bluuebunny/crossref_metadata_2025 huggingface dataset:
Inequity in exercise-based interventions for adults with rheumatoid arthritis: a systematic review
Authors: Jenkins Natalie , Jhundoo Nishita , Rainbow Philippa , Sheehan Katie Jane , Bearne Lindsay Mary
Published: January 2023

Objectives

This systematic review describes the extent to which PROGRESS-Plus equity factors were considered in the eligibility criteria of trials of exercise interventions for adults with RA.

Methods

Electronic databases were searched for published (Cinahl, Embase, Medline, Physiotherapy Evidence Database), unpublished (Opengrey) and registered ongoing (International Standard Randomized Controlled Trial Number registry) randomized controlled trials (RCTs) of exercise interventions for adults with RA. Two authors independently performed study selection and quality assessment (Cochrane risk of bias tool).

Results

A total of 9696 records were identified. After screening, 50 trials were included. All trials had either some concerns or high risk of bias and reported at least one PROGRESS-Plus equity factor within the eligibility criteria; this included place of residence, personal characteristics (age and disability), language, sex, social capital, time-dependent factors or features of relationship factors. Where reported, this equated to exclusion of 457 of 1337 potential participants (34%) based on equity factors.

Conclusion

This review identified the exclusion of potential participants within exercise-based interventions for people with RA based on equity factors that might affect health-care opportunities and outcomes. This limits the generalizability of results, and yet this evidence is used to inform management and service design. Trials need to optimize participation, particularly for people with cardiovascular conditions, older adults and those with cognitive impairments. Reasons for exclusions need to be justified. Further research needs to address health inequalities to improve treatment accessibility and the generalizability of research findings.

PROSPERO registration

CRD42021260941.
The behavioural epidemiology of sedentary behaviour in inflammatory arthritis: where are we, and where do we need to go?
Authors: Fenton Sally A M , O’Brien Ciara M , Kitas George D , Duda Joan L , Veldhuijzen van Zanten Jet J C S , Metsios George S
Published: January 2023

In the last decade, studies into sedentary behaviour in inflammatory arthritis have raised important questions regarding its role in this condition. Specifically, evidence is needed on whether sedentary behaviour might exacerbate adverse inflammatory arthritis outcomes, and whether reducing sedentary behaviour might offer an effective avenue for self-management in this population. Research exploring these important research questions is still very much in its infancy and lacks the direction and scientific rigour required to inform effective intervention design, delivery and evaluation. Behavioural epidemiology refers to research that aims explicitly to understand and influence health behaviour patterns to prevent disease and improve health. To this end, the Behavioural Epidemiology Framework specifies a focused approach to health behaviour research, which leads to the development of evidence-based interventions directed at specific populations. In this review, we introduce the Behavioural Epidemiology Framework in the context of research into sedentary behaviour in inflammatory arthritis and ask: where are we, and where do we need to go?
Quality standards for the care of people with giant cell arteritis in secondary care
Authors: Coath Fiona L , Bukhari Marwan , Ducker Georgina , Griffiths Bridget , Hamdulay Shahir , Hingorani Melanie , Horsburgh Candy , Jones Colin , Lanyon Peter , Mackie Sarah , Mollan Susan , Mooney Janice , Nair Jagdish , Patil Ajay , Robson Joanna , Saravanan Vadivelu , O’Sullivan Eoin P , Whitlock Madeline , Mukhtyar Chetan B
Published: January 2023

Objective

GCA is the commonest primary systemic vasculitis in adults, with significant health economic costs and societal burden. There is wide variation in access to secondary care GCA services, with 34% of hospitals in England not having any formal clinical pathway. Quality standards provide levers for change to improve services.

Methods

The multidisciplinary steering committee were asked to anonymously put forward up to five aspects of service essential for best practice. Responses were qualitatively analysed to identify common themes, subsequently condensed into domain headings, and ranked in order of importance. Quality standards and metrics for each domain were drafted, requiring a minimum 75% agreement.

Results

13 themes were identified from the initial suggestions. Nine quality standards with auditable metrics were developed from the top 10 themes. Patient Access, glucocorticoid use, pathways, ultrasonography, temporal artery biopsy, PET scan access, rheumatology/ophthalmology expertise, education, multidisciplinary working have all been covered in these quality standards. Access to care is a strand that has run through each of the developed standards. An audit tool was developed as part of this exercise.

Conclusion

These are the first consensus auditable quality standards developed by clinicians from rheumatology and ophthalmology, nursing representatives and involvement of a patient charity. We hope that these standards will be adopted by commissioning bodies to provide levers for change from the improvement of patient care of individuals with GCA.
Predictors of long-term functional outcomes of juvenile idiopathic arthritis–enthesitis-related arthritis: a single centre experience
Authors: Ravichandran Naveen , Guleria Shivika , Mohindra Namita , Aggarwal Amita
Published: January 2023

Objectives

Long-term functional outcomes in enthesitis-related arthritis (ERA) is limited from developing countries. We assessed the clinical and genetic factors that predicted the long-term functional outcome in ERA.

Methods

Patients with ERA having ≥5 years of disease and >16 years of age were included in this cross-sectional study. Data on clinical features within 6 months of disease onset was collected from hospital records. Bath indices, HAQ Disability Index (HAQ-DI) and World Health Organization’s Quality of Life (WHO-QOL) were assessed at last visit. Poor functional outcome (PFO) was defined as BASFI > 1.5 or HAQ-DI > 1. Persistent disease activity (PDA) was defined as BASDAI ≥ 4. Endoplasmic reticulum aminopeptidase 1 (ERAP1) and IL-23 receptor single nucleotide polymorphism genotyping was performed with the TaqMan method and HLA-B27 by PCR.

