Tag: pubmed

Circ Heart Fail. 2024 Dec 6:e011962. doi: 10.1161/CIRCHEARTFAILURE.124.011962. Online ahead of print.

ABSTRACT

BACKGROUND: In heart failure, sympathetic excess and exercise intolerance impair quality of life. In heart failure with reduced ejection fraction, exercise stimulates a reflex increase in muscle sympathetic nerve activity (MSNA) that relates inversely to peak oxygen uptake (V̇O_2peak). Whether similar sympathoexcitatory responses are present in heart failure with preserved EF (HFpEF) and relate to V̇O_2peak are unknown.

METHODS: In 13 patients with HFpEF (70±6 years), 17 comorbidity-matched controls (CMC; 67±8 years), and 18 healthy controls (65±8 years), we measured heart rate, blood pressure, and MSNA (microneurography) during (1) 7-minute baseline; (2) 2-minute isometric handgrip (40% maximal voluntary contraction) or rhythmic handgrip (50% and 30% maximal voluntary contraction) exercise, followed by 2-minute postexercise circulatory occlusion; and (3) 4-minute 1-leg cycling (2 minutes each at mild and moderate intensity). V̇O_2peak was obtained by open-circuit spirometry.

RESULTS: Resting MSNA was higher and V̇O_2peak was lower in HFpEF versus CMCs and healthy controls (all P<0.05). During handgrip, MSNA increased in all groups (all P<0.05); in HFpEF, MSNA was greater than CMCs and healthy controls during HG and postexercise circulatory occlusion at 40% isometric handgrip (all P<0.05) and HG only at 50% and 30% rhythmic handgrip (all P<0.05). During cycling, MSNA (bursts·min^-1) decreased during mild (-4±4; P=0.01) and moderate (-8±6; P<0.001) cycling in healthy controls, was unchanged during mild (+1±7; P=0.42) and moderate (+2±8; P=0.28) cycling in CMCs, yet increased in HFpEF during mild (+8±8; P<0.001) and moderate (+9±10; P<0.001) cycling. In HFpEF, the change in MSNA during moderate cycling related inversely to relative (r=-0.72; R ²=0.51; P<0.01) and percent-predicted (r=-0.63; R ²=0.39; P=0.03) V̇O_2peak. No statistically significant relationships were detected in controls (P>0.05).

CONCLUSIONS: In contrast to CMCs, patients with HFpEF exhibit augmented MSNA at rest and during exercise. The magnitude of such paradoxical sympathoexcitation during dynamic cycling relates inversely to V̇O_2peak, consistent with a neurogenic, vasoconstrictor limit on exercise capacity in HFpEF.

PMID:39641163 | DOI:10.1161/CIRCHEARTFAILURE.124.011962

Hand (N Y). 2024 Dec 6:15589447241298982. doi: 10.1177/15589447241298982. Online ahead of print.

ABSTRACT

BACKGROUND: Artificial intelligence (AI) is a promising tool to aid in diagnostic accuracy and patient communication. Prior literature has shown that ChatGPT answers medical questions and can accurately diagnose surgical conditions. The purpose of this study was to determine the accuracy of ChatGPT 4.0 in evaluating radiologic imaging of common orthopedic upper extremity bony pathologies, including identifying the imaging modality and diagnostic accuracy.

METHODS: Diagnostic imaging was sourced from an open-source radiology database for 6 common upper extremity bony pathologies: distal radius fracture (DRF), metacarpal fracture (MFX), carpometacarpal osteoarthritis (CMC), humerus fracture (HFX), scaphoid fracture (SFX), and scaphoid nonunion (SN). X-ray, computed tomography (CT), and magnetic resonance imaging (MRI) modalities were included. Fifty images were randomly selected from each pathology where possible. Images were uploaded to ChatGPT 4.0 and queried for imaging modality, laterality, and diagnosis. Each image query was completed in a new ChatGPT search tab. Multinomial linear regression was used to identify variations in ChatGPT’s diagnostic accuracy across imaging modalities and medical conditions.

