Strict Selection Criteria Research Articles

Ocular graft host disease after allogeneic stem cell transplant: unique risk factors and outcomes

Objective The aim of this study was to formulate a retrospective study investigating the ocular findings and associated risk factors in long-term survivors after allogenic-hematopoietic stem cell transplantation (HSCT) in Saudi Arabia. Patients and methods This observational study was conducted on patients who underwent HSCT from 1996 to 2016 at King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. The study included 72 patients who were human leukocyte antigen-matched donors with identical matched sibling donors. Peripheral blood was the source of stem cells in 61 patients. The ophthalmological examination included visual acuity (VA) testing, refraction, tear break-up time, Schirmer’s test, slit-lamp biomicroscopy, and dilated ophthalmoscopy. Chronic ocular graft-versus-host disease (GVHD) inclusion was based on strict selection criteria. The patients identified with mild to moderate ocular GVHD had less than or equal to three corneal staining, 13–32 points ocular surface disease index (OSDI), and Schirmer’s test of 6–15 mm were classified as group 1, while those with severe ocular GVHD defined as having more than four corneal stainings, more than or equal to 33 points OSDI, and less than or equal to 5 mm Schirmer’s test were classified as group 2. Impairment of VA was classified as mild (20/22–20/50), moderate (20/70–>20/200), or severe (≤20/200) impairment. Results Chronic GVHD was diagnosed in 394 patients within the first 5 years after transplantation. Ocular GVHD was detected in 81 (20.56%) patients. They were classified into group 1 (65 patients, 80.25%) with mild to moderate ocular GVHD and group 2 (16 patients, 19.75%) with severe ocular GVHD. All patients had OSDI ranging from more than or equal to 13 to more than or equal to 33. Retinal changes were detected in five patients, optic disc changes in two patients, steroid-induced proliferative diabetic retinopathy in three patients, and old branch retinal vein occlusion in one patient. All patients with identical matched sibling donor showed normal or mild to moderate impaired VA except for two patients. All patients responded to topical eye drops except for nine who required surgical procedures. Normal or mild impaired VA was reported in 59 patients with statistical significance (P=0.0053), while 42 male patients versus 29 females had normal or mild impaired VA with a statistically significant difference (P=0.0179). Conclusion Ocular GVHD is a complex disease in our unique population. Every patient before allogenic HSCT be referred to a cornea specialist to evaluate the baseline parameters for the pre-HSCT diagnosis of dry eye disease.

Prevalence and Causes of Blood Deferral in Tertiary Care Teaching Hospital Islamabad

Background: A blood transfusion is a vital and potentially life-saving operation in modern therapeutic and surgical procedures; yet, it requires a sufficient supply of safe blood from a healthy donor. In addition to laboratory testing of blood bags for infectious illnesses, appropriate, safe, and healthy donor selection is required. On the other hand, the loss of valuable blood components that are accessible for transfusion results from fit donors deferring. Understanding the reasons for both temporary and permanent deferrals can help us prevent this, put our knowledge into practice. The current study aimed to assess the incidence and reasons behind blood donor deferrals at Islamabad teaching hospital that provides tertiary care. Methods: This cross-sectional study was conducted at Dr. Akbar Niazi Teaching Hospital’s blood bank. All Blood donors reporting to donate blood at a blood bank between the periods of 1st September 2020 to 24th December 2021 were included in the study. The data was obtained by interviewing the donors using specially designed Performa. The collected data of deferred blood donors was analyzed using SPSS version 21. Results: Out of a total of 2054 blood donors, 523 (25.5%) were deferred due to different reasons and ineligible to donate blood. Out of 523 deferred donors, 455(87%) were males and 68(13%) were females. The average age of the blood donors was 26(4.2%) and most blood donors were between 20 to 40 years age. The common causes for deferral were low hemoglobin (41.3%), recent COVID-19 vaccination (12.6%) and increased TLC (7.1%). Hepatitis B virus 39(7.5%), Hepatitis C virus (4.4%), HIV 5(1.0%) and Syphilis 18 (3.4%). Conclusion: The most frequent reasons for delay were elevated TLC count, recent COVID-19 immunization, and low hemoglobin levels. The cornerstone of a safe blood supply is the donor education on self-exclusion and strict selection criteria.