Results

One hundred and eighty-one patients [170 male, median (interquartile range) age of disease onset 12.5 (10–15) years, disease duration 7 (5–11) years] were recruited. There was a delay in diagnosis of 3 (1–5) years. The median Ankylosing Spondylitis Disease Activity Score (ASDAS)-ESR, BASDAI, HAQ-DI and BASFI at inclusion were 2.6 (1.8–3.6), 2.6 (1–5.2), 0.5 (0–0.5) and 1.6 (0.3–3.2), respectively. BASFI and HAQ-DI correlated with ASDAS-ESR, ASDAS-CRP and WHO-QOL-BREF. Those with PFO (n = 98) had a longer delay in diagnosis (4 vs 2 years, P < 0.001), lower prevalence of arthritis at onset [odds ratio (OR) = 0.3; 95% CI: 0.1, 0.8], higher prevalence of ERAP1 (rs27044) allele C (OR = 7.2; 95% CI: 1.5, 33.7) and higher disease activity currently. Delay in diagnosis (OR = 1.2; 95% CI: 1.08, 1.4) was the sole predictor of PFO in multivariate analysis. One-third of patients had PDA. Tarsitis at disease onset was the sole predictor of PDA (OR = 2.3; 95% CI: 1.009, 5.4).

Conclusions

PFO was seen in one-half of JIA-ERA in the long-term and was associated with active disease with delay in diagnosis as its sole predictor.
Compounded sulfamethoxazole improved the prognosis of dermatomyositis patients positive with anti-melanoma differentiation-associated gene 5
Authors: Liu Lijun , Zhang Yinli , Liu Shengyun , Wang Cong , Zhang Lei , Guan Wenjuan , Zhang Xin , Li Wei , Shu Xiaoming , Li Tianfang
Published: January 2023

Objectives

Mortality of dermatomyositis patients positive with anti-melanoma differentiation-related gene 5 antibody (anti-MDA5-DM) is alarming, especially during the first several months. Infection is an important cause of early death. As there are no reports regarding the effect of prophylactic use of compounded sulfamethoxazole (coSMZ; each tablet contains 400 mg of sulfamethoxazole and 80 mg of trimethoprim) in anti-MDA5-DM patients, we conducted this study to evaluate the efficacy of coSMZ in reducing the incidence of Pneumocystis jirovecii pneumonia (PJP).

Methods

Consecutive patients with new-onset anti-MDA5-DM from June 2018 to October 2021 in our centre were retrospectively reviewed for >12 months. They were divided into two groups—coSMZ and non-coSMZ—based on the initial use of prophylactic coSMZ. Mortality and the incidence of severe infection within 12 months were compared between two groups.

Results

Compared with the non-coSMZ group (n = 93), the coSMZ group (n = 121) had lower mortality (18.8% vs 51.1%; P < 0.001) and a lower incidence of PJP (6.8% vs 15.2%; P = 0.040) and fatal infection (16.1% vs 3.3%; P = 0.001) during the first 12 months from diagnosis. After adjusting for age, gender, disease duration, peripheral blood lymphocyte count, anti-MDA5 antibody titres, ground-glass opacity scores and treatments, an inverse association was revealed between the prophylactic use of coSMZ and incidence of PJP [adjusted odds ratio 0.299 (95% CI 0.102–0.878), P = 0.028].

Conclusion

Prophylactic use of coSMZ is an effective and safe way to improve the prognosis of anti-MDA5-DM patients by preventing the incidence of PJP.
Role of cooked green banana in home management of acute diarrhea in under-5 children
Authors: Islam Kamirul , Konar Mithun Chandra , Roy Atanu , Biswas Biswajit , Nayek Kaustav , Middya Subhasri
Published: January 2023

Background

Acute diarrhea is an important contributor to under-5 mortality. Green banana is traditionally used as a home-based remedy for diarrhea.

Objectives

To identify the effect of green banana on duration, recovery and prevention of severe dehydration in under-5 children with acute watery diarrhea with no/some dehydration.

Methods

This study was conducted in the rural field practice area of a tertiary care center between January 2020 and December 2021 in under-5 children presenting with acute diarrhea with no/some dehydration. One hundred fifty-three children were divided into group A (received cooked green banana supplementation along with standard management) and group B (received only standard management). Duration of diarrhea, proportion of children recovered, requirement of hospitalization, development of persistent diarrhea and number of diarrheal episodes in 1 year follow-up period were compared between two groups.

Results

Green banana supplementation was significantly associated with reduction in duration [median (interquartile range)—4 (1.5) day versus 5.5 (1) day, P < 0.001] of diarrhea, less hospitalization (9.2% versus 22.1%, P = 0.03) and early recovery, both at day 3 (17.1% versus 3.9%, P = 0.007) and day 7 (90.8% versus 77.9%, P = 0.03). Green banana also protected children from the development of persistent diarrhea (7.9% versus 19.5%, P = 0.04). It also reduced future episodes of diarrhea by 40.5%.

Conclusion

Green banana supplementation could be a promising adjunct therapy in acute diarrhea and thereby it might reduce under-5 mortality.
Cash Transfers, Trust, and Inter-household Transfers: Experimental Evidence from Tanzania
Authors: Evans David K , Kosec Katrina
Published: January 2023

Institutionalized conditional cash transfer (CCT) programs may affect pre-existing, informal safety nets such as inter-household transfers and trust among community members. This study reports on a randomized controlled trial used to test the impact of CCTs on various measures of trust and informal safety nets within communities in Tanzania. It provides evidence that the introduction of a CCT program increased program beneficiaries’ trust in other community members and their perceived ability to access support from other households (e.g., childcare). Although CCTs reduced the total size of transfers to beneficiary households in the community in the short run (after 1.75 years of transfers), that reduction had disappeared 2.75 years after transfers began. Taken together, this evidence suggests that formal CCT programs do not necessarily crowd out informal safety nets in the longer term, and they may in fact boost trust and support across households.
Soil Metatranscriptomics: An Improved RNA Extraction Method Toward Functional Analysis Using Nanopore Direct RNA Sequencing
Authors: Poursalavati Abdonaser , Javaran Vahid J. , Laforest-Lapointe Isabelle , Fall Mamadou L.
Published: January 2023

