: Ma Hua-Jian , Zheng Yu-Chen , Shao Yang , Xie Bin
Published: December 2022

Background

Though controversial for its various disadvantages, involuntary admission (IA) is necessary in providing mental health care for patients suffering from schizophrenia in China. This article examines the IA rate in a representative sample, and under which circumstances are these patients more likely to be admitted involuntarily.

Methods

Adult patients consecutively admitted to two typical hospitals in Shanghai between 2013 and 2014 with a diagnosis of ICD-10 schizophrenia were included. 2167 patients were included in this study. Sociodemographic and clinical data, as well as personal information of psychiatrists who made risk assessment, were collected. The whole sample was divided into voluntary and involuntary admission groups. Group comparisons were performed with SPSS 17.0, using one-way ANOVA, Wilcoxon rank sum test, Chi-squares and Logistic regression.

Results

Among 2167 inpatients, the majority (2003, 92.4%) were involuntarily admitted. Clinical features, including age of patients (p < 0.001, OR = 1.037), lacking of insight (p < 0.001, OR = 3.691), were statistically significant for IA. Psychiatrist’s age (p < 0.001, OR = 1.042) was independently associated with IA. However, risk behaviors had dramatically affected patients’ admission status, of which the strongest predictor of IA was noncompliance with treatment (p < 0.001, OR = 3.597). The areas under the curve of the ROC and accuracy for the regression model were 0.815 and 0.927, respectively.

Conclusion

IA patients account for a major proportion of all those hospitalized with schizophrenia in China. Insights and risk behaviors contributed the most reasons for admission status of patients. This research shed light on necessity of further qualitative studies learning detailed evaluation processes of IA and high-quality interventional studies aiming to limit the performance of IA among patients with schizophrenia.
Development of a behavioural support intervention for e-bike use in Australia
Authors: McVicar Jenna , Nourse Rebecca , Keske Michelle A. , Maddison Ralph
Published: December 2022

Background

Insufficient physical activity (PA) is a risk factor for the development of many non-communicable diseases. Electric bicycles (e-bikes) offer considerable potential to support people to be physically active, however, no previous e-bike intervention studies have supported e-bike use with behavioural support. The aim of this study was to co-develop theory-based intervention components which can be used to increase physical activity through e-cycling among people who are overweight or obese and physically inactive.

Methods

We conducted a mixed-methods study using an online survey and virtual co-design workshops. We utilised the Behaviour Change Wheel (BCW) to inform the development of the behavioural support intervention to facilitate day-to-day e-cycling.

Results

One hundred participants completed an online survey and seven participated in the online co-design workshops. The development of the intervention identified five intervention functions (enablement, training, environmental restructuring, education, and persuasion) and 16 behaviour change techniques (BCTs) from 11 BCT groups (goals and planning, feedback and monitoring, social support, shaping knowledge, natural consequences, comparison of behaviour, associations, repetition and substitution, comparison of outcomes, antecedents, and self-belief).

Conclusion

To our knowledge, this is the first study to combine co-design and the BCW to develop a comprehensive behavioural support intervention for e-bike use. Theory based intervention options should be considered when providing e-bikes to individuals to help them increase their habitual PA levels.
Tracheal airway pressure in tracheostomy tube capping trials: an experimental study
Authors: Nowak Andreas , Martin Sten , Höhne Maik , Heller Winfried , Usichenko Taras I. , Klemm Eckart
Published: December 2022

Background

Tracheostomy tube capping is a commonly used test to determine if the tracheostomy tube can be removed. The success of the capping trial depends on the patient’s ability to maintain sufficient spontaneous breathing with an occluded tracheostomy tube. The impact of an occluded tracheotomy tube on airway resistance is currently unknown. The aim of this study was to investigate tracheal pressure during capping or stoma button insertion and potential determinants concerning cuff.

Methods

Eight cuffed and uncuffed tracheostomy tubes and three stoma buttons of various manufacturers and sizes were inserted into the trachea model. Cuffs were completely deflated or contained atmospheric pressure. The trachea was ventilated bidirectional with a respirator in volume-controlled mode and volume flows 15–60 L/min. Tracheal pressure drop during inspiration as a parameter of pressure required to move gas through the airway was measured.

