bluuebunny/crossref_metadata_2025 huggingface dataset:
Large-scale epidemiological analysis of common skin diseases to identify shared and unique comorbidities and demographic factors
Authors: Li Qinmengge , Patrick Matthew T. , Sreeskandarajan Sutharzan , Kang Jian , Kahlenberg J. Michelle , Gudjonsson Johann E. , He Zhi , Tsoi Lam C.
Published: January 2024

Introduction

The utilization of large-scale claims databases has greatly improved the management, accessibility, and integration of extensive medical data. However, its potential for systematically identifying comorbidities in the context of skin diseases remains unexplored.

Methods

This study aims to assess the capability of a comprehensive claims database in identifying comorbidities linked to 14 specific skin and skin-related conditions and examining temporal changes in their association patterns. This study employed a retrospective case-control cohort design utilizing 13 million skin/skin-related patients and 2 million randomly sampled controls from Optum’s de-identified Clinformatics® Data Mart Database spanning the period from 2001 to 2018. A broad spectrum of comorbidities encompassing cancer, diabetes, respiratory, mental, immunity, gastrointestinal, and cardiovascular conditions were examined for each of the 14 skin and skin-related disorders in the study.

Results

Using the established type-2 diabetes (T2D) and psoriasis comorbidity as example, we demonstrated the association is significant (P-values<1x10-15) and stable across years (OR=1.15-1.31). Analysis of the 2014-2018 data reveals that celiac disease, Crohn’s disease, and ulcerative colitis exhibit the strongest associations with the 14 skin/skin-related conditions. Systemic lupus erythematosus (SLE), leprosy, and hidradenitis suppurativa show the strongest associations with 30 different comorbidities. Particularly notable associations include Crohn’s disease with leprosy (odds ratio [OR]=6.60, 95% confidence interval [CI]: 3.09-14.08), primary biliary cirrhosis with SLE (OR=6.07, 95% CI: 4.93-7.46), and celiac disease with SLE (OR=6.06, 95% CI: 5.49-6.69). In addition, changes in associations were observed over time. For instance, the association between atopic dermatitis and lung cancer demonstrates a marked decrease over the past decade, with the odds ratio decreasing from 1.75 (95% CI: 1.47-2.07) to 1.02 (95% CI: 0.97-1.07). The identification of skin-associated comorbidities contributes to individualized healthcare and improved clinical management, while also enhancing our understanding of shared pathophysiology. Moreover, tracking these associations over time aids in evaluating the progression of clinical diagnosis and treatment.

Discussion

The findings highlight the potential of utilizing comprehensive claims databases in advancing research and improving patient care in dermatology.
Disease patterns and specific trajectories of anti-MDA5-related disease: a multicentre retrospective study of 70 adult patients
Authors: de Boysson Hubert , Cuchet Marie , Cassius Charles , Cuchet Pierre , Agard Christian , Audemard-Verger Alexandra , Marchand-Adam Sylvain , Cohen-Sors Raphaëlla , Gallay Laure , Graveleau Julie , Lesort Cécile , Ly Kim , Meyer Alain , Monseau Grégoire , Néel Antoine , Bonnotte Bernard , Pérard Laurent , Schleinitz Nicolas , Mariotte Delphine , Le Mauff Brigitte , Bourdenet Gwladys , Masmoudi Wafa , Deshayes Samuel , Dumont Anaël , Dompmartin Anne , Kottler Diane , Aouba Achille
Published: January 2024

Introduction

This study aimed to provide an updated analysis of the different prognostic trajectories of patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibodies.

Methods

Among a cohort of 70 patients, baseline characteristics and phenotypes, treatments and outcomes were analyzed. A Cox proportional hazards model was used to identify factors associated with poor outcomes, i.e., death or progressive disease at the last follow-up.

Results

Among the 70 patients, 45 were women, and 54 were Caucasian. A dermatologic involvement was observed in 58 (83%) patients, including 40 with MDA5 vasculopathy-related skin lesions. Muscular involvement was observed in 39 (56%) patients. Interstitial lung disease (ILD) was observed at baseline in 52 (74%) patients, including 23 (44%) who developed rapidly progressive (RP) ILD. Seven (10%) patients showed thromboembolic complications within the first weeks of diagnosis, and eight (11%) other patients developed a malignancy (4 before the diagnosis of anti-MDA5 disease). Poor outcomes were observed in 28 (40%) patients, including 13 (19%) deaths. Among the 23 patients with RP-ILD, 19 (79%) showed poor outcomes, including 12 (63%) who died. In multivariate analyses, RP-ILD (hazard ratio (HR), 95% CI: 8.24 [3.21–22], p<0.0001), the occurrence of thromboembolic events (HR: 5.22 [1.61–14.77], p=0.008) and the presence of any malignancy (HR: 19.73 [6.67–60], p<0.0001) were the three factors independently associated with poor outcomes.