Quasar Island – three new z ∼ 6 quasars, including a lensed candidate, identified with contrastive learning

ABSTRACT Of the hundreds of z ≳ 6 quasars discovered to date, only one is known to be gravitationally lensed, despite the high lensing optical depth expected at z ≳ 6. High-redshift quasars are typically identified in large-scale surveys by applying strict photometric selection criteria, in particular by imposing non-detections in bands blueward of the Lyman-α line. Such procedures by design prohibit the discovery of lensed quasars, as the lensing foreground galaxy would contaminate the photometry of the quasar. We present a novel quasar selection methodology, applying contrastive learning (an unsupervised machine learning technique) to Dark Energy Survey imaging data. We describe the use of this technique to train a neural network which isolates an ‘island’ of 11 sources, of which seven are known z ∼ 6 quasars. Of the remaining four, three are newly discovered quasars (J0109−5424, z = 6.07; J0122−4609, z = 5.99; J0603−3923, z = 5.94), as confirmed by follow-up and archival spectroscopy, implying a 91 per cent efficiency for our novel selection method; the final object on the island is a brown dwarf. In one case (J0109−5424), emission below the Lyman limit unambiguously indicates the presence of a foreground source, though high-resolution optical/near-infrared imaging is still needed to confirm the quasar’s lensed (multiply imaged) nature. Detection in the g band has led this quasar to escape selection by traditional colour cuts. Our findings demonstrate that machine learning techniques can thus play a key role in unveiling populations of quasars missed by traditional methods.

The link among X-ray spectral properties, AGN structure, and the host galaxy

In this work, we compare the supermassive black hole (SMBH) and host galaxy properties of X-ray obscured and unobscured AGN. For that purpose, we used ∼35 000 X-ray detected AGN in the 4XMM-DR11 catalogue for which there are available measurements for their X-ray spectral parameters, such as the hydrogen column density, NH, and photon index, Γ, from the XMM2Athena Horizon 2020 European project. We constructed the spectral energy distributions (SEDs) of the sources, and we calculated the host galaxy properties via SED fitting analysis, utilising the CIGALE code. We applied strict photometric requirements and quality selection criteria to include only sources with robust X-ray and SED fitting measurements. Our sample consists of 1443 AGN. In the first part of our analysis, we used different NH thresholds (1023 cm−2 or 1022 cm−2) while also taking into account the uncertainties associated with the NH measurements in order to classify these sources as obscured and unobscured (or mildly obscured). We find that obscured AGN tend to live in more massive systems (by ∼0.1 dex) that have a lower star-formation rate, SFR, (by ∼0.25 dex) compared to their unobscured counterparts. However, only the difference in stellar mass, M*, appears statistically significant (> 2σ). The results do not depend on the NH threshold used to classify AGN. The differences in M* and SFR are not statistically significant for luminous AGN (log (LX,2−10 KeV/erg s−1) > 44). Our findings also show that unobscured AGN have, on average, higher specific black hole accretion rates, λsBHAR, compared to their obscured counterparts, a parameter which is often used as a proxy of the Eddington ratio. In the second part of our analysis, we cross-matched the 1443 X-ray AGN with the SDSS DR16 quasar catalogue of Wu and Shen to obtain information on the SMBH properties of our sources. This resulted in 271 type 1 AGN at z < 1.9. Our findings show that type 1 AGN with increased NH (> 1022 cm−2) tend to have higher black hole masses, MBH, compared to AGN with lower NH values at similar M*. The MBH/M* ratio remains consistent for NH values below 1022 cm−2, but it exhibits signs of increasing at higher NH values. Finally, we detected a correlation between Γ and Eddington ratios, but only for type 1 sources with NH < 1022 cm−2.

A Double-Edged Sword: Quality and Credibility of Colon Cancer Screening Content on YouTube.

Introduction Colorectal cancer (CRC) remains a significant public health challenge globally, with its pathogenesis involving the transformation of benign adenomas into malignant carcinomas. Despite advancements in screening and early detection significantly improving outcomes, the rise of digital platforms like YouTube for disseminating health information presents new challenges. Concerns over the accuracy and reliability of content underline the necessity for rigorous evaluation of these digital health education tools. Methods Our study was conducted at Nassau University Medical Center, East Meadow, New York. We meticulously analyzed YouTube videos on "colon cancer screening awareness," employing strict selection criteria to ensure both relevance and quality, focusing on English-language content with pertinent audio. Videos were evaluated for their quantitative and qualitative attributes-views, subscriber counts, likes/dislikes, comments, and content type, classifying them as scholarly or personal. We assessed video credibility through scientific accuracy using the DISCERN instrument, Global Quality Score (GQS), and Patient Education Materials Assessment Tool (PEMAT), ensuring consistency in quality and reliability evaluation among seven researchers via the intraclass correlation coefficient. These tools - DISCERN for assessing reliability and quality, GQS for evaluating overall quality, and PEMAT for understandability and actionability - facilitated a comprehensive evaluation framework. Our analysis, leveraging descriptive and inferential statistics, scrutinized differences in content quality between academic and private institutions, employing t-tests to identify statistically significant disparities. The study utilized Microsoft Excel (version 16.73, Microsoft Corporation, Redmond, Washington, United States) and IBM SPSS Statistics for Windows, version 29.0 (released 2022; IBM Corp., Armonk, New York, United States). for robust data processing and analysis, confirming the educational value and trustworthiness of the examined YouTube content. Results Our study of 156 YouTube videos on educational content, split between academic (68 videos) and private sources (88 videos), revealed significant quality differences. Using the DISCERN, PEMAT, and GQSmetrics, academic videos consistently outperformed private ones, with significant margins: DISCERN (54.61 vs. 34.76), PEMAT (3.02 vs. 2.11), and GQS (3.90 vs. 2.02), supported by low p-values indicating a statistically significant superiority. These findings suggest that the source of content-academic versus private-plays a crucial role in determining the quality and reliability of educational materials on platforms like YouTube, highlighting the academic sector's commitment to higher educational standards. Conclusion The study emphasizes the critical role of credible sources in enhancing the quality of health education content on YouTube, particularly concerning CRC screening. The superiority of academic institutions in providing high-quality content suggests a need for viewers to critically assess the source of information. It also calls for enhanced regulatory oversight and measures to ensure the accuracy and reliability of health information online.