RESULTS: Overall, ChatGPT provided a diagnosis for 52% of images, with accuracy ranging from 0% to 55%. Diagnostic accuracy was significantly lower for SFX and MFX relative to HFX. ChatGPT was significantly less likely to provide a diagnosis for MRI relative to CT. Diagnostic accuracy ranged from 0% to 40% with regard to imaging modality (x-ray, CT, MRI) though this difference was not statistically significant.

CONCLUSIONS: ChatGPT’s accuracy varied significantly between conditions and imaging modalities, though its iterative learning capabilities suggest potential for future diagnostic utility within hand surgery.

PMID:39641156 | DOI:10.1177/15589447241298982

Pediatr Transplant. 2025 Feb;29(1):e14885. doi: 10.1111/petr.14885.

ABSTRACT

INTRODUCTION: Incidence of and risk factors for early hospital readmission (EHR) are poorly defined in pediatric liver transplant recipients. Therefore, we evaluated EHR incidence and risk factors for pediatric liver recipients in a nationally representative sample.

METHODS: Using the Society of Pediatric Liver Transplantation database, we retrospectively analyzed 2808 pediatric liver-only recipients transplanted 2011-2022. Recipient-, donor-, and center-level characteristics were evaluated as possible risk factors for EHR within 30 days of hospital discharge using multivariable modified Poisson regression.

RESULTS: Overall, 23% (N = 642) of pediatric recipients experienced EHR. Independent risk factors for EHR include diabetes (adjusted relative risk [aRR] 2.33, 95% CI: 1.41-3.86, p = 0.001), history of malignancy (aRR 1.59, 95% CI: 1.19-2.11, p = 0.002), and shorter length of transplant hospitalization. Recipients in the shortest length of stay quartile (median [IQR] 8 [7-9] days) had a ninefold increased risk for EHR compared with recipients in the longest length of stay quartile (34 [28-48] days) (aRR 8.86, 95% CI: 5.68-13.81, p < 0.001). Incidence of EHR did not vary by transplant center and was not associated with other characteristics of the donor (DCD vs. not DCD), recipient (age, race, sex, and diagnosis), procedure (whole vs. split liver, ischemic time), or transplant center.

CONCLUSION: We found the 30-day readmission rate for pediatric liver transplant recipients was 23%. Shorter hospital stays were a major risk factor for EHR, highlighting that longer initial transplant hospital stays may be beneficial for predischarge optimization and coordination of their complex care.

PMID:39641150 | DOI:10.1111/petr.14885

Eur Urol Open Sci. 2024 Nov 18;71:15-21. doi: 10.1016/j.euros.2024.10.019. eCollection 2025 Jan.

ABSTRACT

BACKGROUND AND OBJECTIVE: Our objective was to evaluate whether a very large prostate volume significantly affects the incidence of perioperative complications and compromises outcomes among patients undergoing holmium laser enucleation of the prostate (HoLEP).

METHODS: We retrospectively analyzed data for 1815 adult patients who underwent HoLEP at Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, between January 2019 and May 2024. Patients were divided into two groups according to their prostate volume: ≤149 ml (group A) and ≥150 ml (group B). Propensity score matching on age, body mass index, American Society of Anesthesiologists physical status, and the presence of an indwelling catheter was used to balance baseline differences. A Mann-Whitney U test was used for comparison of continuous variables between the groups, and a χ² test for comparison of categorical variables, with p < 0.05 considered statistically significant. Postoperative complications were assessed according to the Clavien-Dindo classification.