Discussion

This new independent cohort confirms the presence of different clinical phenotypes of anti-MDA5 diseases at baseline and the poor prognosis associated with RP-ILD. Thromboembolic events and malignancies were also identified as prognostic factors.
Adjuvant immunotherapy improves recurrence-free and overall survival following surgical resection for intermediate/advanced hepatocellular carcinoma a multicenter propensity matching analysis
Authors: Xu Xiao , Wang Ming-Da , Xu Jia-Hao , Fan Zhong-Qi , Diao Yong-Kang , Chen Zhong , Jia Hang-Dong , Liu Fu-Bao , Zeng Yong-Yi , Wang Xian-Ming , Wu Han , Qiu Wei , Li Chao , Pawlik Timothy M. , Lau Wan Yee , Shen Feng , Lv Guo-Yue , Yang Tian
Published: January 2024

Background & aims

The effectiveness of adjuvant immunotherapy to diminish recurrence and improve long-term prognosis following curative-intent surgical resection for hepatocellular carcinoma (HCC) is of increased interest, especially among individuals at high risk of recurrence. The objective of the current study was to investigate the impact of adjuvant immunotherapy on long-term recurrence and survival after curative resection among patients with intermediate/advanced HCC.

Methods

Using a prospectively-collected multicenter database, patients who underwent curative-intent resection for Barcelona Clinic Liver Cancer (BCLC) stage B/C HCC were identified. Propensity score matching (PSM) analysis was used to compare recurrence-free survival (RFS) and overall survival (OS) between patients treated with and without adjuvant immune checkpoint inhibitors (ICIs). Multivariate Cox-regression analysis further identified independent factors of RFS and OS.

Results

Among the 627 enrolled patients, 109 patients (23.3%) received adjuvant immunotherapy. Most ICI-related adverse reactions were grading I-II. PSM analysis created 99 matched pairs of patients with comparable baseline characteristics between patients treated with and without adjuvant immunotherapy. In the PSM cohort, the median RFS (29.6 vs. 19.3 months, P=0.031) and OS (35.1 vs. 27.8 months, P=0.036) were better among patients who received adjuvant immunotherapy versus patients who did not. After adjustment for other confounding factors on multivariable analyzes, adjuvant immunotherapy remained independently associated with favorable RFS (HR: 0.630; 95% CI: 0.435-0.914; P=0.015) and OS (HR: 0.601; 95% CI: 0.401-0.898; P=0.013). Subgroup analyzes identified potentially prognostic benefits of adjuvant immunotherapy among patients with intermediate-stage and advanced-stage HCC.

Conclusion

This real-world observational study demonstrated that adjuvant immunotherapy was associated with improved RFS and OS following curative-intent resection of intermediate/advanced HCC. Future randomized controlled trials are warranted to establish definitive evidence for this specific population at high risks of recurrence.
A facile approach to preparing personalized cancer vaccines using iron-based metal organic framework
Authors: Li Xia , Hattori Shinya , Ebara Mitsuhiro , Shirahata Naoto , Hanagata Nobutaka
Published: January 2024

Background

Considering the diversity of tumors, it is of great significance to develop a simple, effective, and low-cost method to prepare personalized cancer vaccines.

Methods

In this study, a facile one-pot synthetic route was developed to prepare cancer vaccines using model antigen or autologous tumor antigens based on the coordination interaction between Fe3+ ions and endogenous fumarate ligands.

Results

Herein, Fe-based metal organic framework can effectively encapsulate tumor antigens with high loading efficiency more than 80%, and act as both delivery system and adjuvants for tumor antigens. By adjusting the synthesis parameters, the obtained cancer vaccines are easily tailored from microscale rod-like morphology with lengths of about 0.8 μm (OVA-ML) to nanoscale morphology with sizes of about 50~80 nm (OVA-MS). When cocultured with antigen-presenting cells, nanoscale cancer vaccines more effectively enhance antigen uptake and Th1 cytokine secretion than microscale ones. Nanoscale cancer vaccines (OVA-MS, dLLC-MS) more effectively enhance lymph node targeting and cross-presentation of tumor antigens, mount antitumor immunity, and inhibit the growth of established tumor in tumor-bearing mice, compared with microscale cancer vaccines (OVA-ML, dLLC-ML) and free tumor antigens.

Conclusions

Our work paves the ways for a facile, rapid, and low-cost preparation approach for personalized cancer vaccines.
A life-and-death struggle: interaction of insects with entomopathogenic fungi across various infection stages
Authors: Ma Meiqi , Luo Jing , Li Chong , Eleftherianos Ioannis , Zhang Wei , Xu Letian
Published: January 2024

Insects constitute approximately 75% of the world’s recognized fauna, with the majority of species considered as pests. Entomopathogenic fungi (EPF) are parasitic microorganisms capable of efficiently infecting insects, rendering them potent biopesticides. In response to infections, insects have evolved diverse defense mechanisms, prompting EPF to develop a variety of strategies to overcome or circumvent host defenses. While the interaction mechanisms between EPF and insects is well established, recent findings underscore that their interplay is more intricate than previously thought, especially evident across different stages of EPF infection. This review primarily focuses on the interplay between EPF and the insect defense strategies, centered around three infection stages: (1) Early infection stage: involving the pre-contact detection and avoidance behavior of EPF in insects, along with the induction of behavioral responses upon contact with the host cuticle; (2) Penetration and intra-hemolymph growth stage: involving the initiation of intricate cellular and humoral immune functions in insects, while symbiotic microbes can further contribute to host resistance; (3) Host insect’s death stage: involving the ultimate confrontation between pathogens and insects. Infected insects strive to separate themselves from the healthy population, while pathogens rely on the infected insects to spread to new hosts. Also, we discuss a novel pest management strategy underlying the cooperation between EPF infection and disturbing the insect immune system. By enhancing our understanding of the intricate interplay between EPF and the insect, this review provides novel perspectives for EPF-mediated pest management and developing effective fungal insecticides.
Polymeric nanocapsules loaded with poly(I:C) and resiquimod to reprogram tumor-associated macrophages for the treatment of solid tumors
Authors: Anfray Clément , Varela Carmen Fernández , Ummarino Aldo , Maeda Akihiro , Sironi Marina , Gandoy Sara , Brea Jose , Loza María Isabel , León Sergio , Calvo Alfonso , Correa Juan , Fernandez-Megia Eduardo , Alonso María José , Allavena Paola , Crecente-Campo José , Andón Fernando Torres
Published: January 2024