Results

Tracheal pressure drops occurred linearly or irregularly during capping trials to a maximum of 4.2 kPa at flow rates of 60 L/min for atmospheric pressure cuffs. In tracheostomy tubes with completely deflated cuffs, pressure drop in the trachea reaches a maximum of 3.4 kPa at a flow rate of 60 L/min. For tracheostomy tubes with cuff smaller inner or outer diameters do not regularly result in lower tracheal pressure drop. The pressure drop varies between different tracheostomy tubes depending on the manufacturer. In cuffed tracheostomy tubes, we observed three phenomena: sail-like positioning, folding over, and tightening of the cuff during flow. The maximum tracheal pressure drop during stoma button insertion reaches 0.014 kPa.

Conclusions

The cuff is a central element for the pressure drop in the airway and thus airway resistance during spontaneous translaryngeal breathing with a capped TT. Complete deflation reduces the pressure drop in the trachea. Due to deformation of the cuff, measured pressures are irregular as the volume flow is increased. Incomplete deflated cuffs and material characteristics of tracheostomy tubes and cuffs in addition to anatomical and clinical variables may cause unsuccessful capping trials due to increased airway resistance. All stoma buttons showed that pressure drop and thus airway resistance due to stoma buttons has no clinical relevance.
Biomechanical application of finite elements in the orthopedics of stiff clubfoot
Authors: Liu Wei , Li Fei , He Haiyang , Teraili Aihelamu , Wang Xue , Wahapu Paerhati , Wang Chengwei
Published: December 2022

Background

The purpose of this study was to evaluate the effect of varying the different correction angles of hindfoot osteotomy orthosis on the biomechanical changes of the adjacent joints after triple arthrodesis in adult patients with stiff clubfoot to determine the optimal hindfoot correction angle and provide a biomechanical basis for the correction of hindfoot deformity in patients with stiff clubfoot.

Methods

A 26-year-old male patient with a stiff left clubfoot was selected for the study, and his ankle and foot were scanned using dual-source computed tomography. A three-dimensional finite element model of the ankle was established, and after the validity of the model was verified by plantar pressure experiments, triple arthrodesis was simulated to analyze the biomechanical changes of the adjacent joints under the same load with “3°” of posterior varus, “0°” of a neutral position and “3°, 6°, 9°” of valgus as the correction angles.

Results

The peak plantar pressure calculated by the finite element model of the clubfoot was in good agreement with the actual plantar pressure measurements, with an error of less than 1%. In triple arthrodesis, the peak von Mises stress in the adjacent articular cartilage was significantly different and less than the preoperative stress when the corrected angle of the hindfoot was valgus “6°”. In comparison, the peak von Mises stress in the adjacent articular cartilage was not significantly different in varus “3°”, neutral “0°”, valgus “3°” and valgus “9°” compared with the preoperative stress.

Conclusion

The results of this study showed that different angles of hindfoot correction in triple arthrodesis did not increase the peak von Mises stress in the adjacent joints, which may not lead to the development of arthritis in the adjacent joint, and a hindfoot correction angle of “6°” of valgus significantly reduced the peak von Mises stress in the adjacent joints after triple arthrodesis.
Analysis and comparison of tear protein profiles in dogs using different tear collection methods
Authors: Ritchoo Sudpatchara , Havanapan Phattara-orn , Phungthanom Nuanwan , Rucksaken Rucksak , Muikaew Rattana , Sussadee Metita
Published: December 2022

Background

Tear proteomic analysis has become an important tool in medical and veterinary research. The tear collection method could influence the tear protein profile. This study aims to evaluate the protein profiles of dog tears collected using microcapillary tubes (MT), Schirmer tear strips (ST), and ophthalmic sponges (OS).

Methods

The tear samples were collected using MT, ST, and OS. Tear protein profiles were analyzed using two-dimensional electrophoresis (2-DE) and the different protein spots’ expression was compared. Fourteen protein spots were identified using liquid chromatography-tandem mass spectrometry (LC-MS/MS).

Results

Tear protein concentrations ranged from 2.80 to 4.03 μg/μL, with no statistically significant differences among collection methods. Protein expression in each collection method differed in terms of both the number and intensity of the spots. There were 249, 327, and 330 protein spots found from tears collected with MT, ST, and OS, respectively. The proteins albumin, haptoglobin, and lactoferrin identified from OS were found to have higher spot intensities than other methods of collection. The use of MT demonstrated the downregulation of nine proteins.

