Oral Glucose-Lowering Agents vs Insulin for Gestational Diabetes: A Randomized Clinical Trial.

Importance: Metformin and glyburide monotherapy are used as alternatives to insulin in managing gestational diabetes. Whether a sequential strategy of these oral agents results in noninferior perinatal outcomes compared with insulin alone is unknown.

Objective: To test whether a treatment strategy of oral glucose-lowering agents is noninferior to insulin for prevention of large-for-gestational-age infants.

Comparing loss of contractual employment pre- and post-diagnosis in patients with rare versus common cancer types: a national registry-based study.

Purpose: Patients with rare cancer often experience diagnostic delays and limited treatment options, potentially negatively impacting their working lives. We explored whether those with rare vs. common cancer have an increased risk of loss of contractual employment (1) up to 2 years pre-diagnosis, (2) up to 5 years post-diagnosis, and (3) which characteristics of rare cancer survivors are associated with loss of contractual employment 5 years post-diagnosis.

Oligometastatic Esophagogastric Cancer: Does It Exist and How Do We Treat It?

Purpose Of The Review: This narrative review aims to provide an overview of recently completed randomized trials and expert consensus recommendations, and their implications for clinical practice and future trial design in patients with de-novo esophagogastric oligometastatic disease (OMD).

Recent Findings: The IKF-575/RENAISSANCE phase III trial showed no significant overall survival difference between systemic therapy alone and systemic therapy combined with local therapy for patients with gastric or gastroesophageal junction cancer and de-novo OMD, except for patients with retroperitoneal lymph node metastases only. The ESO-Shanghai 13 phase II trial demonstrated superiority of adding local therapy to systemic therapy for progression-free and overall survival in oligometastatic esophageal squamous cell carcinoma.

Endothelial-Ercc1 DNA repair deficiency provokes blood-brain barrier dysfunction.

Aging of the brain vasculature plays a key role in the development of neurovascular and neurodegenerative diseases, thereby contributing to cognitive impairment. Among other factors, DNA damage strongly promotes cellular aging, however, the role of genomic instability in brain endothelial cells (EC) and its potential effect on brain homeostasis is still largely unclear. We here investigated how endothelial aging impacts blood-brain barrier (BBB) function by using excision repair cross complementation group 1 (ERCC1)-deficient human brain ECs and an EC-specific Ercc1 knock out (EC-KO) mouse model.

ATC-to-RxNorm mappings - A comparison between OHDSI Standardized Vocabularies and UMLS Metathesaurus.

Introduction: The World Health Organization global standard for representing drug data is the Anatomical Therapeutic Chemical (ATC) classification. However, it does not represent ingredients and other drug properties required by clinical decision support systems. A mapping to a terminology system that contains this information, like RxNorm, may help fill this gap.

Longevity of antibody responses is associated with distinct antigen-specific B cell subsets early after infection.

Introduction: Upon infection, T cell-driven B cell responses in GC reactions induce memory B cells and antibody-secreting cells that secrete protective antibodies. How formation of specifically long-lived plasma cells is regulated via the interplay between specific B and CD4+ T cells is not well understood. Generally, antibody levels decline over time after clearance of the primary infection.

Incidence and Outcomes of Patients With Mismatch Repair Deficient Rectal Cancer Operated in 2016: A Nationwide Cohort From The Netherlands.

Introduction: Data regarding the incidence and outcomes of mismatch repair deficient (dMMR) rectal cancer is limited. This study characterizes dMMR rectal cancer patients, comparing response after neoadjuvant radiotherapy and oncological outcomes to mismatch repair proficient (pMMR) rectal cancer patients.

Method: A retrospective cross-sectional cohort study was conducted in 67 Dutch centers.

Healthcare providers intentions to use an electronic personal health record for undocumented migrants: A qualitative exploration study in The Netherlands.

Electronic Personal Health Records (EPHRs) are potentially effective tools for improving the continuity and quality of care for migrants and refugees, and specifically for undocumented migrants (UDMs). However, little is known about the intention and preconditions of healthcare providers (HCPs) to use an EPHR for UDM in the Netherlands. Between April 2023 and June 2023, thirteen interviews, using a semi-structured topic guide, were conducted with Dutch HCPs.

