bluuebunny/crossref_metadata_2025_split huggingface dataset:
P-759. Re-examining Respiratory Isolation for Tuberculosis: A review of isolation practices for people diagnosed with tuberculosis at a major academic medical center in 2022-2023
Authors: Moreira Aliya , Hassneiah Dana , Nathavitharana Ruvandhi 
Published: January 2025

Abstract

Background
Respiratory isolation to reduce tuberculosis (TB) transmission is routinely implemented yet adversely affects employment, education, food/housing security, and mental health. The National TB Coalition of America recently published guidelines on shortened respiratory isolation for TB in community settings, recommending five days of isolation post initiation of effective treatment in most circumstances. We sought to examine current isolation practices for people diagnosed with TB at an academic medical center.Table 1:Baseline characteristics of the study group

Methods
We undertook a retrospective record review to identify patients for whom the ICD-10 codes A15-A19 for TB had been utilized at Beth Israel Deaconess Medical Center in Boston from 2022-2023. We included people with TB disease and extracted data that included duration of isolation, results of smear, culture, and Xpert MTB/RIF testing, timing of smear conversion, documented discharge requirements, and patient perspectives on isolation requirements. Quantitative data were analyzed descriptively. Qualitative data were analyzed thematically.Table 2:Duration of admission, isolation, and treatment in relation to different factors (Mean ± SD)

Results
After reviewing 173 records, we identified 14 patients diagnosed with TB disease during a hospitalization, of whom eight had pulmonary TB (PTB), five had extrapulmonary TB (EPTB), and one had both PTB/EPTB. Six (43%) had some form of drug-resistance, predominantly isoniazid-resistant TB (29%). The majority (93%) were non-US born. The duration of inpatient isolation was 15.2 ± 8.3 days (mean ± standard deviation) (16.2 days for PTB, 13.4 days for EPTB). After TB treatment was initiated, patients remained in isolation for 10.6 ± 10.1 days (11.9 days for PTB, 8.2 days for EPTB). Inpatient stays were extended by 1.6 days after patients were documented as medically ready for discharge due to the need for Department of Public Health clearance. Qualitative data highlighted patients with TB experienced adverse events such as social isolation, stigma, language barriers, and delirium.Table 3:Key quotations from chart documentation regarding impact of isolation

Conclusion
Our data highlight the long duration of inpatient isolation for people with TB, including after the initiation of treatment and in those with EPTB, and its negative impacts on patients. Implementation research is needed to understand the acceptability and reach of new isolation recommendations.

Disclosures
All Authors: No reported disclosures
P-766. Patient Experiences of Deferring Treatment for Further Evaluation and Monitoring after a Trace Xpert Ultra Result
Authors: Visek Caitlin , Mukiibi James , Nantale Mariam , Nalutaaya Annet , Biché Patrick , Sung Joowhan , Kayondo Francis , Akampurira Joab , Mukiibi Michael , Kiyonga Rogers , Katamba Achilles , Kendall Emily A 
Published: January 2025

Abstract

Background
For people with “trace” sputum results (PWTS) on Xpert MTB/RIF Ultra, further evaluation and monitoring rather than reflex TB treatment may be appropriate. Patients’ preferences regarding treatment deferral have not been explored.
Reported anxiety among participants with trace positive sputum over 6 months of follow up

Methods
We enrolled PWTS identified through community screening or clinic-based diagnostic evaluation, in Kampala, Uganda. They underwent extensive clinical, microbiological, and radiographic TB evaluation, and those with uncertain TB status were offered treatment deferral with periodic reassessment for up to 2 years. At 0, 1, and 6 months, PWTS were asked about their experience, including their perceived likelihood of having TB and associated anxiety, whether they would choose treatment if not being closely monitored, and the acceptability of extensive diagnostic testing. PWTS and matched Xpert-positive and -negative individuals were asked to choose, in a vignette, between more sensitive and more specific TB tests.
Reported inclination toward TB treatment among participants with trace positive sputum over 6 months of follow up

Results
We enrolled 273 PWTS (128 from community; 145 from clinics), 217 people with positive results, and 252 with negative Xpert results. Among PWTS, treatment was recommended or started within 1 day of enrollment for 32/273 (12%), mostly based on recommendations of non-study clinicians in people with HIV, and within 1 month for 98/273 (36%), of whom 52/98 (53%) had Xpert or culture confirmation. Most PWTS (220/272, 81%) reported little to no anxiety at baseline and continued to report low levels of anxiety over time if they remained untreated, while many (25/52, 48%) PWTS with moderate or high initial levels of anxiety started treatment within 1 month (Fig 1). At baseline, 153/272 (56%) said they would seek TB treatment if monitoring were not offered, and most who remained untreated maintained the same preference over time (Fig 2). Most participants, including 65% of PWTS, preferred a highly sensitive test despite the risk of false positives when positive predictive value was 50%, and 47% favored sensitivity even when positive predictive value decreased to 17% (Table 1). PWTS rated laboratory and radiologic testing as valuable and minimally burdensome.
Table 1
Participants’ preferences regarding TB test sensitivity versus specificity

Conclusion
From the patient perspective, close monitoring rather than immediate treatment after a trace result may be acceptable.