Background

In the tumor microenvironment (TME), tumor-associated macrophages (TAMs) play a key immunosuppressive role that limits the ability of the immune system to fight cancer. Toll-like receptors (TLRs) ligands, such as poly(I:C) or resiquimod (R848) are able to reprogram TAMs towards M1-like antitumor effector cells. The objective of our work has been to develop and evaluate polymeric nanocapsules (NCs) loaded with poly(I:C)+R848, to improve drug stability and systemic toxicity, and evaluate their targeting and therapeutic activity towards TAMs in the TME of solid tumors.

Methods

NCs were developed by the solvent displacement and layer-by-layer methodologies and characterized by dynamic light scattering and nanoparticle tracking analysis. Hyaluronic acid (HA) was chemically functionalized with mannose for the coating of the NCs to target TAMs. NCs loaded with TLR ligands were evaluated in vitro for toxicity and immunostimulatory activity by Alamar Blue, ELISA and flow cytometry, using primary human monocyte-derived macrophages. For in vivo experiments, the CMT167 lung cancer model and the MN/MCA1 fibrosarcoma model metastasizing to lungs were used; tumor-infiltrating leukocytes were evaluated by flow cytometry and multispectral immunophenotyping.

Results

We have developed polymeric NCs loaded with poly(I:C)+R848. Among a series of 5 lead prototypes, protamine-NCs were selected based on their physicochemical properties (size, charge, stability) and in vitro characterization, showing good biocompatibility on primary macrophages and ability to stimulate their production of T-cell attracting chemokines (CXCL10, CCL5) and to induce M1-like macrophages cytotoxicity towards tumor cells. In mouse tumor models, the intratumoral injection of poly(I:C)+R848-protamine-NCs significantly prevented tumor growth and lung metastasis. In an orthotopic murine lung cancer model, the intravenous administration of poly(I:C)+R848-prot-NCs, coated with an additional layer of HA-mannose to improve TAM-targeting, resulted in good antitumoral efficacy with no apparent systemic toxicity. While no significant alterations were observed in T cell numbers (CD8, CD4 or Treg), TAM-reprogramming in treated mice was confirmed by the relative decrease of interstitial versus alveolar macrophages, having higher CD86 expression but lower CD206 and Arg1 expression in the same cells, in treated mice.

Conclusion

Mannose-HA-protamine-NCs loaded with poly(I:C)+R848 successfully reprogram TAMs in vivo, and reduce tumor progression and metastasis spread in mouse tumors.
Investigating the effect of nativeness and speaker age on the credibility of spoken sentences
Authors: Truong Thanh Lan , Weber Andrea
Published: January 2024

Previous studies found mixed results regarding a bias in credibility ratings for trivia statements made by L2 speakers in comparison to L1 speakers. Perceptual fluency, social attitudes, and pragmatic lenience have been proposed as underlying causes for the bias. The present study examined credibility ratings for L2 speakers and extended the scope of the investigation by adding the factor age of the speaker. In the present study, German native adult listeners were asked to judge the credibility of trivia statements recorded by L2 adults and L1 children in Experiment 1 and statements by L1 adults and L1 children in Experiment 2. In Experiment 1, the ratings showed no difference in credibility between the L2 adult statements and the L1 child statements. In Experiment 2, listeners rated statements from L1 child speakers as more credible than statements from L1 adult speakers, suggesting a positive bias for the credibility of children. The results are discussed in terms of their relevance for previously suggested causes contributing to a credibility bias.
Chinese-English bilinguals prefer being truthful in the native language
Authors: Yang Wenwen , Rauwolf Paul , Frances Candice , Molina-Nieto Olivia , Duñabeitia Jon Andoni , Thierry Guillaume
Published: January 2024

Bilinguals make decisions differently across languages likely due to reduced affect in the foreign language, but very little is known about language use in relation to deception. Here, we tested whether late Chinese-English bilinguals prefer to lie in the foreign language when betting against a virtual opponent. In each trial, participants freely announced bets in Chinese or English depending on whether they had drawn a coin or not. Results showed that bilinguals preferred using their native language, Chinese, over their foreign language, English, when being truthful—namely, announcing a coin when they had one. Even though participants did not choose English more to lie than to tell the truth, our results can be interpreted as a tendency to lie more in English when their behavior in the truth condition is considered the baseline. Participants also switched between languages more often after telling the truth than lying, and after telling the truth they switched more to Chinese. These results provide the first empirical evidence for strategic language use in bilinguals.
An analysis of the tripartite evolutionary game for building the ecological security barrier in the Bohai Sea under the threshold of land-sea integration
Authors: Luan Di , Cao Hongjun , Qu Tongkun
Published: January 2024

