bluuebunny/crossref_metadata_2025 huggingface dataset:
Opportunities and challenges of computer aided diagnosis in new millennium: A bibliometric analysis from 2000 to 2023
Authors: Wu Di , Ni Jiachun , Fan Wenbin , Jiang Qiong , Wang Ling , Sun Li , Cai Zengjin
Published: December 2023

Background:

After entering the new millennium, computer-aided diagnosis (CAD) is rapidly developing as an emerging technology worldwide. Expanding the spectrum of CAD-related diseases is a possible future research trend. Nevertheless, bibliometric studies in this area have not yet been reported. This study aimed to explore the hotspots and frontiers of research on CAD from 2000 to 2023, which may provide a reference for researchers in this field.

Methods:

In this paper, we use bibliometrics to analyze CAD-related literature in the Web of Science database between 2000 and 2023. The scientometric softwares VOSviewer and CiteSpace were used to visually analyze the countries, institutions, authors, journals, references and keywords involved in the literature. Keywords burst analysis were utilized to further explore the current state and development trends of research on CAD.

Results:

A total of 13,970 publications were included in this study, with a noticeably rising annual publication trend. China and the United States are major contributors to the publication, with the United States being the dominant position in CAD research. The American research institutions, lead by the University of Chicago, are pioneers of CAD. Acharya UR, Zheng B and Chan HP are the most prolific authors. Institute of Electrical and Electronics Engineers Transactions on Medical Imaging focuses on CAD and publishes the most articles. New computer technologies related to CAD are in the forefront of attention. Currently, CAD is used extensively in breast diseases, pulmonary diseases and brain diseases.

Conclusion:

Expanding the spectrum of CAD-related diseases is a possible future research trend. How to overcome the lack of large sample datasets and establish a universally accepted standard for the evaluation of CAD system performance are urgent issues for CAD development and validation. In conclusion, this paper provides valuable information on the current state of CAD research and future developments.
The experiences of adjuvant endocrine therapy for women breast cancer survivors: A literature review
Authors: Long Yaoyao , Xie Shaoju , Liu Qinghua , Xu Fan , Li Qiao , Wang Na , Zhang Youcai
Published: December 2023

Introduction:

Adjuvant endocrine therapy (AET) is commonly recommended for non-metastatic breast cancer survivors. However, the side-effects associated with AET can have a negative impact on survivors’ functional status and quality of life. Understanding the factors influencing adherence to AET is crucial in improving its utilization among female breast cancer survivors.

Conclusions:

This literature review critically evaluated 15 articles to explore the experiences of female breast cancer survivors in adhering to and persisting with AET. The findings highlight that while AET can cause drug side-effects, the involvement of healthcare professionals (HCP) plays a significant role in facilitating better use of AET. Unfortunately, many HCP fail to discuss vital information related to AET or provide guidance on managing side-effects and daily medication. Consequently, survivors often lack guidance in these areas. Despite experiencing discomfort, survivors maintain a positive attitude towards using AET and employ self-management strategies and social networks to overcome barriers. The impact of HCP on AET adherence among female breast cancer survivors is substantial. Future research should focus on understanding perspectives that promote HCP involvement, which will inform practical intervention strategies in clinical practice.
Single-plate versus double-plate comparison in the surgical treatment of comminuted clavicle fractures: Is the secondary plate reliable?
Authors: Yurteri Ahmet , Mercan Numan , Gem Kadir , Bilgiç Abdulkadir , Kiliç Mehmet , Doğar Fatih
Published: December 2023

The objective of this study is to retrospectively assess the use of single-plate (SP) and double-plate (DP) fixation in the open reduction and internal fixation of comminuted clavicle fractures, focusing on fracture union and complications. We retrospectively evaluated comminuted diaphyseal clavicle fractures (Arbeitsgemeinschaft für Osteosynthesefragen type 15.B1-3) treated with open reduction and internal fixation and having a minimum 1-year follow-up. Two patient cohorts were identified: DP (utilizing a superiorly located clavicle-specific plate and an anteriorly located tubular plate) and SP (utilizing a superiorly located clavicle-specific plate). These groups were compared in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, Disabilities of Arm, Shoulder and Hand (DASH), and American Shoulder and Elbow Surgeons (ASES) scores. The study included 27 SP and 23 DP patients meeting the inclusion criteria. There was no significant difference between the 2 cohorts in terms of union time, peri-incisional numbness, implant irritation, return to work time, union rates, re-operation rates, DASH, and ASES scores at the end of the first year (P = .889, P = 1.00, P = .122, P = 1.00, P = 1.00, P = .493, P = .736, P = .762, P = .937 respectively). However, it was observed that the DP group showed a significantly earlier return to work time and better DASH scores at 3rd and 6th months, whereas the SP group exhibited significantly better ASES scores at 3rd and 6th months (P = .034, P = .016, P = .032, P = .036, P = .021, respectively). No significant difference was observed in terms of union and complications in acute clavicle fractures treated with SP and DP fixation. The DP group demonstrated an earlier return to work and superior early functional scores compared to the SP group. Our findings suggest that a secondary plate can be reliably used, particularly in situations where clavicle fracture fixation is insufficient or in cases of comminuted clavicle fractures.
Renal angina index in critically ill children as an applicable and reliable tool in the prediction of severe acute kidney injury: Two tertiary centers’ prospective observational study from the Middle East
Authors: Soliman Ahmed S.A. , Al-Ghamdi Hamdan S. , Abukhatwah Mohamed W. , Kamal Nagla M. , Dabour Shaheen A. , Elgendy Soha A. , Alfaifi Jaber , Abukhatwah Omar M.W. , Abosabie Salma A.S. , Abosabie Sara A. , Oshi Mohammed A.M. , Althobaity Jwaher , Sakr Sherbiny Hanan , Al-Juaid Futun A. , Rahman Eman G. Abdel
Published: December 2023