Soil microbes play an undeniable role in sustainable agriculture, plant health, and soil management. A deeper understanding of soil microbial composition and function has been gained through next-generation sequencing. Although soil metagenomics has provided valuable information about microbial diversity, issues stemming from RNA extraction, low RNA abundance in some microbial populations (e.g., viruses), and messenger RNA enrichment have slowed the progress of soil metatranscriptomics. A variety of soil RNA extraction methods have been developed thus far yet none of the available protocols can obtain RNA with high quality, purity, and yield for third-generation sequencing. The latter requires RNA with high quality and large quantities (with no or low contamination such as humic acids). Also, use of commercial kits for in-batch soil RNA extraction is quite expensive, and these commercial kits lack buffer composition details, which prevents the optimization of protocols for different soil types. An improved and cost-effective method for extracting RNAs from mineral and organic soils is presented in this article. An acidic sodium acetate buffer and phosphate buffer with modifications to bead beating and nucleic acid precipitation lead to higher RNA yields and quality. Using this method, we obtained almost DNA-free RNA. By using nanopore's direct RNA sequencing, the extracted contamination-free RNAs were successfully sequenced. Finally, taxonomic groups such as bacteria, fungi, archaea, and viruses were classified and profiled, and functional annotation of the datasets was carried out using an in-house customized bioinformatics workflow.
Climate-Related Risk Modeling of Banana Xanthomonas Wilt Disease Incidence in the Cropland Area of Rwanda
Authors: Kilwenge Regina , Adewopo Julius , Manners Rhys , Mwizerwa Charles , Kabirigi Michel , Gaidashova Svetlana , Schut Marc
Published: January 2023

Banana Xanthomonas wilt (BXW) is a major threat to banana production in Rwanda, causing up to 100% yield loss. There are no biological or chemical control measures, and little is known about the potential direction and magnitude of its spread; hence, cultural control efforts are reactive rather than proactive. In this study, we assessed BXW risk under current and projected climates to guide early warning and control by applying the maximum entropy (Maxent) model on 1,022 georeferenced BXW datapoints and 20 environmental variables. We evaluated the significance of variables and mapped potential risk under current and future climates to assess spatial dynamics of the disease distribution. BXW occurrence was reliably predicted (mean validation AUC values ranging from 0.79 to 0.85). Precipitation of the coldest quarter, average maximum monthly temperature, annual precipitation, and elevation were the strongest predictors, which were responsible for 22.1, 13, 12.6, and 9.4% of the observed incidence variability, respectively, while mean temperature of the coldest quarter had the highest gain in isolation. Furthermore, the most susceptible regions (western, northern, and southern Rwanda) were characterized by elevation (1,350 to 2,000 m), annual precipitation (900 to 1,700 mm), and average temperature (14 to 20°C), among other variables, suggesting that a consistent, rainy, and warm climate is more favorable for BXW spread. Under the future climate, the risk was predicted to increase and spread to other regions. We conclude that climate change will likely exacerbate BXW-related losses of banana land area and yield under the influence of temperature and moisture. Our findings support evidence-based targeting of extension service delivery to farmers and national early warning for timely action.
Acquisition and Transmission of ‘Candidatus Liberibacter solanacearum’ Differs Among Wolbachia-Infected and -Uninfected Haplotypes of Bactericera cockerelli
Authors: Cooper W. Rodney , Swisher Grimm Kylie D. , Angelella Gina M. , Mustafa Tariq
Published: January 2023

‘Candidatus Liberibacter solanacearum’ (Lso) causes disease symptoms and economic losses in potato, tomato, and other solanaceous crops in North America. Lso is transmitted to plants by the potato psyllid, Bactericera cockerelli, which occurs as distinct haplotypes named western, central, and northwestern that differ in the presence or absence of the bacterial endosymbiont, Wolbachia. Previous work showed that all three vector haplotypes can transmit Lso, but it was not clear whether acquisition and transmission rates of Lso were equal among the haplotypes. The goal of our study was to compare Lso infection rates among psyllids of the western, central, and northwestern haplotypes. Using data collected from several years of periodic testing of Lso infection of laboratory-reared potato psyllid colonies, we showed that psyllids of the western and central haplotypes are more likely to harbor Lso than are psyllids of the northwestern haplotype. We then used greenhouse assays to demonstrate that psyllids of the northwestern haplotype are less likely to acquire and transmit Lso than those of the western haplotype. Lso infection rates corresponded with Wolbachia infection among the three psyllid haplotypes. The Wolbachia-infected central and western haplotypes were more likely to harbor and transmit Lso than the Wolbachia-free northwestern haplotype. Results demonstrate that potato psyllids of the western and central haplotypes pose a greater risk for spread of Lso in crops and suggest a pattern between infection with Lso and Wolbachia in potato psyllid.
Comprehensive analysis of transcriptomic profiling of 5‐methylcytosin modification in placentas from preeclampsia and normotensive pregnancies
Authors: Wei Xiaohong , Zhou Shengping , Liao Lingyun , Liu Min , Gao Yijie , Yin Yangxue , Xu Qin , Zhou Rong
Published: January 2023