KEY FINDINGS AND LIMITATIONS: After propensity score matching, 163 matched cases per group were analyzed. Group B had significantly longer median total operative time (76 vs 47 min; p < 0.001), enucleation time (42 vs 26 min; p < 0.001), coagulation time (11 vs 6 min; p < 0.001), and morcellation time (15 vs 7 min; p < 0.001). Clavien-Dindo grade ≥IIIb complications (8.7% vs 1.2%; p = 0.02) and blood transfusion (2.5% vs 0%; p = 0.045) were significantly more frequent in group B. Catheterization time (1.9 vs 2.0 d; p = 0.01) and the proportion of patients with postoperative residual urine volume ≤50 ml (85.2% vs 80.2%; p = 0.18) were comparable between the groups. Limitations include the retrospective and single-center study design.

CONCLUSIONS AND CLINICAL IMPLICATIONS: Prostate volume ≥150 ml is associated with a longer operative time, a higher rate of major complications, and a more frequent need for blood transfusion. Therefore, HoLEP for prostate glands ≥150 ml should be performed in experienced high-volume centers.

PATIENT SUMMARY: We compared outcomes of laser surgery for enlarged prostate glands of different sizes. We found that while the surgery is generally effective for very large prostates, it takes longer and has a higher risk of complications in comparison to more typical prostate sizes. However, this procedure is still the best treatment available for prostate enlargement and should be carried out in high-volume hospitals specializing in this treatment.

PMID:39641120 | PMC:PMC11617294 | DOI:10.1016/j.euros.2024.10.019

Eur Urol Open Sci. 2024 Nov 16;71:11-14. doi: 10.1016/j.euros.2024.10.021. eCollection 2025 Jan.

ABSTRACT

For men with prostate cancer (PCa) within the European Randomized Study of Screening for Prostate Cancer (ERSPC), the cause of death is determined by a Cause of Death Committee (CODC) that evaluates all medical records using a fixed algorithm. The aim of this study was to compare the classification of PCa-specific mortality (PCSM) between the CODC and Statistics Netherlands. We calculated the sensitivity (PCSM agreement divided by total PCSM deaths according to the CODC) and specificity (agreement for other-cause mortality [OCM] divided by total OCM deaths according to the CODC) using the last 21-yr follow-up data from ERSPC Rotterdam. For the core age group (age 55-69 yr at randomization; n = 1732), the sensitivity was 86% (95% CI 83-89) and specificity was 93% (95% CI 91-94), with no statistical difference between the youngest ages and the oldest ages. Extrapolation of our findings to 30 yr of follow-up would result in an expected risk reduction of PCSM of 30% using data from the CODC and 33% using official statistics in favor of screening. In conclusion, our results support the use of official statistics in determining the cause of death, without compromising the main outcome of ERSPC Rotterdam.

PATIENT SUMMARY: We compared the classification of prostate cancer death between a dedicated trial committee and official statistics in the Netherlands. We found that official statistics are an accurate representation in determining the cause of death.

PMID:39641118 | PMC:PMC11615526 | DOI:10.1016/j.euros.2024.10.021

Heliyon. 2024 Nov 12;10(22):e39804. doi: 10.1016/j.heliyon.2024.e39804. eCollection 2024 Nov 30.

ABSTRACT

Plagiarism has long been a concern within the academic community. However, its prevalence and impact in the Middle Eastern context, particularly in Saudi Arabia, have not been sufficiently addressed. This study aims to investigate Saudi undergraduate students’ perceptions of plagiarism in English as a foreign language (EFL) research writing during e-learning sessions and examine whether their academic levels, grade point average (GPA), and gender play a substantial role in affecting their perceptions of plagiarism. A survey was conducted with 110 Saudi undergraduate students (33 males and 77 females) majoring in English at a university in Saudi Arabia. The findings indicate that most of the participants were aware of the most prevalent forms of plagiarism in EFL research writing during e-learning sessions. The findings also reveal that students’ GPA and gender did not have a statistically substantial impact on the participants’ perceptions. However, it was observed that students’ academic levels had a discernible effect on their perceptions. This study provides some practical implications for enhancing student awareness and assisting them in avoiding plagiarism in EFL research writing.