Acute kidney damage (AKI) is a common cause of pediatric intensive care unit (PICU) admissions. Implementing a reno-protective strategy for AKI prediction can significantly enhance outcomes. The renal angina index (RAI) is a risk stratification tool used to predict severe AKI. We aim to assess the reliability and accuracy of the RAI scoring system in predicting AKI as compared to other conventional AKI markers. A prospective, observational study was conducted in the PICU of 2 tertiary medical centers in the Middle East. A total of 446 patients, aged 1-month to 14-years, without chronic kidney disease were enrolled. The RAI was calculated using the renal risk and renal injury score within the first 8 to 12 hours of admission. The accuracy of RAI was compared to changes in serum creatinine from baseline. The outcome was assessed on Day 3 for presence of AKI according to the kidney disease improving global outcome (KDIGO) criteria and associated sequelae. A positive RAI (RA+) was defined as RAI readings ≥ 8. Among the patients, 89 (19.9%) had a positive RAI within the first 8 to 12 hours of admission. The RA + group had a significantly higher occurrence of Day 3 severe AKI (KDIGO stages 2&3) compared to the RA− group (60.6% vs 4.2%, P < .001). The RA + group also had a significantly higher utilization of renal replacement therapy (RRT) (21.3% vs 1.1%, P < .001), longer mean PICU length of stay in days (11.1 ± 3.5 vs 5.5 ± 2.1, P < .001), and increased mortality (31.4% vs 2.8%, P < .001) compared to the RA− group. The RAI score demonstrated superior predictive ability for Day 3 AKI, with a sensitivity of 72%, specificity of 95%, and area under the curve (AUC) of 0.837, compared to changes in serum creatinine from baseline (sensitivity: 65%, specificity: 89%, AUC: 0.773), fluid overload (sensitivity: 43.7%, specificity: 79%, AUC: 0.613), and illness severity scores (sensitivity: 52.4%, specificity: 80.5%, AUC: 0.657). RAI proved to be a reliable and rapid bedside test for identifying critically ill children at risk of developing severe AKI. This enables physicians to implement reno-protective measures and intervene early, thereby improving prognosis.
Advanced HIV disease in Homa Bay County, Kenya: Characteristics of newly-diagnosed and antiretroviral therapy-experienced clients
Authors: Masaba Rose Otieno , Herrera Nicole , Siamba Stephen , Ouma Millicent , Okal Corneleous , Mayi Allan , Kose Judith , Ndimbii James , Ochanda Boniface , Mwangi Eliud , Okomo Gordon , Woelk Godfrey
Published: December 2023

Advanced HIV disease (AHD) remains a significant burden, despite the widespread use of antiretroviral therapy (ART) programs. Individuals with AHD are at a high risk of death even after starting ART. We characterized treatment naïve and treatment experienced clients presenting with AHD in western Kenya to inform service delivery and program improvement. We conducted a retrospective study using routinely collected program data from October 2016 to September 2019 for AHD clients in eight facilities in Homa Bay County, Kenya. Demographic and clinical data were abstracted from the medical records of AHD clients, defined as HIV-positive clients aged ≥ 5 years with documented CD4 count < 200 cells/mm3 and/or WHO clinical stage II/IV. Associations were assessed using Pearson’s chi-square and Mann–Whitney Rank-Sum tests at 5% level of significance. Of the 19,427 HIV clients at the eight facilities, 6649 (34%) had a CD4 count < 200 cells/mm3 or a WHO III/IV stage. Of these, 1845 were randomly selected for analysis. Over half (991) of participants were aged 45 + years and 1040 (56%) were female. The median age was 46.0 years (interquartile range: 39.2–54.5); 1553 (84%) were in care at county and sub-county hospitals; and 1460 (79%) were WHO stage III/IV at enrollment. At ART initiation, 241 (13%) had tuberculosis, 192 (10%) had chronic diarrhea, and 94 (5%) had Pneumocystis jiroveci pneumonia. At the time of data collection, 89 (5%) participants had died and 140 (8%) were lost to follow-up. Eighteen percent (330) of participants were ART-experienced (on ART for ≥ 3 months). The proportions of ART-experienced and -naïve clients regarding age, sex and marital status were similar. However, a higher proportion of ART-experienced clients received care at primary care facilities, (93(28%) vs. 199 (13%); P < .001); were WHO stage 3/4 at AHD diagnosis, 273 (84%) vs. 1187 (79%) (P = .041); and had died or been LTFU, (124 (38%) vs. 105 (7%); P < .001). With increasing prevalence of patients on ART, the proportion of AHD treatment-experienced clients may increase without effective interventions to ensure that these patients remain in care.
Maternal and neonatal consequences of cystocele and rectocele in the delivery process
Authors: Başkiran Yusuf , Uçkan Kazim , Çeleğen İzzet , Tanoğlu Fatma Başak
Published: December 2023