Increasing evidence suggests that RNA m5C modification and its regulators have been confirmed to be associated with the pathogenesis of many diseases. However, the distribution and biological functions of m5C in mRNAs of placental tissues remain unknown. we collected placentae from normotensive pregnancies (CTR) and preeclampsia patients (PE) to analyze the transcriptomic profiling of m5C RNA methylation through m5C RNA immunoprecipitation (UMI‐MeRIP‐Seq). we discovered that overall m5C methylation peaks were decreased in placental tissues from PE patients. And, 2844 aberrant m5C peaks were identified, of which respectively 1304 m5C peaks were upregulated and 1540 peaks were downregulated. The distribution of m5C peaks were mainly located in CDS (coding sequences) regions in placental tissues of both groups, but compared with the CTR group, the m5C peak in PE group before the stop code of CDS was significantly increased and even higher than the peak value after start code in CDS. Differentially methylated genes were mainly enriched in MAPK/cAMP signaling pathway. Moreover, the up‐regulated genes with hypermethylated modification were enriched in the processes of hypoxia, inflammation/immune response. Finally, through analyzing the mRNA expression levels of m5C RNA methylation regulators, we found only DNMT3B and TET3 were significantly upregulated in PE samples than in control group. And they are not only negatively correlated with each other, but also closely related to those differentially expressed genes modified by differential methylation.Our findings provide new insights regarding alterations of m5C RNA modification into the pathogenic mechanisms of PE.
Neuroprotective effects of melatonin‐mediated mitophagy through nucleotide‐binding oligomerization domain and leucine‐rich repeat‐containing protein X1 in neonatal hypoxic–ischemic brain damage
Authors: Zhang Yi , Chen Dan , Wang Yiwei , Wang Xingzao , Zhang Zhong , Xin Ying
Published: January 2023

Hypoxia–ischemia (HI) is a major cause of brain damage in neonates. Mitochondrial dysfunction acts as a hub for a broad spectrum of signaling events, culminating in cell death triggered by HI. A neuroprotective role of melatonin (MT) has been proposed, and mitophagy regulation seems to be important for cell survival. However, the molecular mechanisms underlying MT‐mediated mitophagy during HI treatment are poorly defined. Nucleotide‐binding oligomerization domain and leucine‐rich repeat‐containing protein X1 (NLRX1) has emerged as a critical regulator of mitochondrial dynamics and neuronal death that participates in the pathology of diverse diseases. This study aimed to clarify whether NLRX1 participates in the regulation of mitophagy during MT treatment for hypoxic–ischemic brain damage (HIBD). We demonstrated that MT protected neonates from HIBD through NLRX1‐mediated mitophagy in vitro and in vivo. Meanwhile, MT upregulated the expression of NLRX1, Beclin‐1, and autophagy‐related 7 (ATG7) but decreased the expression of the mammalian target of rapamycin (mTOR) and translocase of the inner membrane of mitochondrion 23 (TIM23). Moreover, the neuroprotective effects of MT were abolished by silencing NLRX1 after oxygen–glucose deprivation (OGD). In addition, the downregulation of mTOR and upregulation of Beclin‐1 and ATG7 by MT were inhibited after silencing NLRX1 under OGD. In summary, MT modulates mitophagy induction through NLRX1 and plays a protective role in HIBD, providing insight into potential therapeutic targets for MT to exert neuroprotection.
Prolonged Opioid Use and Pain Outcome and Associated Factors after Surgery under General Anesthesia: A Prospective Cohort Association Multicenter Study
Authors: Kuck Kai , Naik Bhiken I. , Domino Karen B. , Posner Karen L. , Saager Leif , Stuart Ami R. , Johnson Ken B. , Alpert Salome B. , Durieux Marcel E. , Sinha Anik K. , Brummett Chad M. , Aziz Michael F. , Cummings Kenneth C. , Gaudet John G. , Kurz Andrea , Rijsdijk Mienke , Wanderer Jonathan P. , Pace Nathan L. ,   the Multicenter Perioperative Outcomes Group Enhanced Observation Study Investigator Group for the Multicenter Perioperative Outcomes Group Enhanced Observation Study Collaborator Group
Published: January 2023

Background

There is insufficient prospective evidence regarding the relationship between surgical experience and prolonged opioid use and pain. The authors investigated the association of patient characteristics, surgical procedure, and perioperative anesthetic course with postoperative opioid consumption and pain 3 months postsurgery. The authors hypothesized that patient characteristics and intraoperative factors predict opioid consumption and pain 3 months postsurgery.

Methods

Eleven U.S. and one European institution enrolled patients scheduled for spine, open thoracic, knee, hip, or abdominal surgery, or mastectomy, in this multicenter, prospective observational study. Preoperative and postoperative data were collected using patient surveys and electronic medical records. Intraoperative data were collected from the Multicenter Perioperative Outcomes Group database. The association between postoperative opioid consumption and surgical site pain at 3 months, elicited from a telephone survey conducted at 3 months postoperatively, and demographics, psychosocial scores, pain scores, pain management, and case characteristics, was analyzed.

Results

Between September and October 2017, 3,505 surgical procedures met inclusion criteria. A total of 1,093 cases were included; 413 patients were lost to follow-up, leaving 680 (64%) for outcome analysis. Preoperatively, 135 (20%) patients were taking opioids. Three months postsurgery, 96 (14%) patients were taking opioids, including 23 patients (4%) who had not taken opioids preoperatively. A total of 177 patients (27%) reported surgical site pain, including 45 (13%) patients who had not reported pain preoperatively. The adjusted odds ratio for 3-month opioid use was 18.6 (credible interval, 10.3 to 34.5) for patients who had taken opioids preoperatively. The adjusted odds ratio for 3-month surgical site pain was 2.58 (1.45 to 4.4), 4.1 (1.73 to 8.9), and 2.75 (1.39 to 5.0) for patients who had site pain preoperatively, knee replacement, or spine surgery, respectively.