Impact of Age, Gender, and Body Mass Index on Short-Term Outcomes of Patients With Cardiogenic Shock on Mechanical Circulatory Support

BackgroundThis single-center observational study assessed the impact of age, sex, and body mass index (BMI) in patients with cardiogenic shock on temporary mechanical circulatory support. MethodsAll adult patients admitted to the Cleveland Clinic main campus Cardiac Intensive Care Unit (CICU) between Dec 1st, 2015, to Dec 31st, 2019, CICU with cardiogenic shock necessitating MCS with Intra-Aortic Balloon Pump (IABP), Impella or Venous Arterial- Extra Corporeal Membrane Oxygenation (VA- ECMO) were retrospectively analyzed for this study. Baseline characteristics and 30-day outcomes were collected via physician directed chart review. The impact of age, sex, and BMI on 30-day mortality was assessed using multivariable logistic regression. Kaplan Meier survival curves were used to analyze the survival difference in specific subsets. ResultsA total of 393 patients with CS on temporary MCS were admitted to our CICU during the study period. The median age of out cohort was 63 years (IQR 54-70yrs), median BMI was 28.50 kg/m2 (IQR 24.62-29.72) and 70% (n=276) were males. 22 patients >80 years had received MCS compared to 372 patients<80 years. Patients>80 years on MCS had significantly higher 30-day mortality compared to those less than 80 years (81.8% vs 49.3%, p=0.006). Upon stratifying patients by BMI, 161 patients (41%) were found to have BMI≥30 kg/m2 whereas 232 patients (59%) had BMI<30 kg/m2. Comparison of 30-day mortality revealed that patients with BMI≥30 did significantly worse than patients with BMI<30 (59.6% vs 45.3%, p=0.007). There was no difference in 30-day mortality between men and women. On multivariable logistic regression both age and BMI had a positive linear relationship with adjusted 30-day mortality whereas sex did not have a major effect. ConclusionsAdvanced age and higher BMI are independently associated with worse outcomes in patients with CS on MCS. Utilizing a strict selection criterion for patients in CS is pertinent to derive the maximum benefit from advanced mechanical support.

Comparative analysis of alloimmunization in healthy voluntary blood donors versus general patients: A 6-year experience from regional transfusion center in Northwestern part of India

Abstract BACKGROUND: Alloimmunization is a significant complication of blood transfusion and can lead to hemolytic transfusion reactions. The prevalence of alloimmunization in healthy voluntary blood donors and patients in the northwestern part of India is not well documented. AIM AND OBJECTIVE: This study aims to investigate the prevalence, specificity, and clinical significance of antibodies in blood donors and general patients in a regional transfusion centre in the North Western part of India. MATERIAL AND METHODS: This study aimed to investigate the prevalence of alloimmunization in voluntary blood donors and patients over a six-year period in a regional transfusion center. A total of 145,299 donor samples and 58,009 patient samples were screened for unexpected antibodies using standard techniques. RESULTS: Of the 145,299 donor samples screened, only 16 (0.011%) were positive for unexpected antibodies, with anti-M being the most common (62.5%). In contrast, among the 58,009 patients screened, 275 (0.47%) were found to be positive for alloantibodies, with blood group B showing the highest prevalence. The most common alloantibodies found in patients were anti-D, anti-E, anti-c, and anti-K in the Rh and Kell blood group systems. CONCLUSION: The incidence of alloimmunization in voluntary blood donors is low and comparable to other regions, which can be attributed to strict donor selection criteria and pre-donation screening practices. However, the incidence of alloimmunization in patients is higher, highlighting the need for routine screening for unexpected antibodies in patients to prevent hemolytic transfusion reactions. Further studies are needed to explore the underlying factors contributing to the higher incidence of alloimmunization in patients.

Construction of SNP fingerprints and genetic diversity analysis of radish (Raphanus sativus L.).