PMID:39641084 | PMC:PMC11617220 | DOI:10.1016/j.heliyon.2024.e39804

Heliyon. 2024 Nov 6;10(22):e40163. doi: 10.1016/j.heliyon.2024.e40163. eCollection 2024 Nov 30.

ABSTRACT

This study aimed to evaluate the effects of excessive and episodic consumption of ethanol (EtOH, a high-intensity drinking manner) on induced apical periodontitis in rats. Thirty-two animals were divided into the following four groups: control, EtOH, apical periodontitis, and EtOH + apical periodontitis. Ethanol exposure (3 g/kg 20 % w/v EtOH) was performed by orogastric gavage for 3 consecutive days, followed by 4 days of withdrawal for 4 weeks. Lesions were induced by exposing the dental pulp of the lower first molar and by the absence of any treatment/curative for 28 days. Finally, the animals were euthanized, and mandibles were collected. The mandible was divided medially, with one hemimandible being used for micro-computed tomography analysis of the volume of the periapical lesion and bone quality parameters, such as bone volume and trabecular bone assessments; the other hemimandible was used for histological analysis, with a descriptive histopathological analysis of the tissue and the pattern of bone loss presented, as well as an assessment of the collagen content present. The data were subjected to statistical analysis (one-way analysis of variance with Tukey’s post-hoc test). Our results showed that the EtOH + apical periodontitis group had a larger volume of periapical lesions than animals that were not exposed to ethanol. Additionally, bone quality parameters showed a reduction in bone volume and thickening of the trabeculae, associated with increased tissue destruction and reduced collagen content in the remnant region of the alveolar bone. These results suggest that exposure to EtOH in a pattern of excessive alcohol consumption is an aggravating factor in apical periodontitis and, consequently, in its progression, the quality and quantity of the alveolar bone remaining in the region of the periapical lesion are the modulating aspects.

PMID:39641066 | PMC:PMC11617731 | DOI:10.1016/j.heliyon.2024.e40163

Heliyon. 2024 Nov 13;10(22):e40228. doi: 10.1016/j.heliyon.2024.e40228. eCollection 2024 Nov 30.

ABSTRACT

INTRODUCTION: The aim of the study was to assess prognostic factors associated with an increased risk of recurrence of hepatocellular carcinoma (HCC) after radical treatment.

MATERIALS AND METHODS: This is a retrospective, single-center analysis of data on HCC recurrence in patients who underwent radical treatment. Molecular tumor characteristics, baseline laboratory results and hepatic viral status were analyzed.

RESULTS: Data from 111 patients were included in the analysis. The most important prognostic factors for recurrence were vascular microinvasion (HR 4.54; 95 % CI 1.769-11.681; p 0.001), baseline white blood count (HR 2.13; 95 % CI 1.261-3.567; p 0.004) and baseline alpha-fetoprotein (HR 1.00009; 95 % CI 1.000001-1.00002; p 0.034). Microvascular invasion was only prognostic factor which correlate significantly with the overall survival (HR 5.04, 95 % CI 2.352-12.413; p < 0.001). PD-L1 expression was confirmed in 4 patients and all of them developed a disease recurrence. However, there was no statistically significant assosciation with prognosis. The presence of CD68 tumor-associated macrophages was confirmed in 62 patients, ranging from 5 % to 40 %. Analysis showed that CD68 was not associated with the risk of recurrence of HCC.

CONCLUSIONS: The results confirm that microvascular invasion is the most important factor associated with an increased risk of hepatocellular carcinoma recurrence and death, while PD-L1 and CD68 expression did not have an impact on patient prognosis.

PMID:39641063 | PMC:PMC11617879 | DOI:10.1016/j.heliyon.2024.e40228

Heliyon. 2024 Nov 16;10(22):e40493. doi: 10.1016/j.heliyon.2024.e40493. eCollection 2024 Nov 30.