The study aimed to investigate the effects of cystocele and rectocele on the stages of vaginal birth and maternal and newborn outcomes. A total of 672 multiparous pregnant women between the ages of 18 to 40 who underwent normal vaginal delivery in our tertiary center between November 2022 and February 2023, were included in this prospective study. Among the participants, 348 (51.8%) had no abnormalities, 78 (11.6%) had rectocele only, 112 (16.7%) had cystocele only, and 134 (19.9) had both cystocele and rectocele. Patients with the coexistence of cystocele and rectocele experienced a notably extended duration for both the first stage and second stage of labor, although the extension in the second stage was not statistically significant. Among the maternal complications, the development of maternal laceration and chorioamnionitis was significantly more common in the patient group with cystocele and rectocele compared to the other groups. When the groups were assessed for postpartum bleeding, while the bleeding risk increased from the normal group to the rectocele + cystocele group, this increase was not statistically significant. There was no difference between the groups in terms of neonatal outcomes. The delivery time of pregnant women with cystocele and rectocele, in the absence of additional risk factors, was determined to be significantly longer than that of the control group. We think that these patients should receive more vigilant monitoring, and this criterion should be kept in mind when assessing the indication for a cesarean section.
Unveiling the hidden clues: Döhle body-like inclusions as morphological markers for MYH9-related disorders: A case report
Authors: Zhang Yan , Zuo Zhongbao , Yu Wenyan , Xu Aifang
Published: December 2023

Rationale:

This study aimed to address the diagnostic challenges associated with MYH9-related disorders (MYH9-RDs) and highlight the importance of recognizing Döhle body-like inclusions as crucial diagnostic markers for this condition.

Patient concerns:

Patients with MYH9-RDs often present with mild and diverse clinical characteristics, leading to misdiagnosis, delayed diagnosis, and inappropriate treatments, such as hormonal therapy and splenectomy. This section highlights the significance of understanding atypical clinical presentations and their impact on patients’ well-being.

Diagnoses:

This section emphasizes the misdiagnosis of MYH9-RDs as immune thrombocytopenia due to overlapping clinical features. This highlights the need for a comprehensive approach, including detailed personal and family history, careful review of peripheral blood smears, and identification of Döhle body-like inclusions to differentiate MYH9-RDs from other conditions.

Intervention:

This study advocates for a shift in the diagnostic approach, urging physicians to pay closer attention to the morphological features observed in peripheral blood smears, particularly the presence of Döhle body-like inclusions and large platelets. This emphasizes the importance of avoiding unnecessary diagnostic studies through effective utilization of this simple and reliable method.

Outcomes:

By adopting a comprehensive approach that combines gene sequencing with morphological analysis, an accurate diagnosis of MYH9-RDs can be achieved. Early identification of MYH9-RDs allows for appropriate management strategies, genetic counseling, and prevention of complications associated with the condition.

Lessons:

This section highlights the lessons learned from this study, emphasizing the need for increased awareness among healthcare professionals about MYH9-RDs and the importance of incorporating peripheral blood smear evaluations into the diagnostic process. This emphasizes the significance of accurate diagnosis to prevent unnecessary treatments and ensure appropriate patient care.
Progress in treatment of facial neuritis by acupuncture combined with medicine from the perspective of modern medicine: A review
Authors: Cao Qingxi , Qi Biao , Zhai Lingyan
Published: December 2023

Facial neuritis is a common clinical disease with high incidence, also known as Bell palsy or idiopathic facial nerve paralysis, which is an acute onset of peripheral facial neuropathy. In modern medicine, there have been obstacles to the effective treatment of facial neuritis. At present, the clinical use of Western medicine treatment is also a summary of clinical experience, the reason is that the cause of facial neuritis is unknown. Facial neuritis belongs to the category of “facial paralysis” in traditional Chinese medicine. For thousands of years, Chinese medicine has accumulated a lot of relevant treatment experience in the process of diagnosis and treatment. At the same time, traditional Chinese medicine, acupuncture and the combination of acupuncture and medicine play an important role in the treatment of facial neuritis. This article discusses the treatment of facial neuritis with acupuncture combined with Chinese medicine, based on the research progress of modern medicine. In this review, we provide an overview of the effectiveness of acupuncture and medication combinations and facial neuritis with current studies investigating acupuncture and medication combinations in the treatment of facial neuritis.
Development and validation of an artificial intelligence algorithm for detecting vocal cords in video laryngoscopy
Authors: Kim Dae Kon , Kim Byeong Soo , Kim Yu Jin , Kim Sungwan , Yoon Dan , Lee Dong Keon , Jeong Joo , Jo You Hwan
Published: December 2023

Airway procedures in life-threatening situations are vital for saving lives. Video laryngoscopy (VL) is commonly performed during endotracheal intubation (ETI) in the emergency department. Artificial intelligence (AI) is widely used in the medical field, particularly to detect anatomical structures. This study aimed to develop an AI algorithm that detects vocal cords from VL images acquired during emergent situations. This retrospective study used VL images acquired in the emergency department to facilitate the ETI. The vocal cord image was labeled with a ground-truth bounding box. The dataset was divided into training and validation datasets. The algorithm was developed from a training dataset using the YOLOv4 model. The performance of the algorithm was evaluated using a test set. The test set was further divided into specific environments during the ETI for clinical subgroup analysis. In total, 20,161 images from 84 patients were used in this study. A total of 10,287, 5766, and 4108 images were used for the model training, validation, and test sets, respectively. The developed algorithm achieved F1 score 0.906, sensitivity 0.963, and specificity 0.842 in the validation set. The performance in the test set was F1 score 0.808, sensitivity 0.823, and specificity 0.804. We developed and validated an AI algorithm to detect vocal cords in VL. This algorithm demonstrated a high performance. The algorithm can be used to determine the vocal cord to ensure safe ETI.
Knowledge, attitude and practices towards surgical wound care and healing among the public in the Jazan Region, Saudi Arabia
Authors: Mashbari Hassan , Hamdi Sulaiman , Darraj Hussam , Awaf Mohammed , Zaalah Shaden , Hakami Faisal , Hakami Khalid M. , Alhazmi Essam , Al khairat Layla , Hakami Shatha A. , Aburasain Amani , Hakami Ibrahim Ali I. , Arishi Abdulaziz A.
Published: December 2023