Conclusions

The recent study supported that tear protein analysis is affected by different tear collection methods. Although ST is commonly used for tear collection, it provides insufficient information to study particular tear proteins.
Exhaled phospholipid transfer protein and hepatocyte growth factor receptor in lung adenocarcinoma
Authors: Andreasson Jesper , Bodén Embla , Fakhro Mohammed , von Wachter Camilla , Olm Franziska , Malmsjö Malin , Hallgren Oskar , Lindstedt Sandra
Published: December 2022

Background

Screening decreases mortality among lung cancer patients but is not widely implemented, thus there is an unmet need for an easily accessible non-invasive method to enable early diagnosis. Particles in exhaled air offer a promising such diagnostic tool. We investigated the validity of a particles in exhaled air device (PExA) to measure the particle flow rate (PFR) and collect exhaled breath particles (EBP) to diagnose primary lung adenocarcinoma (LUAD).

Methods

Seventeen patients listed for resection of LUAD stages IA–IIIA and 18 non-cancer surgical control patients were enrolled. EBP were collected before and after surgery for LUAD, and once for controls. Proteomic analysis was carried out using a proximity extension assay technology. Results were validated in both plasma from the same cohort and with microarray data from healthy lung tissue and LUAD tissue in the GSE10072 dataset.

Results

Of the 92 proteins analyzed, levels of five proteins in EBP were significantly higher in the LUAD patients compared to controls. Levels of phospholipid transfer protein (PLTP) and hepatocyte growth factor receptor (MET) decreased in LUAD patients after surgery compared to control patients. PFR was significantly higher in the LUAD cohort at all timepoints compared to the control group. MET in plasma correlated significantly with MET in EBP.

Conclusion

Collection of EBP and measuring of PFR has never been performed in patients with LUAD. In the present study PFR alone could distinguish between LUAD and patients without LUAD. PLTP and MET were identified as potential biomarkers to evaluate successful tumor excision.
The future of recombinant host defense peptides
Authors: Roca-Pinilla Ramon , Lisowski Leszek , Arís Anna , Garcia-Fruitós Elena
Published: December 2022

The antimicrobial resistance crisis calls for the discovery and production of new antimicrobials. Host defense peptides (HDPs) are small proteins with potent antibacterial and immunomodulatory activities that are attractive for translational applications, with several already under clinical trials. Traditionally, antimicrobial peptides have been produced by chemical synthesis, which is expensive and requires the use of toxic reagents, hindering the large-scale development of HDPs. Alternatively, HDPs can be produced recombinantly to overcome these limitations. Their antimicrobial nature, however, can make them toxic to the hosts of recombinant production. In this review we explore the different strategies that are used to fine-tune their activities, bioengineer them, and optimize the recombinant production of HDPs in various cell factories.
Sex-specific associations between serum lipids and hemostatic factors: the cross-sectional population-based KORA-fit study
Authors: von Falckenstein Johannes Vogel , Freuer Dennis , Peters Annette , Heier Margit , Teupser Daniel , Linseisen Jakob , Meisinger Christa
Published: December 2022

Background

Studies on the associations between lipid parameters and different hemostatic factors in men and women from the general population are scarce. It was therefore examined whether there are possible relationships between routinely measured serum lipids (total cholesterol, HDL-cholesterol, non-HDL-cholesterol, LDL-cholesterol, and triglycerides) and different hemostatic factors (activated partial thromboplastin time (aPTT), fibrinogen, factor VIII, antithrombin III (AT III), protein C, protein S, and D-dimer).

Methods

The analysis was based on data from the Cooperative Health Research in the Region of Augsburg (KORA)-Fit study, which included 805 participants (378 men, 427 women) with a mean age of 63.1 years. Sex-specific associations between serum lipids and coagulation factors were investigated using multivariable linear regression models.

Results

In men, total cholesterol was inversely related to aPTT but positively associated with protein C activity. HDL cholesterol was inversely related to aPTT and fibrinogen. LDL cholesterol, non-HDL cholesterol, and triglycerides showed a positive association with protein C and protein S activity.

In women, LDL-cholesterol, total cholesterol, and non-HDL-cholesterol were positively related to AT III concentrations and protein C and S activity. Additionally, non-HDL-cholesterol was positively associated with factor VIII activity. HDL cholesterol was inversely related to fibrinogen. Triglycerides showed a positive relationship with protein C activity.