Radish (Raphanus sativus L.) is a vegetable crop with economic value and ecological significance in the genus Radish, family Brassicaceae. In recent years, developed countries have attached great importance to the collection and conservation of radish germplasm resources and their research and utilization, but the lack of population genetic information and molecular markers has hindered the development of the genetic breeding of radish. In this study, we integrated the radish genomic data published in databases for the development of single-nucleotide polymorphism (SNP) markers, and obtained a dataset of 308 high-quality SNPs under strict selection criteria. With the support of Kompetitive Allele-Specific PCR (KASP) technology, we screened a set of 32 candidate core SNP marker sets to analyse the genetic diversity of the collected 356 radish varieties. The results showed that the mean values of polymorphism information content (PIC), minor allele frequency (MAF), gene diversity and heterozygosity of the 32 candidate core SNP markers were 0.32, 0.30, 0.40 and 0.25, respectively. Population structural analysis, principal component analysis and genetic evolutionary tree analysis indicated that the 356 radish materials were best classified into two taxa, and that the two taxa of the material were closely genetically exchanged. Finally, on the basis of 32 candidate core SNP markers we calculated 15 core markers using a computer algorithm to construct a fingerprint map of 356 radish varieties. Furthermore, we constructed a core germplasm population consisting of 71 radish materials using 32 candidate core markers. In this study, we developed SNP markers for radish cultivar identification and genetic diversity analysis, and constructed DNA fingerprints, providing a basis for the identification of radish germplasm resources and molecular marker-assisted breeding as well as genetic research.

Research on the Influence of Competency on the Job Performance of College Counsellors

Introduction: This study aims to explore the impact of counselor competencies on work performance, specifically focusing on the provision of academic and personal development support to college students. The research process involved a systematic review of academic databases, including ERIC, JSTOR, and ProQuest, using search terms such as competency, job performance, college counselors, and education management. Theoretical Framework: The study emphasizes the importance of counselor competencies in determining job performance. Counselors excelling in crisis intervention, career counseling, active listening, and interpersonal skills tend to perform better, effectively addressing students' needs and guiding them in academic and personal development. Methodology: Academic databases and publications were systematically reviewed to ensure the retrieval of relevant and recent material. Strict selection criteria were applied to guarantee the caliber and applicability of chosen sources. Results: The findings underscore the significance of counselor competencies in enhancing job performance. Counselors proficient in key areas exhibit effective interaction with students, catering to their needs, and fostering academic and personal development. Conclusion: The study highlights the need to prioritize the evaluation and improvement of counselor competencies. Tailoring counselor training programs to enhance critical abilities can benefit educational institutions, ensuring better support for students' academic and personal growth.

Seropositivity and Trends of Transfusion Section Transmitted Infections among Blood Donors: Five Years Cross-sectional Study on 20,392 Blood Donors in a Tertiary Care Hospital of Ahmedabad, Gujarat, India

Introduction: Blood transfusion is a lifesaving intervention. However, it can also be a source of Transfusion-transmissible Infections (TTIs), posing a potential threat to the recipient. Testing for TTIs before blood transfusion is crucial for the safety of recipients. However, donations occurring during the window period, the prevalence of asymptomatic carriers, viral strains with high genetic variability, and technical errors are responsible for TTIs and remain one of the greatest obstacles in transfusion medicine to deal with. All blood donors are to be screened against five major infections-Human Immunodeficiency Virus (HIV), Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), Syphilis, and Malaria. Aim: To study the seroprevalence and trends of TTI among healthy blood donors at the Blood Centre of Ahmedabad, Gujarat, India. Materials and Methods: A cross-sectional study was carried out by reviewing blood donors’ records over a period of five years from January 1, 2018, to December 31, 2022, at the Blood Centre, Department of Pathology, of Sheth L.G. General Hospital, Maninagar, Ahmedabad, Gujarat, India. The data collected for each seropositive donor included the results of TTI testing, the age group of donors, the type of donation, the frequency of donation, and co-infection. The results were expressed in numbers and percentages. Results: Among a total of 20,392 healthy blood donors during the five-year period, the total number of seropositive cases (n) was 243 (1.19%). TTI seropositive donors in years 2018, 2019, 2020, 2021, and 2022 were 60 (1.29%), 50 (1.16%), 39 (1.22%), 45 (1.14%), and 49 (1.16%), respectively. A maximum of 118 (48.56%) seropositive donors were recorded in age group of 18-29 years. Individual seropositive donors during the fiveyear period for HIV, HBV, HCV, syphilis, and malaria were 19 (0.09%), 155 (0.76%), 28 (0.14%), 41 (0.20%), and 00 (0.00%), respectively. Voluntary Blood Donors (VBD) 10,933 (53.61%) exceeded Replacement Donors (RD) 9,459 (46.39%), and repeat blood donors 14,462 (70.92%) surpassed first-time donors 5,930 (29.08%). The seroprevalence of TTI among replacement, voluntary, first-time, and repeat blood donors was 2.41%, 0.14%, 2.06% and 0.84% respectively. Out of 243 seroreactive donors, two donors (0.82%) showed dual reactivity for TTI during the five-year period. Conclusion: Implementation of strict donor selection criteria, utilisation of sensitive screening modalities, promoting public awareness, and dispelling myths regarding the merits of voluntary blood donation, judicious use of blood products, and mass immunisation for Hepatitis B infection are essential interventions needed to curb TTI to a significant extent.