The purpose of this research was to evaluate how much the people in the Jazan region know about the care and healing of surgical wounds. Proper care of surgical wounds is very important to achieve the best treatment outcomes and to avoid negative consequences. However, factors like obesity, diabetes, and certain medications can impair wound healing, with surgical site infections being a major problem in the healthcare system. Therefore, this study aimed to determine public awareness and perceptions of surgical wound care to help improve education and raise awareness of the importance of proper wound care for better results. We run an observational cross-sectional study among adults above 18 years in the Jazan region. An online self-administered questionnaire was used in the collection of data. Simple random sampling was the used technique and 384 participants were calculated. The study used Statistical Package for the Social Sciences (SPSS) for data analysis and employed descriptive statistics, independent t test, Analysis of Variance (ANOVA), Pearson’s correlation, and multivariate logistic regression to identify factors associated with knowledge of surgical site infection and wound care. This study analyzed 599 participants’ knowledge, attitude, and practice about surgical site infection and wound management. While participants had a strong general understanding of surgical wounds, only 17% had a high degree of knowledge about surgical site infection and wound management. Medical students had the highest degree of knowledge, and being a medical student was the only significant predictor of having a high level of knowledge about surgical site infection (SSI) and wound care. The study emphasizes the necessity of enhanced patient education and investment in medical education quality. The participants in this study had high overall knowledge regarding surgical wounds but lacked particular knowledge concerning surgical site infection and wound management. Medical education was discovered to be a strong predictor of having a high level of knowledge about surgical site infection and wound management. Healthcare professionals should take the lead in giving accurate and reliable information regarding wound care techniques to patients, and legislators should invest in enhancing medical education quality.
P4HA1 expression and function in esophageal squamous cell carcinoma
Authors: Gou Wenbin , Song Beiwen , Yang Yongqiang
Published: December 2023

This study aimed to explore the effect of P4HA1 (prolyl 4-hydroxylase subunit α1) and its ratio on the prognosis of esophageal squamous cell carcinoma. The expression data of P4HA1 in esophageal cancer in The Cancer Genome Atlas and Genotype-Tissue Expression were collected using the public database gene expression profiling interactive analysis. The expression levels of P4HA1 were examined by immunohistochemistry. The relationship between P4HA1 expression and clinicopathological parameters was analyzed the χ2 test. Survival analysis was performed to investigate the effect of P4HA1 and its ratio on prognosis. Compared with normal esophageal mucosal epithelium, there was higher P4HA1 gene mRNA in esophageal cancer tissue. Regarding the expression level, no significant difference was observed in patients with stage I–IV esophageal cancer. Immunohistochemistry showed that P4HA1 was highly expressed in esophageal squamous cell carcinoma (68.7%), while it was negatively expressed in paracancerous tissues. There was a significant difference in expression between cancer and adjacent tissues. The expression of P4HA1 associated with the degree of tumor differentiation, site, lymph node metastasis, and tumor node metastasis stage. The prognostic factors that affected the OS (overall survival) of esophageal cancer patients were the degree of differentiation, lymph node metastasis, and P4HA1 expression. Multivariate analysis of the OS results of patients showed that lymph node metastases and P4HA1 expression were independent prognostic factors that affected the OS of esophageal cancer patients. The prognostic factors affecting the PFS (progression-free survival) of esophageal cancer patients in the univariate survival analysis were as follows: degree of differentiation, lymph node metastasis, and P4HA1 expression. In addition, multivariate analysis of the PFS results of patients showed that lymph node metastasis and P4HA1 expression were independent prognostic factors that affected the PFS of esophageal cancer patients. P4HA1 may be a novel potential biomarker for the early diagnosis, prognosis, and targeted therapy of esophageal cancer.
The performance of hepatitis B surface antigen quantification as a noninvasive biomarker predicting liver injury and serum hepatitis B virus DNA level
Authors: Abdullayeva Madina , Çelik Muammer , Kuruüzüm Ziya
Published: December 2023

Objectives

Chronic hepatitis B (CHB) is still a major public health problem worldwide. Recently, evidence indicating that serum hepatitis B surface antigen (HBsAg) quantification can be used for monitorization of hepatitis B virus (HBV) infection has been increased. In this study, we evaluated HBsAg levels during the natural course of CHB and identified correlations between HBsAg, HBV DNA levels and liver histopathology.

Methods

From 6 August 2016 to 7 June 2017, naive patients, who are ≥18 years old, fulfilled the criteria for the diagnosis of CHB and had a liver biopsy within a year before or after admission, were included. HBsAg levels in serum samples were investigated by electrochemiluminescence immunoassay. Results were correlated with serum HBV DNA levels, histologic activity index (HAI) and fibrosis scores.

Results

In this study 66 patients were included. There was a moderate and significant correlation between HBsAg levels and fibrosis scores (r = 0.386, P = 0.001), but no correlation with HAI. Serum HBsAg levels showed a positive, strong and significant (r = 0.740, P < 0.001) correlation with HBV DNA levels. In hepatitis B e antigen-negative patients, serum HBsAg levels were perfectly correlated with HBV DNA levels (r = 0.992, P < 0.001) and moderately correlated with fibrosis scores (r = 0.360, P = 0.006).