Conclusions

Preoperative opioid use was the strongest predictor of opioid use 3 months postsurgery. None of the other variables showed clinically significant association with opioid use at 3 months after surgery.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Noninvasive Skin Autofluorescence of Advanced Glycation End Products for Detecting Ossification of the Posterior Longitudinal Ligament in the Thoracic Spine
Authors: Doi Toru , Horii Chiaki , Tozawa Keiichiro , Nakarai Hiroyuki , Sasaki Katsuyuki , Yoshida Yuichi , Ito Yusuke , Ohtomo Nozomu , Sakamoto Ryuji , Nakajima Koji , Nagata Kosei , Okamoto Naoki , Nakamoto Hideki , Kato So , Taniguchi Yuki , Matsubayashi Yoshitaka , Tanaka Sakae , Oshima Yasushi
Published: January 2023

Study Design.

A single-center prospective observational study.

Objective.

The aim was to clarify the usefulness of assessing advanced glycation end products (AGEs) by noninvasive skin autofluorescence in patients with ossification of the posterior longitudinal ligament (OPLL).

Summary of Background Data.

AGE accumulation is associated with various systemic disorders, including aging, diabetes mellitus, and obesity. AGEs have also been associated with OPLL, but their assessment by noninvasive skin autofluorescence has not been yet studied in these patients.

Materials and Methods.

We enrolled patients with degenerative spinal spondylosis and divided them into non-OPLL and OPLL groups. The OPLL group was further subdivided into cervical OPLL (C-OPLL) and thoracic OPLL (T-OPLL) groups. We compared patients’ characteristics, serum laboratory data (i.e. hemoglobin A1c, total cholesterol, creatinine, and estimated glomerular filtration rate), and the skin autofluorescence intensity of AGEs (the AGE score) between the non-OPLL and OPLL groups and among the non-OPLL, C-OPLL, T-OPLL groups. Finally, the association of the AGE score with the presence of C-OPLL or T-OPLL was assessed by multinomial logistic regression.

Results.

Among the 240 eligible patients, 102 were in the non-OPLL group and 138 were in the OPLL group (92 with C-OPLL and 46 with T-OPLL). We observed no significant difference in the AGE score between the non-OPLL and OPLL groups, but when comparing the score among the non-OPLL, C-OPLL, and T-OPLL groups, we found that the T-OPLL group had a significantly higher AGE score. The results of multinomial regression analysis showed that a higher AGE score was significantly associated with T-OPLL (odds ratio: 1.46; 95% CI: 1.01–2.11; P=0.044).

Conclusion.

The AGE score determined by noninvasive skin autofluorescence could help to screen for OPLL in the thoracic spine.
Ambulatory Lumbar Fusion
Authors: Subramanian Tejas , Araghi Kasra , Sivaganesan Ahilan , Shahi Pratyush , Vaishnav Avani , Iyer Sravisht , Qureshi Sheeraz A.
Published: January 2023

Study Design/Setting.

Systematic review.

Objective.

The primary purpose was to propose patient selection criteria and perioperative best practices that can serve as a starting point for an ambulatory lumbar fusion program. The secondary purpose was to review patient-reported outcomes (PROs) after ambulatory lumbar fusion.

Summary of Background.

As healthcare costs rise, there is an increasing emphasis on cost saving strategies (i.e. outpatient/ambulatory surgeries). Lumbar fusion procedures remain a largely inpatient surgery. Early studies have shown that fusion procedures can be safely preformed in an outpatient setting but no review has summarized these findings and best practices.

Materials and Methods.

This study was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed/MEDLINE, The Cochrane Library, and Embase were searched. The following data were collected: (1) study design; (2) number of participants; (3) patient population; (4) procedure types; (5) procedure setting; (6) inclusion criteria; (7) protocols; (8) adverse events; (9) PROs; and (10) associations between patient/surgical factors, setting, and outcomes.

Results.

The search yielded 20 publications. The following selection criteria for ambulatory lumbar fusion were identified: age below 70, minimal comorbidities, low/normal body mass index, no tobacco use, and no opioid use. The perioperative protocol can include a multimodal analgesic regimen. The patient should be observed for at least three hours after surgery. The patient should not be discharged without an alertness check and a neurological examination. Patients experienced significant improvements in PROs after ambulatory lumbar fusion; similarly, when compared to an inpatient group, ambulatory lumbar fusion patients experienced a comparable or superior improvement in PROs.

Conclusion.

There are two critical issues surrounding ambulatory lumbar fusion: (1) Who is the ideal patient, and (2) What needs to be done to enable expedited discharge? We believe this review will provide a foundation to assist surgeons in making decisions regarding the performance of lumbar fusion on an ambulatory basis.

Level of Evidence.

Level III.
Differentiating Magnetic Resonance Images of Pyogenic Spondylitis and Spinal Modic Change Using a Convolutional Neural Network
Authors: Mukaihata Tomohito , Maki Satoshi , Eguchi Yawara , Geundong Kim , Shoda Junpei , Yokota Hajime , Orita Sumihisa , Shiga Yasuhiro , Inage Kazuhide , Furuya Takeo , Ohtori Seiji
Published: January 2023

Study Design.

A retrospective analysis of magnetic resonance imaging (MRI).

Objective.

The study aimed to evaluate the performance of a convolutional neural network (CNN) to differentiate spinal pyogenic spondylitis from Modic change on MRI. We compared the performance of CNN to that of four clinicians.

Summary of Background Data.

Discrimination between pyogenic spondylitis and spinal Modic change is crucial in clinical practice. CNN deep-learning approaches for medical imaging are being increasingly utilized.

Methods.