Impact of Early Histological Transformation on Survival in Patients with Follicular Lymphoma

Introduction: FL represents the second most common NHL with an indolent natural history and a median OS exceeding 20 y. Histologic transformation (HT) to an aggressive lymphoma is historically linked to poor outcomes with a median post-transformation survival of 2-5 y. EFS24 and POD24 are established adverse events indicating a poor overall survival. POD24 is associated with a higher incidence of HT following immunochemotherapy. However, the impact of HT within POD24 (HT24) remains unknown. Objective: Given the rarity of HT and the limited resources dedicated to this patient population, we aimed to assess and characterize the risk of HT and its outcomes, including the impact of HT24 on survival. Methods: This was a single-center retrospective observational study from the FL MSKCC database. Eligible pts were diagnosed between 01/1998-01/2022 and had a biopsy-proven grade 1-3A FL at diagnosis, with a subsequent biopsy eventually showing HT. Pts with any component of aggressive lymphoma defined as FL3B, DLBCL, or HGBCL within 3 months of diagnosis were excluded, as well as those with clinically suspected HT but not biopsy-proven. HT24 was defined as HT from 3-24 months from the initial FL diagnosis. POD24 was defined as progression within 24 months of initial diagnosis, irrespective of whether the patient underwent active surveillance or received therapeutic intervention. OS was defined as survival from the day of diagnosis. OS post-HT was defined as survival interval from HT biopsy. OS from a risk-defining event (Casulo, JCO 2015) was defined as survival from HT for HT24 or from 2 y after diagnosis for the reference group (all pts from the cohort without HT at any time). Results: 3,678 pts were identified as eligible for this analysis. At a median follow-up of 7.5 y (CI 95% 7.1,7.8), 415 pts (11%) had experienced HT. The risk of HT was associated with multiple high-burden disease features at diagnosis (i.e. advanced stage, 3 nodes above 3 cm, spleen involvement, higher FLIPI score, elevated LDH, Ki67, and higher SUVmax). In the entire cohort, the median time from initial diagnosis to HT was 4 y (CI95% 3.5; 4.7). The cumulative hazard of HT at 2, 5, and 10 y was 3%, 7%, and 10%, respectively, with an estimated rate of 1%/year over the first 10 y. During follow-up, 695 pts (19%) had died. As expected, median OS was significantly inferior for pts having experienced HT vs. non-HT pts (16 vs 22 y, p&amp;lt;0.001, HR 1.8). Median OS post-HT was 9.8 y (95% CI 7.2;12.5) with 2-, 5-, and 10-years OS of 73%, 61%, and 49%, respectively. Of the 415 pts with HT, 111 (27%) had experienced HT24, and those with HT24 had significantly more adverse initial characteristics ( Table) such as advanced stage, bulk, serous effusion, spleen involvement, high LDH and FLIPI score, anemia, grade 3A, and higher SUVmax. Interestingly, there were no significant risk factors specifically associated with HT&amp;gt;24 months. OS from a risk-defining event in HT24 was significantly inferior compared to the reference group (5-year estimate 66% vs 90%, p&amp;lt;0.001, HR 3.2). OS post-HT did not significantly differ between pts with HT24 vs HT&amp;gt;24 months (5-year estimates 66% vs. 58%, p=0.22). Similar results (51% vs. 55%, p=0.64) were observed when restricted to pts who received initial systemic therapy. POD24 from diagnosis was observed in 303 pts; of them, 192 (63%) maintained FL histology at progression (POD24 +/HT24 -). Pts with HT24 experienced a significantly lower 5-year OS compared to those POD24 +/HT24 - (66% vs. 75%, p=0.0023, HR 1.9), figure. Conclusions: Our study highlights the distinction between HT24 and HT occurring later. High-burden features at diagnosis may predict HT24, suggesting occult HT at diagnosis. We did not identify any predictors for later HT, suggesting it may represent a random event in FL history. In this sizeable single-center cohort of pts with FL, we observed a better outcome for pts with HT than previously described. Furthermore, while HT negatively impacted OS, post-HT survival outcomes were similar in pts with HT24 and those with HT after 24 mo. Strict selection criteria (excluding pts with FL 3B and those with HT documented within 3 months of diagnosis), recent progress in therapy, and tertiary center recruitment biases may account for these data. Patients with HT24 had a poorer outcome than those with POD24 without HT. Further analysis to delineate the pattern of first-line therapy and outcome of pts with HT and POD24 is in progress.