Conclusions

There seem to be sex differences regarding various associations between blood lipid levels and hemostatic factors. Further studies are needed to address the possible impact of these associations on cardiovascular risk and the underlying mechanisms.
Factors associated with health-related quality of life among home-dwelling older adults aged 75 or older in Switzerland: a cross-sectional study
Authors: Siqeca Flaka , Yip Olivia , Mendieta Maria José , Schwenkglenks Matthias , Zeller Andreas , De Geest Sabina , Zúñiga Franziska , Stenz Samuel , Briel Matthias , Quinto Carlos , Blozik Eva , Deschodt Mieke , Obas Katrina , Dhaini Suzanne
Published: December 2022

Background

HRQoL is an indicator of individuals’ perception of their overall health, including social and environmental aspects. As a multidimensional concept, HRQoL can be influenced by a multitude of factors. Studies of HRQoL and factors associated with it among home-dwelling older adults have often been limited to inpatient settings or to a sub-population with a chronic disease. Studying HRQoL and its correlating factors among this population, by providing an ecological lens on factors beyond the individual level, can provide a better understanding of the construct and the role of the environment on how they perceive their HRQoL. Thus, we aimed to assess the HRQoL and investigate the correlates of HRQOL among home-dwelling older adults, guided by the levels of the ecological model.

Methods

This is a cross-sectional population survey conducted in 2019 in Canton Basel-Landschaft, in northwestern Switzerland, and includes a sample of 8786 home-dwelling older adults aged 75 and above. We assessed HRQoL by using the EQ-index and the EQ-VAS. The influence of independent variables at the macro, meso and micro level on HRQoL was tested using Tobit multiple linear regression modelling.

Results

We found that having a better socio-economic status as denoted by higher income, having supplementary insurance and a higher level of education were all associated with a better HRQoL among home-dwelling older adults. Furthermore, being engaged in social activities was also related to an improved HRQoL. On the other hand, older age, female gender, presence of multimorbidity and polypharmacy as well as social isolation and loneliness were found to all have a negative impact on HRQoL.

Conclusions

Understanding factors related to HRQoL by using an ecological lens can help identify factors beyond the individual level that impact the HRQoL of home-dwelling older adults. Our study emphasises the importance of social determinants of health and potential disparities that exists, encouraging policymakers to focus on policies to reduce socio-economic disparities using a life-course approach, which consequently could also impact HRQoL in later stages of life.
Civilian vascular trauma, treatment and outcome at a level 1-trauma centre
Authors: Johannesdottir B. K. , Geisner T. , Gubberud E. T. , Gudbjartsson T.
Published: December 2022

Background

Outcomes after vascular injuries in wartime are well documented, but studies on vascular injuries in a civilian European populations are scarce.

Methods

A retrospective study on all adults admitted to a North-European level 1-trauma centre 2009–2018 with The Abbreviated Injury Scale-codes for non-iatrogenic vascular trauma (VT). Data were extracted from both national and regional trauma-registries, as well as patient charts. Patient demographics, mechanism, and location of vascular injury were registered as well as its treatment. Incidence and injury scores (ISS, NISS and TRISS) were calculated and overall survival (Kaplan–Meier) estimated.

Results

Of 4042 trauma-patients, 68 (1.7%) (median age 44 years, 76% males) sustained 81 vascular injuries (69 arterial; 12 venous); 46 blunt and 22 (32%) penetrating injuries. The total incidence of vascular injuries was 1.45/100,000 inhabitants and did not change over the study-period (95% confidence interval 1.13–1.82). The injuries were located in thorax (n = 17), neck (n = 16) and abdominal region (n = 15); most of the blunt injuries followed traffic (n = 31) or falling accidents (n = 10), and with 17 of the 22 penetrating injuries due to stabbing. The median ISS and NISS-scores were 22 and 33, with 50 (74%) and 55 (81%) patients having scores > 15, respectively. Forty-three (63%) patients had open surgical repair and 8 (12%) received endovascular treatment. Twenty-one patients died within 30-days (31%), 33% and 27% after blunt and penetrating injuries, respectively. Half of the patients that died within 24 h sustained aortic injury.

Conclusions

Traumatic vascular injuries are rare in civilian settings and are less than 2% of major trauma admissions. These patients are often seriously injured and their treatment can be challenging with high 30-day mortality.

Trial registration: Retrospectively registered.
Gene signature for the prediction of the trajectories of sepsis-induced acute kidney injury
Authors: Zhang Zhongheng , Chen Lin , Liu Huiheng , Sun Yujing , Shui Pengfei , Gao Jian , Wang Decong , Jiang Huilin , Li Yanling , Chen Kun , Hong Yucai ,   CMAISE Consortium, Xing Lifeng , Jin Senjun , Sun Jian , Yang Yi , Jin Xiaohong , Yang Min , Gui Chunmei , Yuan Yingpu , Dong Guangtao , Zeng Weizhong , Zeng Jing , Hu Guoxin , Qiao Lujun , Wang Jinhua , Xi Yonglin , Wang Nan , Wang Minmin , Teng Yan , Hou Junxia , Bi Qiaojie , Zhang Gengsheng , Dai Junru
Published: December 2022

Background

Acute kidney injury (AKI) is a common complication in sepsis. However, the trajectories of sepsis-induced AKI and their transcriptional profiles are not well characterized.