Conclusion

We found a positive correlation between serum HBsAg levels and the severity of fibrosis scores and serum HBV DNA levels. These findings suggest that serum HBsAg quantification might be a useful noninvasive diagnostic test for the prediction of fibrosis severity and HBV DNA level.
Effectiveness and prognosis of covered stents with different diameters in transjugular intrahepatic portosystemic shunt: a meta-analysis
Authors: Gong Jiahong , Xia Ziqin , Zhou Zhidai , Chen Liping , Wang Xiaobing , Zhou Feng
Published: December 2023

Purpose

This meta-analysis was designed to evaluate the clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) conducted utilizing stents of different diameters, thus providing recommendations for more logical selections of covered stents for patients with portal hypertension, in particular for the Asian population.

Materials and methods

Web of Science, PubMed, Embase, Cochrane Library, Chinese National Knowledge Infrastructure and Wan Fang were searched for randomized controlled trials and cohort studies from inception until February 2023. The meta-analysis was carried out using Revman 5.4 Software. Heterogeneity between researches was assessed by the χ
2 test and I
2 index. The outcomes evaluated were the incidence of post-TIPS hepatic encephalopathy (HE), variceal rebleeding, shunt dysfunction, 1-year overall survival and decrease in portal pressure gradient (PPG).

Results

Eight appropriate clinical trials with 1246 patients were selected (638 and 608 patients in the experimental and control groups, respectively). In regards to preoperative PPG reduction, there was no discernible difference between the two groups [mean difference = 1.15, 95% confidence interval (CI) = −0.29–2.58, P = 0.12]. The rate of post-TIPS HE was significantly higher in patients in the 8 mm stent group than in the 6–7 mm stent group [odds ratio (OR) = 0.54, 95% CI = 0.42–0.70, P < 0.00001, I
2 = 46%]. There were no significant differences in the rates of variceal rebleeding (OR = 1.05, 95% CI = 0.67–1.65, P = 0.84, I
2 = 0%), shunt dysfunction (OR = 0.88, 95% CI = 0.53–1.47, P = 0.64, I
2 = 0%) and 1-year overall survival (OR = 0.86, 95% CI = 0.50–1.50, P = 0.61, I
2 = 0%).

Conclusion

Asian populations with portal hypertension may benefit more from TIPS with 6–7 mm covered stents because they can reduce the risk of postoperative HE while offering similar efficacy when compared to 8 mm covered stents.
Age-related micro-environmental changes as drivers of clonal hematopoiesis
Authors: Bacharach Tal , Kaushansky Nathali , Shlush Liran I.
Published: December 2023

Purpose of review

Both aging and reduced diversity at the hematopoietic stem cells (HSCs) level are ubiquitous. What remains unclear is why some individuals develop clonal hematopoiesis (CH), and why does CH due to specific mutations occur in specific individuals. Much like aging, reduced diversity of HSCs is a complex phenotype shaped by numerous factors (germline & environment). The purpose of the current review is to discuss the role of two other age-related ubiquitous processes that might contribute to the dynamics and characteristics of losing HSC diversity and the evolution of CH. These processes have not been reviewed in depth so far and include the accumulation of fatty bone marrow (FBM), and the decline in sex hormones.

Recent findings

Interestingly, sex hormone decline can directly shape HSC function, but also reshape the delicate balance of BM supporting cells, with a shift towards FBM. FBM accumulation can shape the clonal expansion of preleukemic mutations, particularly DNMT3A mutations, through IL-6 mediation. DNMT3A mutations are one of the only preleukemic mutations which is more prevalent in women, and especially in women with early menopause, demonstrating an association between age-related hormone decline and CH evolution, the mechanisms of which are yet to be discovered.

Aging is a multifactorial phenotype and the same is true for the aging of the blood system. While many factors which can shape CH have been discussed, we shed more light on FBM and sex hormone decline. Much more is missing: how and should we even try to prevent these phenomena? Why do they occur? and how they are connected to other age-related blood factors?
Brief Report: The Role of Substance Use in Structural Heart Disease Among Women Living With HIV
Authors: Riley Elise D. , Vittinghoff Eric , Ravi Akshay , Coffin Phillip O. , Lynch Kara L. , Wu Alan H. B. , Martinez Claudia , Hsue Priscilla Y.
Published: December 2023

Background:

People living with HIV have increased risk of cardiovascular disease, but few studies focus on women with HIV (WWH) and few account for the use of multiple substances.

Setting:

We recruited WWH from San Francisco shelters, free meal programs, street encampments, and a safety net HIV clinic.

Methods:

Between 2016 and 2019, participants completed 6 monthly interviews, specimen collection, and a transthoracic echocardiogram. We assessed associations between 3 echocardiographic indices of cardiac hypertrophy (concentric hypertrophy, concentric remodeling, and eccentric hypertrophy) and study factors, including cardiovascular risk factors, substance use, and HIV-specific factors (CD4+ count, viral load, HIV medication).

Results:

Among 62 participants, the average age was 53 years and 70% were ethnic minority women. Just over 70% had elevated blood pressure. Toxicology-confirmed substance use included tobacco (63%), cannabis (52%), cocaine (51%), methamphetamine (29%), and alcohol (26%). Concentric hypertrophy was detected in 26% of participants. It was positively associated with cocaine use [adjusted relative risk (aRR) = 32.5, P < 0.01] and negatively associated with cannabis use (aRR = 0.07, P < 0.01). Concentric remodeling was detected in 40% of participants. It was positively associated with cocaine use (aRR = 11.2, P < 0.01) and negatively associated with cannabis use (aRR = 0.17, P = 0.02). Eccentric hypertrophy was not significantly associated with factors studied here.