Challenge Not Only to the Muscles—Surface Instability Shifts Attentional Demands in Young and Older Adults While Performing Resistance Exercise

AbstractRegular physical activity is an important factor in maintaining and improving physical and cognitive functions in an aging society. Compared to resistance and endurance training, motor tasks with attentional demands and cognitive activation are considered to have a greater potential for improving executive functions. Unstable devices increase the coordinative demands and could thus lead to increased cognitive engagement during acute resistance exercises. This study aimed to investigate the required attentional resources during squats on stable and unstable surfaces in young and older adults. For this purpose, 13 young (Mage = 23.5, SD = 2.7 years) and 17 older (Mage = 70.2, SD = 4.3 years) healthy adults performed dumbbell squats on a flat ground (stable condition) and on an unstable device (unstable condition) while simultaneously conducting a visual-verbal Stroop task. Attentional resources for the stable and unstable conditions were assessed by calculating the differences in reaction time for the Stroop task (dual-task effect) from the single-task to the dual-task condition, respectively. As a result, there was a significant higher negative dual-task effect (i.e., cognitive performance decrement) while squatting on an unstable (− 13.96%) versus a stable surface (− 8.68%). Older adults did not show significantly greater dual-task effects than young adults. In conclusion, the attentional resources required during acute resistance training may be increased by the use of unstable devices. The fact that no age differences were found could be a consequence of the strict selection criteria for the study (selection bias).

Endotoxin removal therapy with Polymyxin B immobilized fiber column: a single center experience from EUPHAS2 registry

Although the precise clinical indication for initiation of PMX-HA is widely debated in the literature, a proper patient selection and timing of treatment delivery might play a critical role in the clinical course of a specific subphenotype of septic shock (endotoxic shock). In light of this view, since 2019, we have introduced in our clinical practice a diagnostic-therapeutic flowchart to select patients that can benefit the most from the treatment proposed. In addition, we reported in this study our experience of PMX-HA in a cohort of critically ill patients admitted to our intensive care unit (ICU). We analyzed a single centre, retrospective, observational web-based database (extracted from the EUPHAS2 registry) of critically ill patients admitted to the ICU between January 2016 and May 2021 who were affected by endotoxic shock. Patients were divided according to the diagnostic-therapeutic flowchart in two groups: Pre-Flowchart (Pre-F) and Post-Flowchart (Post-F). From January 2016 to May 2021, 61 patients were treated with PMX-HA out of 531 patients diagnosed with septic shock and of these, fifty patients (82%) developed AKI during their ICU stay. The most common source of infection was secondary peritonitis (36%), followed by community-acquired pneumonia (29%). Fifty-five (90%) out of 61 patients received a second PMX-HA treatment, with a statistically significant difference between the two groups (78% of the Pre-F vs. 100% of the Post-F group, p = 0.005). In both groups, between T0 and T120, the Endotoxin Activity Assay (EAA) decreased, while the SOFA score, mean arterial pressure (MAP), and Vasoactive Inotropic Score (VIS) improved with no statistically significant difference. Furthermore, when performing a propensity score matching analysis to compare mortality between the two groups, statistically significant lower ICU and 90-day mortalities were observed in the Post-F group [p = 0.016]. Although in this experienced centre data registry, PMX-HA was associated with organ function recovery, hemodynamic improvement, and current EAA level reduction in critically ill patients with endotoxic shock. Following propensity score-matched analysis, ICU mortality and 90-day mortalities were lower in the diagnostic-therapeutic flowchart group when considering two temporal groups based on strict patient selection criteria and timing to achieve PMX. Further Randomised Control Trials focused on centre selection, adequate training and a flowchart of action when assessing extracorporeal blood purification use should be performed.

EAO Position Paper: Immediate Implant Placement: Managing Hard and Soft Tissue Stability from Diagnosis to Prosthetic Treatment.