Methods

Sepsis patients admitted to centres participating in Chinese Multi-omics Advances In Sepsis (CMAISE) from November 2020 to December 2021 were enrolled, and gene expression in peripheral blood mononuclear cells was measured on Day 1. The renal function trajectory was measured by the renal component of the SOFA score (SOFArenal) on Days 1 and 3. Transcriptional profiles on Day 1 were compared between these renal function trajectories, and a support vector machine (SVM) was developed to distinguish transient from persistent AKI.

Results

A total of 172 sepsis patients were enrolled during the study period. The renal function trajectory was classified into four types: non-AKI (SOFArenal = 0 on Days 1 and 3,n = 50), persistent AKI (SOFArenal > 0 on Days 1 and 3,n = 62), transient AKI (SOFArenal > 0 on Day 1 and SOFArenal = 0 on Day 3,n = 50) and worsening AKI (SOFArenal = 0 on Days 1 and SOFArenal > 0 on Day 3,n = 10). The persistent AKI group showed severe organ dysfunction and prolonged requirements for organ support. The worsening AKI group showed the least organ dysfunction on day 1 but had higher serum lactate and prolonged use of vasopressors than the non-AKI and transient AKI groups. There were 2091 upregulated and 1,902 downregulated genes (adjustedp < 0.05) between the persistent and transient AKI groups, with enrichment in the plasma membrane complex, receptor complex, and T-cell receptor complex. A 43-gene SVM model was developed using the genetic algorithm, which showed significantly greater performance predicting persistent AKI than the model based on clinical variables in a holdout subset (AUC: 0.948 [0.912, 0.984] vs. 0.739 [0.648, 0.830];p < 0.01 for Delong’s test).

Conclusions

Our study identified four subtypes of sepsis-induced AKI based on kidney injury trajectories. The landscape of host response aberrations across these subtypes was characterized. An SVM model based on a gene signature was developed to predict renal function trajectories, and showed better performance than the clinical variable-based model. Future studies are warranted to validate the gene model in distinguishing persistent from transient AKI.
Score-based prediction model for severe vitamin D deficiency in patients with critical illness: development and validation
Authors: Kuo Yu-Ting , Kuo Li-Kuo , Chen Chung-Wei , Yuan Kuo-Ching , Fu Chun-Hsien , Chiu Ching-Tang , Yeh Yu-Chang , Liu Jen-Hao , Shih Ming-Chieh
Published: December 2022

Background

Severe vitamin D deficiency (SVDD) dramatically increases the risks of mortality, infections, and many other diseases. Studies have reported higher prevalence of vitamin D deficiency in patients with critical illness than general population. This multicenter retrospective cohort study develops and validates a score-based model for predicting SVDD in patients with critical illness.

Methods

A total of 662 patients with critical illness were enrolled between October 2017 and July 2020. SVDD was defined as a serum 25(OH)D level of < 12 ng/mL (or 30 nmol/L). The data were divided into a derivation cohort and a validation cohort on the basis of date of enrollment. Multivariable logistic regression (MLR) was performed on the derivation cohort to generate a predictive model for SVDD. Additionally, a score-based calculator (the SVDD score) was designed on the basis of the MLR model. The model’s performance and calibration were tested using the validation cohort.

Results

The prevalence of SVDD was 16.3% and 21.7% in the derivation and validation cohorts, respectively. The MLR model consisted of eight predictors that were then included in the SVDD score. The SVDD score had an area under the receiver operating characteristic curve of 0.848 [95% confidence interval (CI) 0.781–0.914] and an area under the precision recall curve of 0.619 (95% CI 0.577–0.669) in the validation cohort.

Conclusions

This study developed a simple score-based model for predicting SVDD in patients with critical illness.

Trial registration: ClinicalTrials.gov protocol registration ID: NCT03639584. Date of registration: May 12, 2022.

Graphical Abstract
Microcalcifications, mammographic breast density, and risk of breast cancer: a cohort study
Authors: Kim Soyeoun , Tran Thi Xuan Mai , Song Huiyeon , Park Boyoung
Published: December 2022

Background

Breast density and microcalcifications are strongly associated with the risk of breast cancer. However, few studies have evaluated the combined association between these two factors and breast cancer risk. We investigated the association between breast density, microcalcifications, and risk of breast cancer.