The construction of marine ecological security barriers (MESBs) is fundamental for the sustainable development of the marine ecological environment and of the marine economy, and is an important component of the strategy of land-sea integration. It is difficult to build an effective MESB simply by relying on the power of the government; therefore, to this respect, it is urgent to encourage the multiple participating subjects to work together. This study takes the Bohai Sea as the research object, and uses evolutionary game theory to construct a game model of decision-making behavior among marine enterprises, local governments, and the public in the process of construction of the MESB in the Bohai Sea, so as to explore the strategic stability equilibrium point through the analysis of the interests of the three decision makers, and lay the foundation for promoting this process. The results are as follows: (1) Local government regulation is key to promote the transformation of the Bohai Sea MESB from policy documents to behavior and from goal to practice; moreover, it directly influences whether the main sources of land-based pollution, i.e., marine enterprises, will abandon the traditional approach to production and development and actively promote the construction of the Bohai Sea MESB. (2) The supervision and reporting of the public can be used as a synergistic, auxiliary supervision means. Thanks to the government’s publicity and education, the public will develop social awareness of marine ecological security, which in turn will ensure a better public supervision of the behavior of local governments and, thus, promote the active participation of marine enterprises in the MESB in the Bohai Sea. (3) Participation costs, ecological benefits, corporate social image, fines, and other factors are the main factors considered in the strategic choice of marine enterprises, with different factors having different marginal effects at different stages. Finally, this study proposes effective measures to further clarify the roles and functions of the stakeholders in the construction of the MESB in the Bohai Sea, balance the interests of the game subjects, and provide an effective implementation path for the realization of the “Ocean Power”.
Characterization of extreme wave fields during Mediterranean tropical-like cyclones
Authors: Davison Silvio , Benetazzo Alvise , Barbariol Francesco , Ricchi Antonio , Ferretti Rossella
Published: January 2024

The Mediterranean Sea is a primary source of food, ecosystem services and economic activities and one of the most active cyclogenetic regions in the world, where the influence of orographic and morphological features of the relatively small basin plays an important role. Together with the explosive cyclogenesis, tropical-like cyclones (also called Mediterranean Hurricanes or Medicanes) are among the strongest types of storms that can be found in the Mediterranean basin, occurring predominantly in the Ionian, Balearic and Tyrrhenian sub-basins. Similarly to tropical cyclones (Hurricanes or Typhoons), these cyclonic structures are characterized by strong rotating and translating wind fields, which often lead to a combination of remotely generated swell waves and locally generated wind waves, often referred to as crossing sea states. Despite the well-known potential of Medicanes to cause significant damage near islands and coastal zones, which is predicted to intensify as a result of climate change, to date the characterization of maximum individual waves generated during these events is still lacking. In this study, we carry out the first analysis of the large-scale geographical distribution of wave maxima within the wave fields generated during three recent Medicane events using the WAVEWATCH III® spectral wave model forced by ERA5 reanalysis winds, also investigating the influence of crossing sea states on the maximum wave amplitudes with novel statistical formulations developed for such conditions. Our results show that, as in the case of tropical cyclones, several regions of the cyclone field are characterized by crossing sea states, whose role in the formation of the maximum individual waves occurring near the eye of the storm was found to be confined. Furthermore, extreme wave predictions accounting for the local crossing conditions yield differences up to 5% compared to standard statistical distributions.
Broadband high-resolution direction of arrival estimation using the generalized weighted Radon transform
Authors: Lu Mingyang , Sun Dajun , Gulliver T. Aaron , Lv Yunfei , Mei Jidan
Published: January 2024

Traditional direction of arrival (DOA) estimation algorithms typically have poor spatial resolution and robustness. In this paper, we propose a broadband high-resolution DOA estimation method based on the generalized weighted Radon transform (GWRT). The array signal can be converted into the frequency-wavenumber (f-k) domain using the conditional wavenumber spectrum function (CWSF). Then, a linear integral mathematical model for high-resolution DOA estimation is derived by transforming the f-k domain into the azimuth-energy domain using the GWRT. Computer simulation and sea trials were conducted to validate the feasibility and performance of the proposed method. The results obtained indicate that the proposed method yields a lower sidelobe level and can more effectively suppress the output energy in the non-target direction when compared to the conventional beamforming (CBF), steered minimum variance (STMV), and deconvolution (DCV) methods. Further, the proposed method provides improved spatial resolution and robustness in a multi-target environment.
Study on mechanical properties and self-sensing properties of sprayed high-performance concrete containing glass aggregate
Authors: Wang Jing , Wang Tianren , Zhang Yunlong , Qian Xuesong
Published: January 2024