We retrospectively reviewed MRIs from pyogenic spondylitis and spinal Modic change patients. There were 50 patients per group. Sagittal T1-weighted (T1WI), sagittal T2-weighted (T2WI), and short TI inversion recovery (STIR) MRIs were used for CNN training and validation. The deep learning framework Tensorflow was used to construct the CNN architecture. To evaluate CNN performance, we plotted the receiver operating characteristic curve and calculated the area under the curve. We compared the accuracy, sensitivity, and specificity of CNN diagnosis to that of a radiologist, spine surgeon, and two orthopedic surgeons.

Results.

The CNN-based area under the curves of the receiver operating characteristic curve from the T1WI, T2WI, and STIR were 0.95, 0.94, and 0.95, respectively. The accuracy of the CNN was significantly greater than that of the four clinicians on T1WI and STIR (P<0.05), and better than a radiologist and one orthopedic surgeon on the T2WI (P<0.05). The sensitivity was significantly better than that of the four clincians on T1WI and STIR (P<0.05), and better than a radiologist and one orthopedic surgeon on the T2WI (P<0.05). The specificity was significantly better than one orthopedic surgeon on T1WI and T2WI (P<0.05) and better than both orthopedic surgeons on STIR (P<0.05).

Conclusion.

We differentiated between Modic changes and pyogenic spondylitis using a CNN that interprets MRI. The performance of the CNN was comparable to, or better than, that of the four clinicians.
Cardiac Children Hospital Early Warning ScoreVersus the Inadequate Oxygen Delivery Index for the Detection of Early Warning Signs of Deterioration
Authors: Khalil Mujtaba , Abbas Qalab , Azhar Mohammad Kumael , Aamir Faiqa Binte , Hashmi Shiraz , Ali Sadaqat , Faiz Tahira , Malik Mahim Akmal
Published: January 2023

OBJECTIVES:

To assess the utility of the Cardiac Children’s Hospital Early Warning Score (C-CHEWS) in the early detection of deterioration.

DESIGN:

Single-center longitudinal pilot study.

SETTING:

Pediatric cardiac ICU (PCICU), Aga Khan University.

INTERVENTIONS:

C-CHEWS and Inadequate Oxygen Delivery (IDO2) Index calculation every 2 hours.

PATIENTS:

A total of 60 children (0 d to 18 yr old).

MEASUREMENTS AND MAIN RESULTS:

A single-center longitudinal pilot study was conducted at PCICU. All postoperative extubated patients were assessed and scored between 0 and 11, and these scores were then correlated with the IDO2 index data available from the T3 platform. Adverse events were defined as a need for cardiopulmonary resuscitation, or reintubation, and death. A total of 920 C-CHEWS and IDO2 scores were analyzed on 60 patients during the study period. There were 36 males and 24 females, and the median age of the study population was 34 months (interquartile range, 9.0–72.0 mo). Fourteen patients (23.3%) developed adverse events; these included 9 reintubations and 5 cardiopulmonary arrests, resulting in 2 deaths. The area under the curve (AUC) for C-CHEWS scores fell in an acceptable range of 0.956 (95% CI, 0.869–0.992), suggesting an optimal accuracy for identifying early warning signs of cardiopulmonary arrest. Whereas, IDO2 showed no discriminatory power to detect the adverse events with an AUC of 0.522 (95% CI, 0.389–0.652).

CONCLUSIONS:

The C-CHEWS tool provides a standardized assessment and approach to deteriorating congenital cardiac surgery patients in recognizing early postoperative deterioration.
Reproductive health and liver disease: a patient-friendly summary of the 2021 AASLD guidance
Authors: Levy Cynthia , Brady Carla W. , Terrault Norah , Stotts Matthew J. , Sarkar Monika
Published: January 2023

Watch the interview with the author.
Detection rates of adenomas, advanced adenomas, and colorectal cancers among the opportunistic colonoscopy screening population: a single-center, retrospective study
Authors: Gong Yan , Zheng Yansong , Wu Rilige , Liu Miao , Li Hong , Zeng Qiang
Published: January 2023

Background:

Colorectal cancer (CRC) screening is effective in reducing CRC incidence and mortality. The aim of this study was to retrospectively determine and compare the detection rate of adenomas, advanced adenomas (AAs) and CRCs, and the number needed to screen (NNS) of individuals in an average-risk Chinese population of different ages and genders.

Methods:

This was a retrospective study performed at the Institute of Health Management, Chinese People's Liberation Army General Hospital. Colonoscopy results were analyzed for 53,152 individuals finally enrolled from January 2013 to December 2019. The detection rate of adenomas, AAs, or CRCs was computed and the characteristics between men and women were compared using chi-squared test.

Results:

The average age was 48.8 years (standard deviation [SD], 8.5 years) for men and 50.0 years (SD, 9.0 years) for women, and the gender rate was 66.27% (35,226) vs. 33.73% (17,926). The detection rates of adenomas, AAs, serrated adenomas, and CRCs were 14.58% (7750), 3.09% (1641), 1.23% (653), and 0.59% (313), respectively. Men were statistically significantly associated with higher detection rates than women in adenomas (17.20% [6058/35,226], 95% confidence interval [CI] 16.74–17.53% vs. 9.44% [1692/17,926], 95% CI 8.94–9.79%, P < 0.001), AAs (3.72% [1309], 95% CI 3.47–3.87% vs. 1.85% [332], 95% CI 1.61–2.00%, P < 0.001), and serrated adenomas (1.56% [548], 95% CI 1.43–1.69% vs. 0.59% [105], 95% CI 0.47–0.70%, P < 0.001). The detection rate of AAs in individuals aged 45 to 49 years was 3.17% (270/8510, 95% CI 2.80–3.55%) in men and 1.69% (69/4091, 95% CI 1.12–1.86%) in women, and their NNS was 31.55 (95% CI 28.17–35.71) in men and 67.11 (95% CI 53.76–89.29) in women. The NNS for AAs in men aged 45 to 49 years was close to that in women aged 65 to 69 years (29.07 [95% CI 21.05–46.73]).