Disclosures
All Authors: No reported disclosures
P-785. Construction and Validation of a Clinical Diagnostic Model for Active Tuberculosis in Patients with Systemic Lupus Erythematosus
Authors: Zhang Lifan , Zhao Lidan , Liu Yuchen , Shi Xiaochun , Liu Xiaoqing 
Published: January 2025

Abstract

Background
Systemic Lupus Erythematosus (SLE), an autoimmune disease, involves multiple immune dysfunctions. The progression of M.tb infection is closely related to the host's immune status. Abnormal immune functions increase the risk of active tuberculosis (ATB), particularly in patients with autoimmune diseases. Meanwhile, both SLE and ATB’s clinical symptoms includes several overlaps, resulting in a diagnosis challenge when without etiological evidence.
Forest plot showing the results of univariate logistic regression in the discovery cohort

Methods
We included 66 SLE patients with ATB hospitalized at Peking Union Medical College Hospital from 1975 to 2017, and 132 age matched SLE patients without ATB as the discovery cohort. An external validation cohort was drawn from the ETHERTB cohort, which covers rheumatic and immune disease patients from 13 tertiary hospitals in China. Univariate Logistic regression analysis was used in the discovery cohort to identify risk factors for ATB among SLE patients. A neural network algorithm was used to construct the clinical diagnostic model. The external validation cohort was used to validate the diagnostic potential of our model.
models developed
Importance of all risk factors (A) and variables included in our model (B). Neural network-based model architecture (C).

Results
In the discovery cohort, fever (OR=47.2), night sweats (OR=5.3), cough (OR=14.5), weight loss (OR=70.1), moderate to severe SLE disease activity (SLEDAI-2000 5-9, OR=5.1; SLEDAI-2000≥10, OR=6.7), close contact with TB (OR=7.8), T-SPOT.TB (OR=1.004), and the use of specific immunosuppressants such as azathioprine (AZA) (OR=3.4), leflunomide (LEF) (OR=2.7), cyclosporine A (CYSA) (OR=3.8), and a maximum daily dose of 30 mg of corticosteroids (OR=14.9) were identified as risk factors for ATB in SLE patients. Variables including fever, night sweats, cough, weight loss, TB contact, T-SPOT.TB, SLEDAI-2000, and maximum daily corticosteroids dose were included in the diagnostic model based on an importance threshold of 0.5. The model's AUC was 0.96(95%Cl: 0.927-0.996), with a sensitivity of 85.3%, specificity of 96.0%, and an accuracy of 93.7%. In the external validation cohort, the AUC was 0.88(95Cl: 0.800-0.963), sensitivity 84.4%, specificity 88.1%, and accuracy 88.0%.
Evaluation of diagnosis model
Distribution of risk scores in the discovery cohort (A) and validation cohort (B), and ROC curves in the discovery (C) and validation cohorts (D).

Conclusion
Our study constructed and validated a diagnostic model for ATB in SLE patients. The model demonstrated good diagnostic potential, which could assist in diagnosis in the absence of etiological evidence.

Disclosures
All Authors: No reported disclosures
On the Role of Loewner Entropy in the Statistical Mechanics of the 2D Ising System
Authors: Shibasaki Yusuke 
Published: January 2025