Using glass sand as a substitute for sand in high-performance concrete not only conserves resources but also helps protect the environment. This study replaced manufactured sand with glass sand and added carbon fiber to prepare high-performance shotcrete. Its mechanical and self-sensing properties were then tested separately. The findings suggest that with an increase in glass sand content, the compressive strength of high-performance shotcrete initially rises and subsequently declines. When the replacement ratio of glass sand is 75%, the compressive strength exhibits its maximum value, whereas an increase in the glass sand content leads to a reduction in both splitting tensile strength and flexural strength. Although increasing carbon fiber content does not significantly contribute to compressive strength, it significantly improves flexural strength and splitting tensile strength. In addition, when testing the self-sensing performance of the material, it was found that its self-sensing performance increased significantly with increasing carbon fiber content but decreased with increasing glass sand content. Finally, an Ansys APDL simulation using the relevant parameters of the optimal group of mechanical properties was performed to model a tunnel and verify its feasibility and validity. This study provides a theoretical and practical reference for future engineering applications.
Prediction of flow stress and microstructure evolution mechanism during thermal tensile process of ZK60 alloy
Authors: Liu Fangjia , Yang Chong , Liao Zijun , Wu Hairui
Published: January 2024

In this work, the hot deformation behavior and microstructure evolution of ZK60 alloy are investigated. Meanwhile, constructive models and hot processing maps of ZK60 alloy during thermal tension are also established. Toward these ends, thermal tensile tests were performed at elevated deformation temperatures (523 K–673 K) and wide-ranging strain rates (0.0005 s−1 to 0.1 s−1). The findings indicated that as the tensile temperature increases and the strain rate decreases, the flow stress exhibited a decrease. To better evaluate the flow behavior of the alloy, Arrhenius model coupled strain effects and particle swarm optimization support vector machine (PSO-SVM) regression model are developed. Both the developed Arrhenius model and PSO-SVM regression model could depict the flow stress of the hot deformation ZK60 alloy. However, the results comparison revealed that the PSO-SVM regression model provides a more accurate prediction of the stress in the studied alloy with the AARE and R of 1.12% and 0.9984, respectively. The microstructure observation revealed that the primary softening mechanism in the alloy is predominantly dynamic recrystallization (DRX). Using the created hot processing map, the stability processing areas for this alloy were concentrated in the range of 573 K–653 K with a strain rate of 0.001 s-1 to 0.08 s-1. The described model is implemented in the finite element software. Then, the wire-drawing process of ZK60 alloy is also simulated.
Omadacycline for the treatment of severe pneumonia caused by Chlamydia psittaci complicated with acute respiratory distress syndrome during the COVID-19 pandemic
Authors: Wang Dao-Xin , Xiao Ling-Xi , Deng Xin-Yu , Deng Wang
Published: January 2024

Introduction

Chlamydia psittaci infection in humans is a rare cause that mainly present as community-acquired pneumonia. Severe Chlamydia psittaci pneumonia can lead to acute respiratory distress syndrome (ARDS), septic shock, or multiple organ dysfunction with a mortality rate of 15%–20% before accurate diagnosis and targeted treatment. Metagenomic next-generation sequencing (mNGS) has an advantage in achieving early diagnosis. In the study, omadacycline implementation was described to provide a better understanding of effectiveness in severe psittacosis pneumonia with ARDS.

Methods

Sixteen patients with severe psittacosis pneumonia with ARDS were selected between September 2021 and October 2022. They were diagnosed using mNGS and treated with omadacycline. Retrospective analysis of clinical manifestations, laboratory data, disease progression, diagnostic tool, treatment, and prognosis was summarized.

Results

Common symptoms included fever, dyspnea, and cough. All patients developed ARDS, accompanied by septic shock (43.7%) and pulmonary embolism (43.7%). Laboratory data showed normal leucocytes, increased creatine kinase isoenzyme, and decreased albumin with liver dysfunction in most patients. All patients had increased neutrophils, C-reactive protein, procalcitonin, and D-dimer with decreased lymphocytes. Airspace consolidation, ground glass opacity, and pleural effusion were found on chest CT. mNGS results were obtained in 24–48 h to identify the diagnosis of Chlamydia psittacosis. All patients received mechanical ventilation with omadacycline treatment. Fourteen patients experienced complete recovery, while the other two patients died from multidrug-resistant bacterial infection and renal failure.

Conclusion

mNGS has a significant value in the diagnosis of Chlamydia psittaci infection. Timely treatment of omadacycline can improve prognosis and provide a promising new option for the treatment of severe Chlamydia psittaci pneumonia with ARDS.
Knowledge and awareness of nicotine, nicotine replacement therapy, and electronic cigarettes among general practitioners with a special interest in respiratory medicine in China
Authors: Zhong Qian , An Kang , Wu Zengxiang , Zhang Haijun , Li Shengxi , Zhang Lin , Li Caizheng , Li Heting , Zhuo Ga Qi Mei , Yang Zong De Ji , An Zhenmei
Published: January 2024

Objectives

This study aimed to assess the knowledge and awareness of nicotine, nicotine replacement therapy (NRT), and electronic cigarettes (e-cigarettes) among general practitioners with a special interest (GPwSIs) in respiratory medicine.

Methods

A cross-sectional study was conducted from October 2021 to February 2022. Knowledge and awareness were compared among smokers and non-smokers, as well as different age and gender groups.

Results

The study consisted of 102 GPwSIs from 21 cities in Sichuan Province, China. Most respondents would recommend NRT for long-term use. Only a few believed that e-cigarettes are an effective means of smoking cessation and 71.6% would not recommend e-cigarettes as a substitute for cigarettes to their patients. Additionally, the majority did not regularly provide extensive help to assist patients in quitting smoking and needed smoking cessation counseling training.