Conclusions:

Routine evaluation of stimulant use as a contributing factor to cardiovascular risk may improve risk assessment in WWH. Whether cannabis use mitigates the impact of cocaine use on structural heart disease among WWH merits further investigation.
Intimate Partner Violence and Adherence to PrEP and ART Among Ugandan HIV Serodifferent Couples
Authors: Thomas Dorothy , Nakabugo Lylianne , Nambi Florence , Kibuuka Joseph , Muwonge Timothy R. , Feutz Erika , Thomas Katherine K. , Simoni Jane M. , Montgomery Elizabeth T. , Ware Norma , Wyatt Monique A. , Katz Ingrid T. , Kadama Herbert , Mujugira Andrew , Heffron Renee ,   for the Partners PrEP Program Team
Published: December 2023

Background:

Intimate partner violence (IPV) is associated with increased risk of HIV acquisition and reduced engagement in HIV care. There is limited understanding of the ways in which IPV exposure and other maladaptive relationship dynamics may influence adherence to antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) for individuals in committed, HIV serodifferent partnerships.

Methods:

We used binomial generalized linear mixed-effect regression models to evaluate the association between IPV exposure and ART/PrEP adherence among members of serodifferent couples in Uganda. Secondarily, we assessed the association between relationship powerlessness and ART/PrEP adherence.

Results:

We enrolled and followed both partners in 149 heterosexual serodifferent couples. The partner living with HIV was female in 64% of couples. IPV exposure was associated with low ART adherence (15% vs. 5% in quarters with no IPV, odds ratio: 4.78, 95% confidence interval: 1.48 to 15.42), but not low PrEP adherence (33% vs. 36%, P = 0.69). Among HIV-negative individuals, those reporting moderate relationship powerlessness were less likely to have poor PrEP adherence compared with those with low relationship powerlessness (20% vs. 30%, odds ratio: 0.57, 95% confidence interval: 0.36 to 0.90). We observed no association between relationship powerlessness and ART adherence.

Conclusions:

We found that IPV exposure was associated with low adherence to ART and that relationship powerlessness was associated with good adherence to PrEP. These findings contribute to the evidence base outlining the influence of IPV and relationship power on ART/PrEP adherence for individuals in HIV serodifferent unions.
Barriers and Facilitators to Long-Acting Injectable HIV Pre-Exposure Prophylaxis Implementation in Primary Care Since Its Approval in the United States
Authors: Keddem Shimrit , Thatipelli Sneha , Caceres Omaris , Roder Navid , Momplaisir Florence , Cronholm Peter
Published: December 2023

Background:

HIV pre-exposure prophylaxis (PrEP) is a highly effective method to mitigate the HIV epidemic, but uptake of PrEP has been slow and is associated with racial and gender disparities. Oral PrEP requires high levels of adherence to be effective, which may disadvantage certain high-risk groups. The first injectable HIV PrEP, a drug given every 2 months rather than as a daily pill, was approved by the US Food & Drug Administration in December 2021.

Setting:

A Family Medicine practice in a single health organization in the United States (November 2022 to February 2023).

Methods:

We conducted interviews with patients and key stakeholders to characterize factors affecting long-acting injectable (LAI) PrEP implementation. Data collection and analysis were guided by the Consolidated Framework for Implementation Research. Interviews were transcribed and analyzed using guided content analysis.

Results:

Twenty-five patients (n = 13) and practice stakeholders (n = 12) were interviewed. Overall, stakeholders described a very low uptake of LAI PrEP. Barriers to LAI PrEP included a lack of awareness, insurance and access issues, a lack of streamlined workflow, and a trust in pills over injectables. Facilitators to LAI PrEP implementation included the absence of a pill burden, a culture of shared decision making, and pharmacy support.

Conclusions:

Although uptake has been slow, we have identified several promising strategies for improving rollout and implementation of LAI PrEP. Approaches that can bolster rollout of LAI PrEP include having an interdisciplinary care team that is supported by PrEP navigators and pharmacists and are informed by a patient-centered model of care to increase patient engagement and trust.
Alcohol Consumption and Illicit Drug Use: Associations With Fall, Fracture, and Acute Health Care Utilization Among People With HIV Infection
Authors: Kim Theresa W. , Bertholet Nicolas , Magane Kara M. , Lloyd-Travaglini Christine , Winter Michael R. , Samet Jeffrey H. , Erlandson Kristine M. , Stein Michael D. , Bryant Kendall J. , Saitz Richard , Heeren Timothy C.
Published: December 2023

Background:

Given alcohol and/or other drug (AOD) use occurs among people with HIV (PWH), we examined its association with falls and fall-related outcomes and whether frailty moderates the association.

Setting:

Northeastern US city.

Methods:

We analyzed an observational cohort of PWH with current or past AOD use. Alcohol measures were any past 14-day heavy use, average alcohol/day, and days with heavy use. Drug use measures were past 30-day illicit use of cocaine, opioids, and sedatives. Repeated cross-sectional associations were estimated with separate multivariable generalized estimating equation regression models for each fall-related outcome.