Conclusions:

The detection rates of adenomas, AAs, and serrated adenomas are high in the asymptomatic population undergoing a physical examination and are associated with gender and age. Our findings will provide important references for effective population-based CRC screening strategies in the future.
Recurrent Extreme Bilateral Gigantomastia Caused by Pseudoangiomatous Stromal Hyperplasia (PASH) Syndrome: A Case Report
Authors: Parisi Paola , Vinci Federica , Di Meglio Filippo , Marruzzo Giovanni , De Luca Alessandro , Ascione Andrea , Vittori Luigi , Ribuffo Diego
Published: January 2023

Pseudoangiomatous stromal hyperplasia (PASH) of the breast is a rare and benign medical condition in which the breast tissue is affected by an abnormal myofibroblastic proliferation, which mimics a low-grade sarcoma angiomatous proliferation. PASH usually presents itself either as a palpable mass or as an incidental diagnosis during breast specimens’ histological examination. A few cases have been reported in the literature of a diffuse form of breast PASH syndrome in which the clinical presentation is a bilateral form of gigantomastia without palpable masses. In such cases, the optimal surgical management is still debated due to a significant risk of relapse after breast reduction. Mastectomy seems to be the endpoint of this condition in relapsing cases. Recent studies report a good outcome with a Tamoxifen regimen when surgery cannot be performed, supporting a hormonal component for the etiology of the condition. This study reports on an extremely rare case of bilateral, rapid, and severe PASH in a young patient, presenting as a truly disabling gigantomastia that forced the patient to use a wheelchair due to the excessive breast weights (25 kg the right breast and 21 kg the left). We describe her complicated medical history, her diagnosis, and our course of treatment.
Integrative analysis implicates the significance of m6A in the liver fibrosis of biliary atresia by regulating THY1
Authors: Wang Junfeng , Du Min , Meng Lingdu , Yang Yifan , He Shiwei , Zhu Ye , Ren Xue , Wei Meng , Dong Rui , Zheng Shan , Chen Gong
Published: January 2023

Whether N6-methyladenosine (m6A) is involved in biliary atresia (BA) remains undefined. Herein, we comprehensively evaluated the m6A profile in BA. When compared with normal controls, BA had an elevated m6A level with upregulated m6A writers. The m6A level was correlated with liver function, stage of fibrosis and jaundice clearance in BA. Methylated RNA immunoprecipitation sequencing (MeRIP-seq) demonstrated an altered m6A topology in BA. MeRIP-seq and RNA sequencing filtered out 130 m6A-modified genes, which were enriched in fibrogenetic pathways. MeRIP-qPCR in vivo and interventions of LX-2 and primary HSCs in vitro validated the regulatory role of m6A on COL1A1 and THY1. THY1+ myofibroblasts expanded in portal area of BA, and highly expressed profibrogenic genes (COL1A1, MMP2, PDGFRA, and DCN). THY1 was correlated with liver fibrosis and jaundice clearance in BA. Bulk array (GSE46960, GSE15235), single-cell RNA sequencing (GSE136103), primary HSC interventions, and co-immunoprecipitation revealed that THY1 was correlated with extracellular matrix organization, promoted HSC activation, showed higher interactions with integrins on myeloid cells in cholestatic fibrosis, and was correlated with native liver survival in BA. Our study highlights the significance of m6A in BA-induced liver fibrogenesis by regulating THY1, shedding new light on the novel therapies to alleviate liver fibrosis by targeting m6A/THY1 axis in BA.
Comparable outcomes between immune-tolerant and active phases in noncirrhotic chronic hepatitis B: a meta-analysis
Authors: Lee Han Ah , Kim Seung Up , Seo Yeon Seok , Ahn Sang Hoon , Rim Chai Hong
Published: January 2023

Background:

Antiviral therapy is not indicated for patients with chronic hepatitis B (CHB) in the immune-tolerant (IT) phase. We compared the outcomes between the untreated IT phase and the treated immune-active (IA) phase in noncirrhotic HBeAg-positive CHB patients.

Methods:

We systematically searched 4 databases, including PubMed, Medline, Embase, and Cochrane, until August 2021. The pooled incidence rates of HCC and mortality in the IT and IA cohorts and phase change in the IT cohort were investigated. Studies that included patients with liver cirrhosis were excluded.

Results:

Thirteen studies involving 11,903 patients were included. The overall median of the median follow-up period was 62.4 months. The pooled 5-year and 10-year incidence rates of HCC were statistically similar between the IT and IA cohorts (1.1%, 95% CI: 0.4%–2.8% vs. 1.1%, 95% CI: 0.5%–2.3%, and 2.7%, 95% CI: 1.0%–7.3% vs. 3.6%, 95% CI: 2.4%–5.5%, respectively, all p>0.05). The pooled 5-year odds ratio of HCC between IT and IA cohorts was 1.05 (95% CI: 0.32–3.45; p=0.941). The pooled 5-year incidence rate of mortality was statistically similar between the IT and IA cohorts (1.9%, 95% CI: 1.1%–3.4% vs. 1.0%, 95% CI: 0.3%–2.9%, p=0.285). Finally, the pooled 5-year incidence rate of phase change in the IT cohort was 36.1% (95% CI: 29.5%–43.2%).

Conclusion:

The pooled incidence rates of HCC and mortality were comparable between the untreated IT and the treated IA phases in noncirrhotic HBeAg-positive CHB patients.
Effects of statins and aspirin on HCC risk in alcohol-related cirrhosis: nationwide emulated trials
Authors: Kraglund Frederik , Christensen Diana H. , Eiset Andreas H. , Villadsen Gerda E. , West Joe , Jepsen Peter
Published: January 2023

Background and Aims:

Observational studies have shown an association between statin or aspirin use and a decreased risk of HCC, but the effects of a well-defined treatment strategy remain unknown. We emulated trials of the effects of continuous statin or aspirin use on HCC risk in patients with cirrhosis due to alcohol-related liver disease (ALD cirrhosis).