Conclusion

GPwSIs in respiratory medicine in China could have a relatively low level of knowledge and awareness regarding nicotine, NRT, and e-cigarettes. The study highlights the need for smoking cessation training among GPwSIs to improve their knowledge and provide better assistance to patients who want to quit smoking.
Blood–brain barrier breakdown, central nervous system cell damage, and infiltrated T cells as major adverse effects in CAR-T-related deaths: a literature review
Authors: Del Duca Fabio , Napoletano Gabriele , Volonnino Gianpietro , Maiese Aniello , La Russa Raffaele , Di Paolo Marco , De Matteis Serena , Frati Paola , Bonafè Massimiliano , Fineschi Vittorio
Published: January 2024

Background

CAR-T-related deaths observed worldwide are rare. The underlying pathogenetic mechanisms are the subject of study, as are the findings that enable diagnosis. A systematic literature search of the PubMed database and a critical review of the collected studies were conducted from the inception of this database until January 2023. The aim of the study is to determine when death is related to CAR-T cell therapy and to develop a shareable diagnostic algorithm.

Methods

The database was searched by combining and meshing the terms (“CAR-t” OR “CART”) AND (“Pathology” OR “Histology” OR “Histological” OR “Autopsy”) AND (“Heart” OR “Cardiac” OR “Nervous System” OR “Kidney” OR “Liver”) with 34 results and also the terms: [(Lethal effect) OR (Death)] AND (CAR-T therapy) with 52 results in titles, abstracts, and keywords [all fields]. One hundred scientific articles were examined, 14 of which were additional records identified through other sources. Fifteen records were included in the review.

Results

Neuronal death, neuronal edema, perivascular edema, perivascular and intraparenchymal hemorrhagic extravasation, as well as perivascular plasmatodendrosis, have been observed in cases with fatal cerebral edema. A cross-reactivity of CAR-T cells in cases of fatal encephalopathy can be hypothesized when, in addition to the increased vascular permeability, there is also a perivascular lymphocyte infiltrate, which appears to be a common factor among most authors.

Conclusion

Most CAR-T-related deaths are associated with blood–brain barrier breakdown, central nervous system cell damage, and infiltrated T cells. Further autopsies and microscopic investigations would shed more light on the lethal toxicity related to CAR-T cells. A differential diagnosis of CAR-T-related death is crucial to identifying adverse events. In this article, we propose an algorithm that could facilitate the comparison of findings through a systematic approach. Despite toxicity cases, CAR-T therapy continues to stand out as the most innovative treatment within the field of oncology, and emerging strategies hold the promise of delivering safer therapies in future.
Testosterone and soluble ST2 as mortality predictive biomarkers in male patients with sepsis-induced cardiomyopathy
Authors: Wang Lu , Dai Wen , Zhu Ruiyao , Long Tingting , Zhang Zhaocai , Song Zhenju , Mu Sucheng , Wang Shasha , Wang Huijuan , Lei Jiaxi , Zhang Jing , Xia Wenfang , Li Guang , Gao Wenwei , Zou Handong , Li Yan , Zhan Liying
Published: January 2024

Sepsis-induced cardiomyopathy (SIC) is characterized by high mortality and poor outcomes. This study aimed to explore the relationship between testosterone and soluble ST2 (sST2) and all-cause mortality in patients with SIC. Clinical data from SIC patients at Renmin Hospital of Wuhan University from January 2021 and March 2023 were reviewed. Serum testosterone and sST2 were measured at admission. Kaplan–Meier analysis and receiver operative characteristic curve (ROC) were used to estimate the predictive values of testosterone and sST2 on 28 days and 90 days mortality of SIC. A total of 327 male subjects with SIC were enrolled in this study. During the 28 days and 90 days follow-up, 87 (26.6%) and 103 deaths (31.5%) occurred, respectively. Kaplan–Meier analysis showed significantly higher 28 days and 90 days survival in patients with higher testosterone and decreased sST2 levels (p < 0.001). Testosterone, sST2, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were significantly associated with 28 days and 90 days mortality (p < 0.05). Partial correlation analysis showed strong positive correlation between testosterone and left ventricular ejection fraction (LVEF) (p < 0.001), and negative correlation between testosterone and sST2 (p < 0.001), high-sensitivity troponin I (hs-TnI) levels (p < 0.001) and smoke history (p < 0.01). The concentrations of sST2 were positively related with E/e′ ratio (p < 0.001), and negatively correlated with TAPSE (p < 0.001). The combination of testosterone and sST2 enhanced the prediction of both 28 days [area under the ROC curve (AUC), 0.805] and 90 days mortality (AUC, 0.833). Early serum testosterone and sST2 levels could predict mortality of SIC independently and jointly. Further research is needed to determine the utility of biochemical markers in identifying high-risk patients with SIC.
The influence of “industry policy” and “financial institution” configuration effect on innovation performance of China’s biomedical industry-based on necessary condition analysis and qualitative comparative analysis
Authors: Zhang Yaqiong
Published: January 2024