Methods

This cohort study included 3,910,815 women aged 40–74 years who were screened for breast cancer between 2009 and 2010 and followed up until 2020. The National Health Insurance Service database includes national health-screening results from the national breast cancer screening program, which is an organized screening program provided every 2 years for all women aged 40 years or older. Breast density was assessed based on the Breast Imaging Reporting and Data System (BI-RADS) 4th edition, mostly through visual assessment by radiologists. The presence or absence of microcalcifications was obtained from the mammographic results. Cox proportional hazard regression for breast cancer risk was used to estimate hazard ratios (aHRs) adjusted for breast cancer risk factors.

Results

A total of 58,315 women developed breast cancer during a median follow-up of 10.8 years. Women with breast cancer had a higher proportion of microcalcifications than women without breast cancer (0.9% vs. 0.3%). After adjusting for breast density, women with microcalcification had a 3.07-fold (95% confidence interval [CI] 2.82–3.35) increased risk of breast cancer compared to women without microcalcification. The combined association between microcalcification and breast density dramatically increased the risk of breast cancer, corresponding to a higher level of breast density. Among postmenopausal women, the highest risk group was women with BI-RADS 4 and microcalcification. These women had more than a sevenfold higher risk than women with BI-RADS 1 and non-microcalcification (aHR, 7.26; 95% CI 5.01–10.53).

Conclusion

Microcalcification is an independent risk factor for breast cancer, and its risk is elevated when combined with breast density.
Patient-reported outcomes in terms of swallowing and quality of life after prophylactic versus reactive percutaneous endoscopic gastrostomy tube placement in advanced oropharyngeal cancer patients treated with definitive chemo-radiotherapy: Swall PEG study
Authors: Dragan Tatiana , Van Gossum André , Duprez Frederic , Lalami Yassine , Lefebvre Yolene , Mootassim-Billah Sofiana , Beauvois Sylvie , Gulyban Akos , Vandekerkhove Christophe , Boegner Petra , Paesmans Marianne , Ameye Lieveke , Digonnet Antoine , Quiriny Marie , Dequanter Didier , Lipski Samuel , Willemse Esther , Rodriguez Alejandra , Carlot Sebastien , Karaca Yasemin , Lemort Marc , Emonts Patrick , Al Wardi Clémence , Van Gestel Dirk
Published: December 2022

Background

Percutaneous endoscopic gastrostomy (PEG) is often used to provide nutritional support in locally advanced head and neck cancer patients undergoing multimodality treatment. However, there is little published data on the impact of prophylactic versus reactive PEG. PEG placement may affect swallowing-related physiology, function, and quality of life. The Swall PEG study is a randomized controlled phase III trial testing the impact of prophylactic versus reactive PEG on patient-reported outcomes in terms of swallowing and quality of life in oropharyngeal cancer patients.

Methods

Patients with locally advanced oropharyngeal cancer receiving chemo-radiotherapy will be randomized to either the prophylactic or reactive PEG tube group. Randomization will be stratified by human papillomavirus (HPV) status and unilateral versus bilateral positive neck lymph nodes. The primary objective of the study is the patient’s reported outcome in terms of swallowing (MD Anderson Dysphagia Inventory (MDADI)) at 6 months. Secondary objectives include health-related quality of life, dosimetric parameters associated with patient-reported outcomes, chemo-radiation toxicities, PEG tube placement complications, the impact of nutritional status on survival and toxicity outcomes, loco-regional control, overall survival, the impact of HPV and tobacco smoking on survival outcomes and toxicities, and the cost-effectiveness of each treatment strategy.

Discussion

Findings from this study will enhance clinical evidence regarding nutritional management in oropharyngeal cancer patients treated by concurrent chemo-radiation.

Trial registration

ClinicalTrials.gov NCT04019548, study protocol version 2.0_08/08/2019. Registered on 15 July 2019
Underrepresentation of women in randomized controlled trials: a systematic review and meta-analysis
Authors: Daitch Vered , Turjeman Adi , Poran Itamar , Tau Noam , Ayalon-Dangur Irit , Nashashibi Jeries , Yahav Dafna , Paul Mical , Leibovici Leonard
Published: December 2022

Background

Although regulatory changes towards correcting the underrepresentation of women in randomized controlled trials (RCTs) occurred (National Institutes of Health 1994), concerns exist about whether an improvement is taking place. In this systematic review and meta-analysis, we aimed to assess the inclusion rates of women in recent RCTs and to explore the potential barriers for the enrollment of women.