Approach and Results:

We specified target trials for statins and, separately, aspirin and emulated them using Danish health care registries. All eligible patients with ALD cirrhosis diagnosed in 2000–2018 were included in either an exposed or an unexposed arm. Patients were followed until HCC or death without HCC. The 5-year risk of HCC was estimated using marginal structural models with inverse probability weighting. Using statins continuously for 5 years compared with not using statins resulted in a relative risk (RR) of HCC of 0.67 (95% CI: 0.45–0.91). The RR of death without HCC was 0.69 (95% CI: 0.65–0.77). For aspirin, the RR was 1.05 (95% CI: 0.60–1.42) for HCC and 1.02 (95% CI: 0.95–1.09) for death without HCC.

Conclusions:

In patients with ALD cirrhosis, 5 years of continuous statin use resulted in a 33% RR reduction of HCC (number needed to treat = 94) and a 31% RR reduction of death without HCC (number needed to treat = 7). Such strong causal effects are implausible and best explained by uncontrollable confounding, highlighting the need for randomized trials. Aspirin use likely does not affect the risk of HCC or death without HCC.
Maternal Western diet is associated with distinct preclinical pediatric NAFLD phenotypes in juvenile nonhuman primate offspring
Authors: Nash Michael J. , Dobrinskikh Evgenia , Janssen Rachel C. , Lovell Mark A. , Schady Deborah A. , Levek Claire , Jones Kenneth L. , D’Alessandro Angelo , Kievit Paul , Aagaard Kjersti M. , McCurdy Carrie E. , Gannon Maureen , Friedman Jacob E. , Wesolowski Stephanie R.
Published: January 2023

Pediatric NAFLD has distinct and variable pathology, yet causation remains unclear. We have shown that maternal Western-style diet (mWSD) compared with maternal chow diet (CD) consumption in nonhuman primates produces hepatic injury and steatosis in fetal offspring. Here, we define the role of mWSD and postweaning Western-style diet (pwWSD) exposures on molecular mechanisms linked to NAFLD development in a cohort of 3-year-old juvenile nonhuman primates offspring exposed to maternal CD or mWSD followed by CD or Western-style diet after weaning. We used histologic, transcriptomic, and metabolomic analyses to identify hepatic pathways regulating NAFLD. Offspring exposed to mWSD showed increased hepatic periportal collagen deposition but unchanged hepatic triglyceride levels and body weight. mWSD was associated with a downregulation of gene expression pathways underlying HNF4α activity and protein, and downregulation of antioxidant signaling, mitochondrial biogenesis, and PPAR signaling pathways. In offspring exposed to both mWSD and pwWSD, liver RNA profiles showed upregulation of pathways promoting fibrosis and endoplasmic reticulum stress and increased BiP protein expression with pwWSD. pwWSD increased acylcarnitines and decreased anti-inflammatory fatty acids, which was more pronounced when coupled with mWSD exposure. Further, mWSD shifted liver metabolites towards decreased purine catabolism in favor of synthesis, suggesting a mitochondrial DNA repair response. Our findings demonstrate that 3-year-old offspring exposed to mWSD but weaned to a CD have periportal collagen deposition, with transcriptional and metabolic pathways underlying hepatic oxidative stress, compromised mitochondrial lipid sensing, and decreased antioxidant response. Exposure to pwWSD worsens these phenotypes, triggers endoplasmic reticulum stress, and increases fibrosis. Overall, mWSD exposure is associated with altered expression of candidate genes and metabolites related to NAFLD that persist in juvenile offspring preceding clinical presentation of NAFLD.
Health-related quality of life improvement by adalimumab therapy in patients with rheumatoid arthritis in Taiwan: A nationwide prospective study
Authors: Hsieh Song-Chou , Tsai Ping-Han , Kuo Chang-Fu , Cheng Tien-Tsai , Lai Ning-Sheng , Lin Jing-Chi , Lin Liang-Hung , Tsai Chang-Youh
Published: January 2023

Background:

To determine the effects of adalimumab on health-related quality of life (HRQoL) in Taiwanese patients with moderate-to-severe rheumatoid arthritis (RA) (NCT02616380).

Methods:

During a 24-week observational period, 100 biologic-naive patients with RA received 40 mg adalimumab subcutaneously, every 2 weeks. The primary endpoint was a change in Health Assessment Questionnaire–Disability Index (HAQ-DI) score at 24 weeks. The secondary endpoints included change in HAQ-DI at week 12, number and percentage of patients achieving a meaningful improvement in HAQ-DI at weeks 12 and 24, and changes in the 36-Item Short Form Health Survey (SF-36), EuroQol 5-dimension 3-level version (EQ-5D-3L) index, and Work Productivity and Activity Impairment (WPAI) questionnaire scores at weeks 12 and 24.

Results:

At weeks 12 and 24, mean changes in HAQ-DI from baseline were −0.34 ± 0.46 and −0.44 ± 0.59 (both p < 0.001), and clinically meaningful improvement in HAQ-DI was achieved by 60.4% and 59.6% of patients, respectively. SF-36, EQ-5D-3L index, and WPAI scores significantly improved (p < 0.001) from baseline to weeks 12 and 24. Exploratory analyses showed diabetes was significantly associated with changes in HAQ-DI, EQ-5D-3L, and WPAI scores whereas peptic ulcer correlated with changes in the SF-36 physical component summary T-score.

Conclusion:

HRQoL improved after initiation of adalimumab therapy in Taiwanese patients with moderate-to-severe RA.