Biomedical industry is a strategic emerging industry in China, especially the outbreak of the Covid pandemic. The biomedical industry is characterized by high risk, high investment, high technology and long cycle, and each stage contains risks and challenges. How to optimize the policy environment and financial environment, explore the unique “policy” and “finance” model for the development of the biomedical industry, and improve the innovation performance has become an important issue. This paper analyzes the relationship among industry policy, financial institution and innovation performance in the biomedical industry from the configuration perspective, combining necessary condition analysis (NCA) and qualitative comparative analysis (QCA) research methods, using the A-share listed enterprises in Shanghai and Shenzhen in the biomedical industry from 2012 to 2020 as the research objects. It is found that (1) individual policy preference or financial institution dimension cannot constitute a necessary condition for generating high innovation performance of biomedical company, but increasing tax incentive and raising the proportion of equity-based financing method play a significant role in generating high innovation performance; (2) four “political” and “financial “synergistic grouping paths can generate high innovation performance, including tax incentives, financial institutions’ professional level and institutional background synergistic drive type; government subsidy, financing method and financial institutions’ professional level synergistic drive type; tax incentive and financing method synergistic drive type; tax incentive and institutional background drive type. Different synergistic grouping paths represent various ways to achieve high innovation performance of biomedical enterprise. In addition, the results show that the two “political” and “financial” groupings lead to low-to-medium innovation performance, which indicates that industry policy plays a very important role in the innovation performance and that the government’s support for emerging industries through policy is a significant force for the innovation development. This paper introduces the “political” and “financial” aspects to investigate the configuration effect of industry policy and financial institutions on the innovation performance of biomedical enterprise. The findings have important theoretical and practical implications for revealing the synergistic path of high innovation performance in the Chinese biomedical industry.
Artificial intelligence for skin cancer detection and classification for clinical environment: a systematic review
Authors: Furriel Brunna C. R. S. , Oliveira Bruno D. , Prôa Renata , Paiva Joselisa Q. , Loureiro Rafael M. , Calixto Wesley P. , Reis Márcio R. C. , Giavina-Bianchi Mara
Published: January 2024

Background

Skin cancer is one of the most common forms worldwide, with a significant increase in incidence over the last few decades. Early and accurate detection of this type of cancer can result in better prognoses and less invasive treatments for patients. With advances in Artificial Intelligence (AI), tools have emerged that can facilitate diagnosis and classify dermatological images, complementing traditional clinical assessments and being applicable where there is a shortage of specialists. Its adoption requires analysis of efficacy, safety, and ethical considerations, as well as considering the genetic and ethnic diversity of patients.

Objective

The systematic review aims to examine research on the detection, classification, and assessment of skin cancer images in clinical settings.

Methods

We conducted a systematic literature search on PubMed, Scopus, Embase, and Web of Science, encompassing studies published until April 4th, 2023. Study selection, data extraction, and critical appraisal were carried out by two independent reviewers. Results were subsequently presented through a narrative synthesis.

Results

Through the search, 760 studies were identified in four databases, from which only 18 studies were selected, focusing on developing, implementing, and validating systems to detect, diagnose, and classify skin cancer in clinical settings. This review covers descriptive analysis, data scenarios, data processing and techniques, study results and perspectives, and physician diversity, accessibility, and participation.

Conclusion

The application of artificial intelligence in dermatology has the potential to revolutionize early detection of skin cancer. However, it is imperative to validate and collaborate with healthcare professionals to ensure its clinical effectiveness and safety.
Enhancing undergraduate research talents: the role of tutors in dental basic research education
Authors: Miao Xiaoyu , Chen Xuanyu , Li Jiayi , Wu Zhe , Guo Lvhua , Luo Siqi , Luo Tao , Yang Xuesong
Published: January 2024

Purpose

This study endeavors to investigate ways to optimize the role of teachers in undergraduate dental basic research education (UDBRE) with the aim of nurturing the research potential of undergraduate students.

Methods

We conducted a cross-sectional study among medical undergraduates enrolled at the School of Stomatology, Guangzhou Medical University. Descriptive statistics were employed to comprehensively analyze UDBRE’s fundamental aspects. Kendall rank correlation analysis was performed to evaluate the relationship between the quality of feedback provided by tutors to undergraduates and the students’ scientific research abilities. Additionally, multivariate logistic regression analysis was employed to uncover the factors influencing the effectiveness of UDBRE.

Results

A total of 168 medical students were surveyed with a valid response rate of 93.85%. The effectiveness of UDBRE was demonstrated by undergraduates’ self-rated research abilities, active participation in scientific research projects, and a certain amount of academic outputs. Significant and positive correlations (𝓣b> 0.5, p < 0.001) were identified between the tutor-undergraduate feedback quality and students’ self-rated scores for scientific research abilities. These abilities included developing scientific questions, designing research projects, retrieving and reading literature, academic writing, experiment operation, and analyzing and evaluating experimental results. Positive effects on students’ academic performance (p < 0.05) were observed when higher-quality feedback, an authoritative tutoring style and tutors with middle-career experience were present.

Conclusion

This study underscores the pivotal role of UDBRE in fostering the scientific research aptitude of medical undergraduates. It emphasizes the constructive influence of tutor-undergraduate feedback, authoritative teaching styles, providing valuable insights for establishing an effective mentorship framework.
Relationship between serum sodium level and sepsis-induced coagulopathy
Authors: Han Yanyu , Duan Jianfeng , Chen Ming , Huang Shijie , Zhang Beiyuan , Wang Yan , Liu Jiali , Li Xiaoyao , Yu Wenkui
Published: January 2024

Purpose

A discussion about the correlation between the level of serum sodium and sepsis-induced coagulopathy (SIC).