In this position paper, the state of the art in immediate implant placement (IIP) at incisor-cuspid-premolar sites is described. The literature supports that the following prerequisites need to be simultaneously met for a predictable outcome: (1) there must be no acute infection; (2) there must be apical and palatal/lingual bone for implant anchorage; (3) the tooth must be inside the bone envelope; (4) the alveolar socket must have a favorable morphology (type I, IIa, IIb avoiding wide dehiscences); (5) there must be no midfacial recession; (6) the right implant must be selected; and (7) the surgeon needs to be experienced and skilled. A preoperative CBCT is required for IIP because multiple aforementioned prerequisites (2, 3, and 4) can only be assessed on the basis of 3D imaging. The final prerequisite relates to the importance of a perfect implant position, preferably leaving a horizontal gap of at least 2 mm between the implant shoulder and buccal bone wall. Guided surgery is preferred over free-hand surgery to accomplish this. Flapless surgery, socket grafting, connective tissue graft (CTG), and immediate provisionalization have been shown to contribute to hard and/or soft tissue stability. When the previously mentioned prerequisites are fulfilled, IIP may be considered over alternative treatment concepts (eg, early implant placement [EIP] and delayed implant placement [DIP]) based on time gain, minimal invasiveness, and similar outcomes in the literature. Given very strict selection criteria, clinicians should primarily screen patients for IIP before considering other treatment options with wider indications. Int J Prosthodont 2023;36:533-545.

Association Between Adult Antibiotic Use, Microbial Dysbiosis and Atopic Conditions - A Systematic Review.

Strong associations between early antibiotic exposure and increased risk of childhood allergies have been established. Antibiotics have the potential to induce microbial dysbiosis that may be linked to allergic conditions. This review examines the limited available evidence on the associations between adult antibiotic use, microbial dysbiosis and atopic conditions. A systematic literature search was conducted using PubMed and Embase for relevant studies, published between 01-01-2000 and 08-17-2022. We searched for associations between antibiotic use, microbial dysbiosis, and allergic conditions in adults, defined as over 13 years of age for the purposes of this review. Twenty-one studies were analyzed, with the inclusion of four narrative reviews as scarce relevant literature was found when stricter selection criteria were employed. Relevant studies predominantly focused on asthma. Significant microbial differences were observed in most measures between healthy subjects and subjects with allergic conditions. However, no system-wise and strain-wise associations were evident. Notably, at the phyla level, the Bacillota and Pseudomonadota phyla were associated with asthmatics, while the Actinobacteria phylum was linked to healthy controls. Asthmatics tends to reflect upregulation in the Bacillota and Pseudomonadota phyla in both airway and gut microbiomes. No compelling evidence could be found between adult antibiotic exposure, consequent microbial dysbiosis, and allergic conditions in adults. Our review is limited by scarce literature and therefore remains inconclusive. However, potential implications of antibiotic use impacting on allergic conditions justify additional research and heightened pharmacovigilance in this area.

AUSTRALIAN MARINE RADIOCARBON RESERVOIR EFFECTS: ΔR ATLAS AND ΔR CALCULATOR FOR AUSTRALIAN MAINLAND COASTS AND NEAR-SHORE ISLANDS

ABSTRACTStudies of pre-bomb mollusks live-collected around the Australian coastline have concluded that near-shore marine radiocarbon reservoir effects are small and relatively uniform. These studies are based on limited samples of sometimes dubious quality representing only selective parts of Australia’s lengthy coastline. We systematically examine spatial variability in the marine radiocarbon reservoir effect (ΔR) through analysis of 292 live-collected mollusk samples across the Australian mainland coasts and near-shore islands subject to strict selection criteria. This study presents 233 new ΔR values combined with an evaluation of 59 previously published values. Results demonstrate significant spatial variability in marine radiocarbon reservoir effects across the study region. ΔR values range from 68 ± 24 14C years off the Pilbara region of Western Australia to –337 ± 46 14C years in the southern Gulf of Carpentaria in Queensland. Most sets of local values exhibit internal consistency, reflecting the dominant influence of regional oceanography, including depletion in ΔR values southwards along the eastern Australian coastline coincident with the East Australian Current. Anomalous values are attributed to inaccurate documentation, species-specific relationships with the carbon cycle and/or short-term fluctuations in marine radiocarbon activities. To account for the heterogeneous distribution of marine 14C, we recommend using a location specific ΔR value calculated using the Australian ΔR Calculator, available at: https://delta-r-calc.jcu.io/.

Predicting non-improvement of symptoms in daily mental healthcare practice using routinely collected patient-level data: a machine learning approach.