Methods

RCTs published in 2017 examining any type of intervention in adults were searched in PubMed and Cochrane Library. The following predefined medical fields were included: cardiovascular diseases, neoplasms, endocrine system diseases, respiratory tract diseases, bacterial and fungal infections, viral diseases, digestive system diseases, and immune system diseases. Studies were screened independently by two reviewers, and an equal number of studies was randomly selected per calendric month. The primary outcome was the enrollment rate of women, calculated as the number of randomized women patients divided by the total number of randomized patients. Rates were weighted by their inverse variance; statistical significance was tested using general linear models (GLM).

Results

Out of 398 RCTs assessed for eligibility, 300 RCTs were included. The enrollment rate of women in all the examined fields was lower than 50%, except for immune system diseases [median enrollment rate of 68% (IQR 46 to 81)]. The overall median enrollment rate of women was 41% (IQR 27 to 54). The median enrollment rate of women decreased with older age of the trials’ participants [mean age of trials’ participants ≤ 45 years: 47% (IQR 30–64), 46–55 years: 46% (IQR 33–58), 56–62 years: 38% (IQR 27–50), ≥ 63 years: 33% (IQR 20–46), p < 0.001]. Methodological quality characteristics showed no significant association with the enrollment rates of women. Out of the 300 included RCTs, eleven did not report on the number of included women. There was no significant difference between these studies and the studies included in the analysis.

Conclusions

Women are being inadequately represented, in the selected medical fields analyzed in our study, in recent RCTs. Older age is a potential barrier for the enrollment of women in clinical trials. Low inclusion rates of elderly women might create a lack of crucial knowledge in the adverse effects and the benefit/risk profile of any given treatment. Factors that might hinder the participation of women should be sought and addressed in the design of the study.
Partial thickness subfoveal hole in a patient treated with tamoxifen: a case report and review of the literature
Authors: Sohn Ashley , Sanchez George , Mantopoulos Dimosthenis
Published: December 2022

Background

We describe a patient presenting with a partial thickness subfoveal hole in the right eye after tamoxifen treatment for breast cancer.

Case presentation

A 76-year-old Caucasian female presented with a 1-day history of acute central scotoma and blurry vision in the right eye. The patient had been receiving oral tamoxifen for 5 years as adjuvant treatment for stage I lobular breast cancer. Her past ocular history was significant for complete, uneventful, and bilateral posterior vitreous detachment. Clinical examination and optical coherence tomography revealed a new, partial thickness subfoveal hole sparing the inner retinal layers. Observation was recommended. At the last follow-up examination, 1 year after the initial presentation, the subfoveal hole remained stable and visual acuity remained stable.

Conclusion

Tamoxifen has been associated with a plethora of ophthalmic adverse events, including macular holes, some of which are partial thickness subfoveal holes. Holes with this almost unique morphology are uncommon, and eye care professionals should be aware of this association given the frequency of tamoxifen use, as well as the low success rate of surgical repair with pars plana vitrectomy.
Single-cell transcriptome reveals core cell populations and androgen-RXFP2 axis involved in deer antler full regeneration
Authors: Ba Hengxing , Wang Xin , Wang Datao , Ren Jing , Wang Zhen , Sun Hai-Xi , Hu Pengfei , Zhang Guokun , Wang Shengnan , Ma Chao , Wang Yusu , Wang Enpeng , Chen Liang , Liu Tianbin , Gu Ying , Li Chunyi
Published: December 2022

Deer antlers constitute a unique mammalian model for the study of both organ formation in postnatal life and annual full regeneration. Previous studies revealed that these events are achieved through the proliferation and differentiation of antlerogenic periosteum (AP) cells and pedicle periosteum (PP) cells, respectively. As the cells resident in the AP and the PP possess stem cell attributes, both antler generation and regeneration are stem cell-based processes. However, the cell composition of each tissue type and molecular events underlying antler development remain poorly characterized. Here, we took the approach of single-cell RNA sequencing (scRNA-Seq) and identified eight cell types (mainly THY1+ cells, progenitor cells, and osteochondroblasts) and three core subclusters of the THY1+ cells (SC2, SC3, and SC4). Endothelial and mural cells each are heterogeneous at transcriptional level. It was the proliferation of progenitor, mural, and endothelial cells in the activated antler-lineage-specific tissues that drove the rapid formation of the antler. We detected the differences in the initial differentiation process between antler generation and regeneration using pseudotime trajectory analysis. These may be due to the difference in the degree of stemness of the AP-THY1+ and PP-THY1+ cells. We further found that androgen-RXFP2 axis may be involved in triggering initial antler full regeneration. Fully deciphering the cell composition for these antler tissue types will open up new avenues for elucidating the mechanism underlying antler full renewal in specific and regenerative medicine in general.
Barriers and facilitators of adherence to treatment among women with vulvovaginal candidiasis: a qualitative study
Authors: Erfaninejad Maryam , Salahshouri Arash , Amirrajab Nasrin
Published: December 2022