Results:

Among PWH (n = 251; mean age 52 [SD = 10]), 35% reported heavy alcohol use, 24% cocaine, 16% illicit opioids, 13% illicit sedatives, and 35% any fall; 27% were frail. Heavy alcohol use was associated with a fall (AOR = 1.49, 95% CI: 1.08 to 2.07), multiple falls (AOR = 1.55 95% CI: 1.10 to 2.19), and fall/fracture–related emergency department visit or hospitalization (AOR = 1.81, 95% CI: 1.10 to 2.97). Higher average alcohol/day and more heavy drinking days were associated with multiple falls. Illicit sedative use was associated with a fall, multiple falls, and emergency department visit/hospitalization and opioid use with fracture. Frailty moderated the association of heavy alcohol use and a fall (AOR = 2.26, 95% CI: 1.28 to 4.01 in those frail) but not in those not frail.

Conclusion:

The effect of AOD use on falls and fall-related outcomes was most pronounced with alcohol, particularly among frail PWH. Heavy alcohol, illicit sedative, and illicit opioid use are high-priority targets for preventing falls and fall-related consequences for PWH.
Brief Report: Substance Use Care Continuum in Women With and Without HIV in the Southern United States
Authors: Ramakrishnan Aditi , Fujita Ayako W. , Mehta C. Christina , Wilson Tracey E. , Shoptaw Steve , Carrico Adam , Adimora Adaora A. , Eaton Ellen F. , Jones Deborah L. , Chandran Aruna , Sheth Anandi N.
Published: December 2023

Background:

Substance use (SU) contributes to poor outcomes among persons living with HIV. Women living with HIV (WWH) in the United States are disproportionately affected in the South, and examining SU patterns, treatment, and HIV outcomes in this population is integral to addressing HIV and SU disparities.

Methods:

WWH and comparable women without HIV (WWOH) who enrolled 2013–2015 in the Women's Interagency HIV Study Southern sites (Atlanta, Birmingham/Jackson, Chapel Hill, and Miami) and reported SU (self-reported nonmedical use of drugs) in the past year were included. SU and treatment were described annually from enrollment to the end of follow-up. HIV outcomes were compared by SU treatment engagement.

Results:

At enrollment, among 840 women (608 WWH, 232 WWOH), 18% (n = 155) reported SU in the past year (16% WWH, 24% WWOH); 25% (n = 38) of whom reported SU treatment. Over time, 30%, 21%, and 18% reported SU treatment at 1, 2, and 3 years, respectively, which did not significantly differ by HIV status. Retention in HIV care did not differ by SU treatment. Viral suppression was significantly higher in women who reported SU treatment only at enrollment (P = 0.03).

Conclusions:

We identified a substantial gap in SU treatment engagement, with only a quarter reporting treatment utilization, which persisted over time. SU treatment engagement was associated with viral suppression at enrollment but not at other time points or with retention in HIV care. These findings can identify gaps and guide future strategies for integrating HIV and SU care for WWH.
Cognitive Complaint Types Can Correlate With Cognitive Testing, Perceived Stress, and Symptom Distress in Older Adults With Normal Cognition and Dementia
Authors: Stites Shana D. , Lee Brian N. , Rubright Jonathan D. , Harkins Kristin , Mechanic-Hamilton Dawn
Published: December 2023

Objective:

We examined how cognitive complaint types (CCTs) correlate with cognitive testing, perceived stress, and symptom distress in older adults with normal cognition and dementia.

Methods:

Older adults (n = 259) with normal cognition, mild cognitive impairment, or mild-stage Alzheimer disease completed cognitive testing and self-report measures (Cognitive Difficulties Scale, Global Distress Index, Perceived Stress Scale). Cross-sectional analyses examined: (1) CCT composition by classification method,( 2) CCTs by diagnostic group, (3) correlations of CCTs with cognitive testing scores, and (4) correlations of CCTs with perceived stress and symptom distress.

Results:

CCTs derived from 2 classification approaches loaded onto 4 factors: memory, attention-concentration (AC), temporal orientation, and praxis. Memory contained complaints about both memory and executive functioning. AC contained both classifications of AC complaints. Complaints about AC (AC1 and AC2) differed by diagnostic group (all P < 0.05). One of 2 classifications of AC (AC1) complaints discerned between impaired and unimpaired long-delay memory scores (both P < 0.05). In multivariable analyses, that same classification of AC (AC1) complaints correlated with higher perceived stress (both P < 0.001) but not symptom distress (both P > 0.05).

Conclusion:

CCTs showed a factor structure that was mostly robust between classification methods; however, some content-divergent CCTs shared factors, suggesting construct overlap. Relatively slight variations in content altered how CCTs correlated with diagnostic groups, perceived stress, and symptom distress. Most CCTs did not discern between impaired and unimpaired cognitive test scores. Research is needed to better understand CCTs as clinical markers and targets of clinical interventions.
Mendelian randomization analysis identifies a causal effect of Streptococcus salivarius on DR mediating via the level of host fasting glucose
Authors: Li Jingjing , Zheng Gongwei , Jiang Dingping , Deng Chunyu , Zhang Yaru , Ma Yunlong , Su Jianzhong
Published: December 2023

Background

Diabetic retinopathy (DR) is one of leading causes of vision loss in adults with increasing prevalence worldwide. Increasing evidence has emphasized the importance of gut microbiome in the etiology and development of DR. However, the causal relationship between gut microbes and DR remains largely unknown.