ABSTRACT

BACKGROUND: As a global public health issue, childhood maltreatment is associated with significant morbidity and mortality. We aimed to investigate the association between childhood maltreatment and immune-mediated inflammatory disorders (IMIDs).

METHODS: We conducted a retrospective matched open cohort study using a UK primary care database between January 1, 1995 and January 31, 2021. Clinical codes were used to identify patients exposed to childhood maltreatment who were matched by general practice (GP), age, and sex to up to four unexposed patients. Cox regression analysis was used to evaluate the risk of developing IMIDs (inflammatory bowel disease, coeliac disease, rheumatoid arthritis, psoriasis, multiple sclerosis, systemic lupus erythematosus) during follow-up in the exposed versus unexposed groups.

RESULTS: 256,130 exposed patients were matched to 712,478 unexposed patients. Those exposed to childhood maltreatment were 1) at an increased risk of developing Rheumatoid arthritis (aHR 1·39; 95 % CI 1·12-1·74) and Psoriasis (aHR 1·16; 95 % CI 1·10-1·23), 2) not statistically significantly at risk of developing inflammatory bowel disease (aHR 0·87; 95 % CI 0·75-1·00), multiple sclerosis (aHR 1·07; 95 % CI 0·77-1·49) and systemic lupus erythematosus (aHR 1·28; 95 % CI 0·89-1·85) and 3) at a reduced risk of coeliac disease (aHR 0·74; 95 % CI 0·62-0·88) compared to the unexposed group.

INTERPRETATIONS: Childhood maltreatment is estimated to affect one in three children globally; therefore, an increased risk of developing rheumatoid arthritis and psoriasis represents a substantial contribution to the burden of IMIDs. Implementation of broad public health approaches to prevent and detect childhood maltreatment and its negative downstream consequences, such as, IMID development, is essential.

PMID:39641040 | PMC:PMC11617863 | DOI:10.1016/j.heliyon.2024.e40493

Heliyon. 2024 Nov 13;10(22):e40282. doi: 10.1016/j.heliyon.2024.e40282. eCollection 2024 Nov 30.

ABSTRACT

BACKGROUND: Since the onset of the SARS-CoV-2 pandemic in late 2019, many studies suggest that actual infection rates may far exceed reported cases. Therefore, this study provides a comprehensive overview of anti-SARS-CoV-2 antibody measurements and their significance in epidemiological surveillance, especially regarding the true extent of SARS-CoV-2 infections, allowing more detailed insights into the dynamics of the pandemic.

METHODS: Antibodies were measured using the Elecsys® Anti-SARS-CoV-2 assay for the nucleocapsid (N) protein and the SARS-CoV-2 IgG (sCOVG) assay for the spike (S) protein. A total of 25197 specimens from University Hospital Heidelberg were analyzed between May 2020 and December 2023, with 16957 samples measured for both antibodies, 2756 for anti-N only, and 5484 for anti-S only.For the epidemiological tracing of the SARS-CoV-2 incidence we analyzed changes in the anti-N positivity rate and anti-S positivity rate within our tertiary hospital setting across consecutive quarters.

RESULTS: Anti-N measurements allowed for a retrospective analysis of SARS-CoV-2 epidemiological developments, revealing significant changes (p <0.05) in the anti-N positivity rate following incidence peaks (increase) and low incidence periods (decrease) with only three non-significant transitions.On the other hand, the anti-S positivity rate showed only four significant transitions between consecutive quarters.

CONCLUSION: The anti-N positivity rate is an effective and straightforward retrospective serological tool for tracking epidemiological trends, while the anti-S rate is influenced by vaccination and epidemiology as well, making it inept for the tracing of epidemiological changes. Although the recent development in SARS-CoV-2 epidemiology with increasing intervals between infection waves already provide an enhanced statistical robustness, we recommend the determination of the anti-N positivity rate in larger study populations.

PMID:39641027 | PMC:PMC11617710 | DOI:10.1016/j.heliyon.2024.e40282