Abstract
The fundamental properties of the 2D Ising system were formulated using the Loewner theory. We focus on the role of the complexity measure of the 2D geometry, referred to as the Loewner entropy, to derive the statistical-mechanical relations of the 2D Ising system by analyzing the structure of the interface (i.e. the phase separation line). For the mixing property of the discrete Loewner evolution, we assume that the Loewner driving force ${\eta }_s( n )$ obtained from the interface has a stationary property, where the autocorrelation function $\langle {{\eta }_s( 0 ){\eta }_s( n )} \rangle$ converges in the long time limit. Using this fact, we reconstruct the continuous Loewner evolution driven by the diffusion process whose increments correspond to the sequence of ${\eta }_s( n )$, and derive the fractal dimension of the generated curve. We show that these formulations lead to a novel expression of the Hamiltonian and the grand canonical ensemble of the system, which also are applicable to the nonequilibrium state of the system. In addition, the relations on the central limit theorem governing the local fluctuation of the interface, the nonequilibrium free energy, and the fluctuation–dissipation relation were derived using the Loewner theory. The present results suggest a possible form of a complexity-based theory for 2D statistical-mechanical systems that is applicable to nonequilibrium states.
Performance of spondyloarthritis-specific health utilities based on the ASAS Health Index: an ancillary analysis from the ASAS-HI validation study
Authors: Calixto Omar-Javier , Kiltz Uta , Bautista-Molano Wilson , Boonen Annelies , van Kuijk Sander , Essers Ivette , van der Heijde Désirée , Braun Juergen , Baraliakos Xenofon 
Published: January 2025

Abstract

Objectives
To compare the Spondyloarthritis (SpA)-specific universal utility estimation from ASAS Health Index (U-ASAS-HI) with generic utilities and to understand the contribution of health outcomes, personal- and country-level factors to the U-ASAS-HI.

Methods
This was an ancillary analysis of the ASAS-HI international validation study. SpA patients who completed the ASAS-HI, 5-level EuroQol-5D (EQ-5D-5L) and Short Form-36 (SF-36) questionnaires were selected, and utilities calculated. Correlations between U-ASAS-HI and generic utility values were tested. Potential explanatory variables were evaluated in a linear multivariable mixed-effects model analysis with multilevel modelling fitted by country.

Results
The number of patients included was 1425, with a mean (s.d.) age of 42 (13.5) years, with 65% male. The mean (s.d.) utility scores were for EQ-5D-5L 0.75 (0.11), for short-form 6-dimension (SF-6D) 0.72 (0.24), and for U-ASAS-HI 0.42 (0.29). Correlation between U-ASAS-HI and EQ-5D-5L and SF-6D was strong (r = 0.75 and r = 0.72, respectively; P &lt; 0.001). The linear mixed-effects model showed that worse disease activity (ASDAS) and lower physical function (BASFI) were associated with lower U-ASAS-HI. Additionally, younger age, female gender, higher comorbidity score and symptoms of depression were associated with lower U-ASAS-HI. SpA subtype had no influence on health utility. The random effects model indicated an intercept s.d. of 0.045 with a 5.5% variance ratio between countries and the total U-ASAS-HI variation.

Conclusion
The U-ASAS-HI captures the physical and mental impact of SpA, as well as personal contextual factors such as age, gender and comorbidities. The influence of the country of residence seems negligible. The U-ASAS-HI algorithm has sufficient support to be used in health economic evaluations for SpA patients across different countries.
Evaluating the efficacy of very high-dose oral prednisolone in West syndrome: in Uttar Pradesh, India, a resource-limited setting
Authors: Prabha Chandra , Kanta Chandra , Bhriguvanshi Arpita , Verma Sanjeev Kumar 
Published: January 2025

Abstract
Managing West syndrome (WS) becomes arduous in regions where access to adrenocorticotropic hormone and vigabatrin is limited, particularly in developing nations. This study aimed to evaluate the efficacy of very high-dose oral prednisolone in children diagnosed with WS. Children aged 2–36 months presenting with WS were consecutively enrolled and given oral prednisolone @ 8 mg/kg/day (maximum 40 mg) for two weeks followed by tapering doses over the subsequent two weeks. Weekly follow-ups were conducted until therapy completion, followed by bi-weekly assessments for three months. Responses (primary outcome) were assessed at two weeks and categorized as complete (spasm-free), partial (&gt;25% reduction), or no response (&lt;25% reduction). Neurodevelopmental outcomes, clinical–radiological profiles, safety, and therapy response predictors were also assessed. Of the 80 children, 73.7% exhibited a complete response, while 21.2% and 5% showed partial and no response, respectively. The mean age at spasm onset and presentation was 4.98 ± 4.37 months and 14.36 ± 7.13 months, respectively. Perinatal brain injury accounted for 87.5% of WS cases. Adverse effects, including weight gain (8.7%), irritability, hypertension, and disturbed sleep (3.7% each), were noted. Spasm cessation at 2 weeks, appropriate gestational age, and the absence of other seizure types were predictive of a favorable response. High-dose oral prednisolone emerges as an effective, low-cost, and safer first-line treatment option with minimal adverse effects in the Uttar Pradesh region in India, and this would likely be true in other resource-limited settings.
Additive effects of curcumin and glucosamine on knee function, cartilage protection, and subchondral bone preservation in a post-traumatic osteoarthritis rat model
Authors: Li Jiming , Huo Shaofeng , Huang Cuishan , Cheng Wenxiang , Liang Shan , Chen Wenrong , Fang Suqiong , Qin Ling , Chen Peng , Lin Ligen , Wang Xinluan 
Published: January 2025