Methods

To investigate the causal associations of DR with gut microbes and DR risk factors, we employed two-sample Mendelian Randomization (MR) analyses to estimate the causal effects of 207 gut microbes on DR outcomes. Inputs for MR included Genome-wide Association Study (GWAS) summary statistics of 207 taxa of gut microbes (the Dutch Microbiome Project) and 21 risk factors for DR. The GWAS summary statistics data of DR was from the FinnGen Research Project. Data analysis was performed in May 2023.

Results

We identified eight bacterial taxa that exhibited significant causal associations with DR (FDR < 0.05). Among them, genusCollinsellaand speciesCollinsella aerofacienswere associated with increased risk of DR, while the speciesBacteroides faecis,Burkholderiales bacterium_1_1_47,Ruminococcus torques, Streptococcus salivarius, genusBurkholderiales_noname, and familyBurkholderiales_nonameshowed protective effects against DR. Notably, we found that the causal effect of speciesStreptococcus salivariuson DR was mediated through the level of host fasting glucose, a well-established risk factor for DR.

Conclusions

Our results reveal that specific gut microbes may be causally linked to DR via mediating host metabolic risk factors, highlighting potential novel therapeutic or preventive targets for DR.
Risk of Atherosclerotic Cardiovascular Disease Hospitalizations after COPD Hospitalization among Older Adults
Authors: Mosher Christopher L. , Osazuwa-Peters Oyomoare L. , Nanna Michael G. , MacIntyre Neil R. , Que Loretta G. , Jones W. Schuyler , Palmer Scott M. , O’Brien Emily C.
Published: December 2023

BACKGROUND

Meta-analyses have suggested the risk of atherosclerotic cardiovascular disease (ASCVD) events is significantly higher after a chronic obstructive pulmonary disease (COPD) exacerbation. However, these studies have been limited to highly selected patient populations potentially not generalizable to the broader population of COPD.

METHODS

We assessed the risk of ASCVD hospitalizations after COPD hospitalization compared to before COPD hospitalization and identified patient factors associated with ASCVD hospitalizations after COPD hospitalization. This retrospective cohort study used claims data from 920,550 Medicare beneficiaries hospitalized for COPD from 2016-2019 in the US. The primary outcome was risk of a ASCVD hospitalization composite outcome (myocardial infarction, percutaneous coronary intervention, coronary artery by-pass graft surgery, stroke, or transient ischemic attack) in the 1 year after-COPD hospitalization relative to the 1 year before-COPD hospitalization. Time from discharge to a composite ASCVD hospitalization outcome was modeled using an extension of the Cox Proportional-Hazards model, the Anderson-Gill model with adjustment for patient characteristics. Additional analyses evaluated for interactions in subgroups and risk factors associated with the composite ASCVD hospitalization outcome.

RESULTS

Among 920,550 patients (mean age, 73 years) the hazard ratio estimate (HR; 95% CI) for the composite ASCVD hospitalization outcome after-COPD hospitalization vs before-COPD hospitalization was 0.99 (0.97, 1.02; p = 0.53) following adjustment. We observed 3 subgroups that were significantly associated with higher risk for ASCVD hospitalizations after COPD hospitalization: 76+ years old, women, COPD hospitalization severity. Among the 19 characteristics evaluated, 10 were significantly associated with higher risk of CVD events 1 year after COPD hospitalization with hyperlipidemia (2.78; 2.67, 2.90) and history of cardiovascular disease (1.77; 1.72 1.83) associated with the greatest risk.

CONCLUSION

Among Medicare beneficiaries hospitalized for COPD, the risk of ASCVD hospitalizations was not significantly increased after COPD-hospitalization relative to before-COPD hospitalization. Although, we identified age 76+ years old, female sex, and COPD hospitalization severity as high risk subgroups and 10 risk factors associated with increased risk of ASCVD events after-COPD hospitalization. Further research is needed to characterize the COPD exacerbation populations at highest ASCVD hospitalization risk.
Longitudinal changes in iron homeostasis in human experimental and clinical malaria
Authors: Woolley Stephen D. , Grigg Matthew J. , Marquart Louise , Gower Jeremy , Piera Kim , Nair Arya Sheela , Amante Fiona M. , Rajahram Giri S. , William Timothy , Frazer David M. , Chalon Stephan , McCarthy James S. , Anstey Nicholas M. , Barber Bridget E.
Published: December 2023

Background

The interaction between iron deficiency and malaria is incompletely understood. We evaluated longitudinal changes in iron homeostasis in volunteers enrolled in malaria volunteer infection studies (VIS) and in Malaysian patients with falciparum and vivax malaria.

Methods

We retrieved samples and associated data from 55 participants enrolled in malaria VIS, and 171 malaria patients and 30 healthy controls enrolled in clinical studies in Malaysia. Ferritin, hepcidin, erythropoietin, and soluble transferrin receptor (sTfR) were measured by ELISA.

Results

In the VIS, participants’ parasitaemia was correlated with baseline mean corpuscular volume (MCV), but not iron status (ferritin, hepcidin or sTfR). Ferritin, hepcidin and sTfR all increased during the VIS. Ferritin and hepcidin normalised by day 28, while sTfR remained elevated. In VIS participants, baseline iron status (ferritin) was associated with post-treatment increases in liver transaminase levels. In Malaysian malaria patients, hepcidin and ferritin were elevated on admission compared to healthy controls, while sTfR increased following admission. Hepcidin normalised by day 28; however, ferritin and sTfR both remained elevated 4 weeks following admission.

Conclusion

Our findings demonstrate that parasitaemia is associated with an individual’s MCV rather than iron status. The persistent elevation in sTfR 4 weeks post-infection in both malaria VIS and clinical malaria may reflect a causal link between malaria and iron deficiency.