Anxiety and mood disorders greatly affect the quality of life for individuals worldwide. A substantial proportion of patients do not sufficiently improve during evidence-based treatments in mental healthcare. It remains challenging to predict which patients will or will not benefit. Moreover, the limited research available on predictors of treatment outcomes comes from efficacy RCTs with strict selection criteria which may limit generalizability to a real-world context. The current study evaluates the performance of different machine learning (ML) models in predicting non-improvement in an observational sample of patients treated in routine specialized mental healthcare. In the current longitudinal exploratory prediction study diagnosis-related, sociodemographic, clinical and routinely collected patient-reported quantitative outcome measures were acquired during treatment as usual of 755 patients with a primary anxiety, depressive, obsessive compulsive or trauma-related disorder in a specialized outpatient mental healthcare center. ML algorithms were trained to predict non-response (< 0.5 standard deviation improvement) in symptomatic distress 6 months after baseline. Different models were trained, including models with and without early change scores in psychopathology and well-being and models with a trimmed set of predictor variables. Performance of trained models was evaluated in a hold-out sample (30%) as a proxy for unseen data. ML models without early change scores performed poorly in predicting six-month non-response in the hold-out sample with Area Under the Curves (AUCs) < 0.63. Including early change scores slightly improved the models' performance (AUC range: 0.68-0.73). Computationally-intensive ML models did not significantly outperform logistic regression (AUC: 0.69). Reduced prediction models performed similar to the full prediction models in both the models without (AUC: 0.58-0.62 vs. 0.58-0.63) and models with early change scores (AUC: 0.69-0.73 vs. 0.68-0.71). Across different ML algorithms, early change scores in psychopathology and well-being consistently emerged as important predictors for non-improvement. Accurately predicting treatment outcomes in a mental healthcare context remains challenging. While advanced ML algorithms offer flexibility, they showed limited additional value compared to traditional logistic regression in this study. The current study confirmed the importance of taking early change scores in both psychopathology and well-being into account for predicting longer-term outcomes in symptomatic distress.

Understanding painful versus non-painful dental pain in female and male patients: A transcriptomic analysis of human biopsies.

Dental pain from apical periodontitis is an infection induced-orofacial pain condition that presents with diversity in pain phenotypes among patients. While 60% of patients with a full-blown disease present with the hallmark symptom of mechanical allodynia, nearly 40% of patients experience no pain. Furthermore, a sexual dichotomy exists, with females exhibiting lower mechanical thresholds under basal and diseased states. Finally, the prevalence of post-treatment pain refractory to commonly used analgesics ranges from 7-19% (∼2 million patients), which warrants a thorough investigation of the cellular changes occurring in different patient cohorts. We, therefore, conducted a transcriptomic assessment of periapical biopsies (peripheral diseased tissue) from patients with persistent apical periodontitis. Surgical biopsies from symptomatic male (SM), asymptomatic male (AM), symptomatic female (SF), and asymptomatic female (AF) patients were collected and processed for bulk RNA sequencing. Using strict selection criteria, our study found several unique differentially regulated genes (DEGs) between symptomatic and asymptomatic patients, as well as novel candidate genes between sexes within the same pain group. Specifically, we found the role of cells of the innate and adaptive immune system in mediating nociception in symptomatic patients and the role of genes involved in tissue homeostasis in potentially inhibiting nociception in asymptomatic patients. Furthermore, sex-related differences appear to be tightly regulated by macrophage activity, its secretome, and/or migration. Collectively, we present, for the first time, a comprehensive assessment of peripherally diseased human tissue after a microbial insult and shed important insights into the regulation of the trigeminal system in female and male patients.

Metachromatic leukodystrophy: To screen or not to screen?

Metachromatic leukodystrophy (MLD) is a neurodegenerative lysosomal storage disorder caused by biallelic pathogenic variants in the gene encoding arylsulfatase A. Disease onset is variable (with late infantile, early and late juvenile, and adult forms) and treatment options depend on age and disease symptoms at onset. In the past, allo-hematopoietic stem cell transplantation (allo-HSCT) has been the best treatment option, following strict selection criteria. The outcome however is variable and morbidity remains high. This paved the way to the development of new treatment options, some of them aiming to be curative. In the light of this changing therapeutic field, newborn screening is becoming a valuable option. This narrative review aims to describe the outcome of allo-HSCT in the different MLD disease forms, and, in addition, reviews new treatment options. Finally, the shift of the field towards newborn screening for MLD is discussed.

Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients.

Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks, is necessary to improve recurrence prediction. A retrospective study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain, between 2010 and 2019 to determine the rate of TR in LT patients and identify associated factors. Patients with liver-kidney transplantation, re-transplantation, HIV infection, survival less than 90 days, or incidental HCC were excluded. Data on demographic, liver disease-related, LT, and tumor-related variables, as well as follow-up records, including TR and death, were collected. TR was analyzed using the Log-Rank test, and a multivariate Cox regression analysis was performed. The study was approved by the IRB of Cantabria. TR occurred in 13.6% of LT patients (95% CI = 7.3-23.9), primarily as extrahepatic recurrence (67%) within the first 5 years (75%). Increased TR was significantly associated with higher Body Mass Index (BMI) (HR = 1.3 [95% CI = 1.1-1.5]), vascular micro-invasion (HR = 8.8 [1.6-48.0]), and medium (HR = 20.4 [3.0-140.4]) and high pre-MORAL risk (HR = 30.2 [1.6-568.6]). TR also showed a significant correlation with increased mortality. Conclusions: LT for HCC results in a 13.6% rate of tumor recurrence. Factors such as BMI, vascular micro-invasion, and medium/high pre-MORAL risk are strongly associated with TR following LT.