Background:
Osteoarthritis (OA) increasingly become a global public health concern. Curcumin and glucosamine, both widely used as dietary supplements for OA, have shown distinct therapeutic effects. However, curcumin’s low bioavailability and the debated efficacy of glucosamine limit their broader clinical use.

Objective:
Investigate the combined effects of curcumin and glucosamine on knee function, subchondral bone preservation, and cartilage protection in post-traumatic OA rat.

Methods:
Post-traumatic OA was induced in Lewis rats through medial meniscus transection (MMT) surgery. Rats were treated for 8 weeks with curcumin phospholipid liposome (C, 120 mg/kg/day), glucosamine (G, 190 mg/kg/day), or a combination of both (CG, C: G=1:3, 63/190 mg/kg/day). Knee width was measured weekly, and weight-bearing was assessed twice weekly. Subchondral bone and cartilage changes were analyzed using micro-CT, toluidine blue staining, and the OARSI (Osteoarthritis Research Society International) score. Collagen II expression in cartilage was evaluated by immunohistochemistry.

Results:
Curcumin phospholipid liposomes significantly reduced joint swelling by up to 4.1% (P<0.001) and improved weight-bearing force by 24.2% at week 2 (P<0.01) and 14.9% at week 8 (P<0.05) in comparison with the MMT group. Analysis of Micro-CT indicated an increase in bone volume (11.6%) and bone mineral content (13.0%) (P<0.05). Histological analysis showed a 28.8% reduction in OARSI scores (P<0.01) and a 53.1% increase in collagen II expression (P<0.005). Glucosamine treatment reduced joint swelling by up to 5.7% (P<0.0001), improved weight-bearing by 31.6% (P<0.001) at week 2, and significantly increased bone volume (30.4%) and bone mineral content (29.9%) (P<0.05). The combined treatment further reduced swelling by up to 6.6% (P<0.0001) and improved the R/L weight-bearing ratio by 24.7% (P<0.0001) at week 8. It also enhanced bone volume (28.6%), bone mineral content (29.7%, and anisotropy degree (59.3%) (P< 0.05). Additionally, the combination therapy decreased OARSI scores by 27.1% (P<0.01) and enhanced the expression of collagen II by 54.2% (P<0.005), indicating enhanced cartilage and subchondral bone protection.

Conclusion:
Curcumin showed superior protection for cartilage, while glucosamine mainly benefited subchondral bone. Combined treatment demonstrated additive effects, improving both knee structure and physical function in OA, offering enhanced pain relief, anti-inflammatory action, and joint preservation.
Short-term costs of alcohol-associated hepatitis care in different clinical settings
Authors: Nguyen Chi Mai , Su Jing , Li Yang , Healey Ryan , Jiang Shihui , Li Jiangqiong , Chalasani Naga , Gawrieh Samer , Liangpunsakul Suthat , Tu Wanzhu 
Published: January 2025

Background:
Alcohol-associated hepatitis (AH) leads to high rates of mortality and health care costs. Understanding the immediate costs after an AH diagnosis and identifying key cost factors is crucial for health care policies and clinical decisions.

Objectives:
This study quantifies medical costs within 30 days of an AH diagnosis across outpatient (OP), emergency department (ED), and inpatient (IP) settings. It also explores concurrent diagnoses and their effects on care costs.

Methods:
We conducted a retrospective cohort study using deidentified data from Optum’s Clinformatics Data Mart. The cohort included individuals aged 21 years and older diagnosed with AH from January 1, 2016, to September 30, 2023. Patients were categorized by care setting (OP, ED, or IP). Costs were calculated for the 30 days before and after AH diagnosis and adjusted to 2023-dollar values. Comorbidities were identified using Elixhauser comorbidity software, and multivariable linear regression models were used to analyze medical costs.

Results:
The cohort included 34,974 individuals diagnosed with AH: 8048 in OP (23%), 2736 in ED (7.8%), and 24,190 in IP (69.2%). Average spending in the 30 days prior to AH diagnosis was $7334 for OP, $5740 for ED, and $14,458 for IP. Following AH diagnosis, average costs rose to $8345 for OP, $20,990 for ED, and $88,655 for IP, reflecting increases of 14%, 266%, and 413%, respectively. Significant cost drivers in IP included comorbidities associated with moderate-to-severe liver disease, metabolic syndrome, liver transplant, and mortality during the 30-day follow-up period.