Materials and methods

A retrospective analysis was conducted on sepsis patients who were admitted to the Intensive Care Unit (ICU) of Nanjing Drum Tower Hospital from January 2021 to December 2022. Based on the presence of coagulation disorders, the patients were divided into two groups: sepsis-induced coagulopathy (SIC) and non-sepsis-induced coagulopathy (non-SIC) groups. We recorded demographic characteristics and laboratory indicators at the time of ICU admission, and analyzed relationship between serum sodium level and SIC.

Results

One hundred and twenty-five patients with sepsis were enrolled, among which, the SIC and the non-SIC groups included 62 and 63 patients, respectively. Compared to patients in the non-SIC group, the level of serum sodium of those in the SIC was significantly higher (p < 0.001). Multi-factor logistic regression showed serum sodium level was independently associated with SIC (or = 1.127, p = 0.001). Pearson’s correlation analysis indicated that the higher the serum sodium level, the significantly higher the SIC score was (r = 0.373, p < 0.001). Additionally, the mortality rate of patients with sepsis in the ICU were significantly correlated with increased serum sodium levels (p = 0.014).

Conclusion

An increase in serum sodium level was independently associated with an increased occurrence of SIC and also associated with the poor prognosis for patients with sepsis.
Randomized controlled trial on healthy volunteers of pharmacokinetic and antimicrobial activity of a novel hydrogel-containing chlorhexidine dressing to prevent catheter-related bloodstream infection
Authors: Masferrer Emili , Riera-Rodríguez Laura , Farré-Alins Víctor , Vilà de Muga Sandra , Arroyo-Muñoz Francisco-Javier , González-Caro María-Dolores
Published: January 2024

Introduction

Catheter-related blood stream infection (CRBSI) is one of the most relevant complications associated to the use of intravascular catheters. In this context, chlorhexidine gluconate (CHG) releasing dressings have been developed to reduce the catheter colonization rate and the risk of infection. The aim of this study is to analyze the release rate of CHG and the antimicrobial activity of a novel CHG-releasing dressing, Oper film® protect CHG, and to compare these parameters to those of the dressing Tegaderm™ CHG in healthy volunteers.

Methods

The study was performed in a cohort of 25 healthy volunteers. Two commercially available chlorhexidine-containing dressings were evaluated and compared in this study, Oper film® protect CHG and Tegaderm™ CHG. The release of CHG and the antimicrobial capacity was determined for one week.

Results

HPLC analysis revealed that both dressings have an equivalent CHG release to the skin 2 days (Oper film® protect CHG, 321 μg/cm2; Tegaderm™ CHG, 279 μg/cm2) and 7 days (Oper film® protect CHG, 456 μg/cm2; Tegaderm™ CHG, 381 μg/cm2) after the placement of the products in the non-disinfected back of the subjects. On the other hand, Oper film® protect CHG and Tegaderm™ CHG similarly reduced colony forming units (CFU) in cultures obtained from the skin under the CHG-containing hydrogel compared to control cultures at both 2 days (control, 3.34 log10 cfu/cm2; Oper film® protect CHG, 0.64 log10 cfu/cm2; Tegaderm™ CHG, 0.7 log10 cfu/cm2) and 7 days (control, 3.95 log10 cfu/cm2; Oper film® protect CHG, 0.11 log10 cfu/cm2; Tegaderm™ CHG, 1 log10 cfu/cm2).

Discussion

Data confirm that the recent commercially available dressing Oper film® protect CHG maintains the release of CHG and the antimicrobial activity during at least 7 days, and possesses equivalent drug release and antimicrobial action to Tegaderm™ CHG.
AI and professional liability assessment in healthcare. A revolution in legal medicine?
Authors: Terranova Claudio , Cestonaro Clara , Fava Ludovico , Cinquetti Alessandro
Published: January 2024

The adoption of advanced artificial intelligence (AI) systems in healthcare is transforming the healthcare-delivery landscape. Artificial intelligence may enhance patient safety and improve healthcare outcomes, but it presents notable ethical and legal dilemmas. Moreover, as AI streamlines the analysis of the multitude of factors relevant to malpractice claims, including informed consent, adherence to standards of care, and causation, the evaluation of professional liability might also benefit from its use. Beginning with an analysis of the basic steps in assessing professional liability, this article examines the potential new medical-legal issues that an expert witness may encounter when analyzing malpractice cases and the potential integration of AI in this context. These changes related to the use of integrated AI, will necessitate efforts on the part of judges, experts, and clinicians, and may require new legislative regulations. A new expert witness will be likely necessary in the evaluation of professional liability cases. On the one hand, artificial intelligence will support the expert witness; however, on the other hand, it will introduce specific elements into the activities of healthcare workers. These elements will necessitate an expert witness with a specialized cultural background. Examining the steps of professional liability assessment indicates that the likely path for AI in legal medicine involves its role as a collaborative and integrated tool. The combination of AI with human judgment in these assessments can enhance comprehensiveness and fairness. However, it is imperative to adopt a cautious and balanced approach to prevent complete automation in this field.