Background

Non-adherence of patients with vulvovaginal candidiasis (VVC) to treatment recommendations leads to treatment failure and recurrence of infection. Therefore, this qualitative study was conducted to identify barriers and facilitators of observance of treatment among women afflicted with vulvovaginal candidiasis.

Methods

This qualitative study was conducted through 26 in-depth unstructured interviews with 24 patients and 2 gynecologists using purposeful sampling with maximum variation in Ahvaz, southwest Iran. Interviews were conducted in person at health centers and the gynecologist’s offices. MAXQDA 10 software and conventional content analysis were used for data analysis.

Results

The findings showed barriers and facilitator factors of adherence to treatment in women with VVC. Some of these factors lead to an increase in adherence to treatment, and others play the role of hindering factors. These factors were classified into two main categories: patients’ beliefs and patients’ fears and concerns.

Conclusion

The results of this study showed that many of the behaviors of patients from the acceptance of the diagnosis process to treatment are rooted in the patient's beliefs and fears. Therefore, it seems necessary to design and carry out interventions based on the findings of this study, which can be used in the development of appropriate solutions, treatment guidelines, and adopting a policy for treatment adherence.
Are opportunistic captures of neonate ungulates biasing relative estimates of litter size?
Authors: Turnley Matthew T. , Larsen Randy T. , Hughes Tabitha A. , Hinton Morgan S. , Sallee Daniel W. , Lamb Sydney , Hersey Kent R. , McMillan Brock R.
Published: December 2022

The capture of neonate ungulates allows for the collection of valuable ecological data, including estimates of litter size. However, varied methods used to capture neonate ungulates can result in sampling biases. Our objective was to determine if opportunistic captures of neonate ungulates (i.e., locating neonates by visually scanning for adult females displaying postpartum behaviors) bias relative estimates of litter size and investigate potential causes if a bias does exist. We analyzed data from 161 litters of mule deer (Odocoileus hemionus) sampled using three different capture methods during 2019–2021 in Utah, USA. Estimates of litter size derived from opportunistic captures were smaller than estimates derived from movement-based captures or captures completed with the aid of vaginal implant transmitters (VITs). Age at capture was inversely related to estimates of litter size and likely influenced the detection bias associated with opportunistic captures. Neonates captured opportunistically were not older than neonates captured using movement-based methods, but were older than neonates captured with the aid of VITs. Distance between neonates from the same litter did not influence estimates of litter size. Researchers should be aware of the biases associated with different capture methods and use caution when interpreting data among multiple capture methods. Estimates of litter size derived from opportunistic captures should not be compared to estimates of litter size derived from alternative capture methods without accounting for the detection bias we observed.
A comparison of three approaches to covariate effects on latent factors
Authors: Wang Ze
Published: December 2022

In educational and psychological research, it is common to use latent factors to represent constructs and then to examine covariate effects on these latent factors. Using empirical data, this study applied three approaches to covariate effects on latent factors: the multiple-indicator multiple-cause (MIMIC) approach, multiple group confirmatory factor analysis (MG-CFA) approach, and the structural equation model trees (SEM Trees) approach. The MIMIC approach directly models covariate effects on latent factors. The MG-CFA approach allows testing of measurement invariance before latent factor means could be compared. The more recently developed SEM Trees approach partitions the sample into homogenous subsets based on the covariate space; model parameters are estimated separately for each subgroup. We applied the three approaches using an empirical dataset extracted from the eighth-grade U.S. data from the Trends in International Mathematics and Science Study 2019 database. All approaches suggested differences among mathematics achievement categories for the latent factor of mathematics self-concept. In addition, language spoken at home did not seem to affect students’ mathematics self-concept. Despite these general findings, the three approaches provided different pieces of information regarding covariate effects. For all models, we appropriately considered the complex data structure and sampling weights following recent recommendations for analyzing large-scale assessment data.