Conclusions:
Immediate costs following an AH diagnosis are substantial, particularly for IP care. Costs increase significantly with high-cost comorbidity clusters and among patients who die, underscoring the need for effective management of comorbidities in AH care.
Hepatocyte Rho-associated kinase signaling is required for mice to survive experimental porphyria-associated liver injury
Authors: Herrera Jessica M. , Weng Yun , Lieberthal Tyler J. , Paoletti Marcus , Chang Tammy T. 
Published: January 2025

Background:
Rho-associated kinases 1 and 2 (ROCK1 and ROCK2) regulate critical cell functions, including actomyosin contractility, apoptosis, and proliferation. Some studies suggest that ROCK inhibition may serve as a treatment for liver fibrosis. More investigation is needed to understand the role of hepatocyte ROCK signaling in vivo, especially in the context of profibrotic liver injury.

Methods:

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mice were given adeno-associated virus serotype 8 (AAV8)-thyroid hormone-binding globulin (TBG)-Cre to produce targeted gene deletion in hepatocytes, or given AAV8-TBG-Null to generate littermate controls (WT). Mice were then placed on a 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet to induce liver injury.

Results:
Upon DDC-induced liver injury, mice with hepatocyte-specific deletion of ROCK1 alone (R1 KO) or ROCK2 alone (R2 KO) demonstrated minimal differences compared to WT. In contrast, mice with hepatocyte-specific deletion of both ROCK1 and ROCK2 (DKO) showed pervasive early mortality, increased hepatocellular injury, and decreased hepatic function. DDC-injured DKO mice demonstrated markedly distorted liver histology characterized by large cavities in the parenchyma. RNA-seq analysis showed upregulation of cell death, inflammatory, and profibrotic pathways in DDC-injured DKO liver as compared to DDC-injured WT liver. Cdkn1a (gene encoding p21) was one of the most highly upregulated genes in the DKO liver in response to DDC-induced injury. Correspondingly, there was increased hepatocyte nuclear localization of p21 and expression of cleaved caspase-3 in DDC-injured DKO liver, consistent with the activation of p21-mediated caspase-3–dependent apoptotic cell death pathways. ROCK1/ROCK2-deficient primary hepatocytes demonstrated increased susceptibility to both caspase-3–mediated apoptosis and caspase-3–independent forms of cell death in a cell intrinsic manner.

Conclusions:
ROCK signaling plays a critical role in mediating hepatocyte cell survival pathways in response to liver injury.
Visual and Orthoptic Development After DSAEK for CHED in Children Younger than 8 years: Case Series and Literature Review
Authors: Neugebauer Antje , Gietzelt Caroline , Fricke Julia , Hedergott Andrea , Bachmann Björn , Cursiefen Claus 
Published: January 2025

Purpose:
Congenital hereditary endothelial dystrophy (CHED) impairs the sensitive phase of visual development. We examined results of Descemet stripping automated endothelial keratoplasty (DSAEK) for CHED regarding the critical period for amblyogenic factors.

Methods:
Retrospective analysis of 11 eyes of 6 consecutive patients with CHED younger than 8 years treated with DSAEK and a PubMed-based literature search on management and optimal timing of the intervention.

Results:
Our series encompasses 11 eyes of 6 children who received 6 DSAEKs and 5 non- or partial DSAEKs. Mean age at surgery was 3.45 years (0.59–7.44). In 3 eyes, further interventions were necessary, 2 were Re-DSAEKs for early graft failure. At final visit, all 10 transplants with a follow-up >1 month were clear, and 2 corneas showed slight stromal opacification. Final visual acuity was 0.8–0.2 logMAR (mean 0.49) in 9 eyes with sufficient follow-up time in cooperative patients. Mean follow-up was 47 months. Six eyes showed postoperative hyperopia > 5D. We found literature reports on 58 DSAEK/non-DSAEK procedures in 36 children with CHED under 8 years, including 11 children under 2 years. Data show a trend for better visual outcomes of DSAEK in CHED at younger age. Non-DSAEKs seem to be associated with more graft complications.

Conclusions:
DSAEK for CHED in young children is an option for achieving corneal transparency with a trend toward better outcomes of surgery at younger age. The special features of amblyopia in CHED make studies with follow-up times to reach age for reliable acuity testing and recovery from amblyopia worthwhile.