Assessing the documentation of publicly available medical image and signal datasets and their impact on bias using the BEAMRAD tool.

Medical datasets are vital for advancing Artificial Intelligence (AI) in healthcare. Yet biases in these datasets on which deep-learning models are trained can compromise reliability. This study investigates biases stemming from dataset-creation practices.

Syndromic Retinitis Pigmentosa.

Retinitis pigmentosa (RP) is a progressive inherited retinal dystrophy, characterized by the degeneration of photoreceptors, presenting as a rod-cone dystrophy. Approximately 20-30% of patients with RP also exhibit extra-ocular manifestations in the context of a syndrome. This manuscript discusses the broad spectrum of syndromes associated with RP, pathogenic mechanisms, clinical manifestations, differential diagnoses, clinical management approaches, and future perspectives.

First case of Streptococcus suis bacteremia caused by a serotype 14 strain without pig or pork contact in the Netherlands: A case report.

Streptococcus suis is a porcine pathogen that causes severe zoonotic infections in humans resulting in meningitis and sepsis. The main risk factors for S. suis zoonotic infections are consumption of raw pork products and direct contact with live pigs or pork, in particular in the presence of skin injuries.

Adaptation of functional gait parameters to a newly provided stiffness-optimized ankle-foot orthosis.

Background: Clinical decisions regarding ankle-foot-orthosis stiffness in people with calf muscle weakness are based on immediate evaluations, not taking gait adaptation into account. This study examined adaptation of step length, walking speed and energy cost of walking in the 3-months post-provision and whether individuals with higher gait variability adapt more compared to individuals with lower gait variability.

Methods: We conducted a post-hoc analysis in eighteen stiffness-optimized ankle-foot-orthosis users with bilateral calf muscle weakness.

Genomic analysis and virulence of human Streptococcus suis serotype 14.

Purpose: Streptococcus suis serotype 14 is the second most prevalent serotype being highly prevalent in Southeast Asia. This study aimed to characterize genetic background, population structure, virulent genes, antimicrobial-resistant genes, and virulence of human S. suis serotype 14.

The return-to-work journey: experiences with communication and collaboration among employees and employers during long-term sick leave and return-to-work.

Purpose: To explore the experiences of long-term sick-listed employees and those of employers with communication and collaboration during sick leave and the return-to-work (RTW) process.

Methods: Previously long-term sick-listed employees ( = 9) and employers ( = 9) were interviewed about their experiences with communication and collaboration during sick leave and RTW. Thematic analysis, utilizing patient journey mapping was applied to analyze and map out their experiences.

Organoids, tissue slices and organotypic cultures: Advancing our understanding of pancreatic ductal adenocarcinoma through in vitro and ex vivo models.

Pancreatic ductal adenocarcinoma (PDAC) has one of the worst prognoses of all common solid cancers. For the large majority of PDAC patients, only systemic therapies with very limited efficacy are indicated. In addition, immunotherapies have not brought the advances seen in other cancer types.

The Carbon Footprint of Hospital Services and Care Pathways: A State-of-the-Science Review.

Background: Climate change is the 21st century's biggest global health threat, endangering health care systems worldwide. Health care systems, and hospital care in particular, are also major contributors to greenhouse gas emissions.

Objectives: This study used a systematic search and screening process to review the carbon footprint of hospital services and care pathways, exploring key contributing factors and outlining the rationale for chosen services and care pathways in the studies.

Knee pain and function in retired male intercounty GAA players: an exploratory study.

Background: Knee injuries are common among elite intercounty Gaelic games players (collectively GAA players).

Aims: The primary aim was to examine knee pain, function, and quality of life in retired elite male GAA players. Secondary objectives were to (i) report the incidence of previous knee surgery and total knee replacement, (ii) assess medication usage, and (iii) investigate any associations between a history of knee injury and/or knee surgery and knee pain, function, and quality of life among retired elite male GAA players.

Human pluripotent stem cell-derived microglia shape neuronal morphology and enhance network activity in vitro.

Background: Microglia, the resident immune cells of the central nervous system, play a critical role in maintaining neuronal health, but are often overlooked in traditional neuron-focused in vitro models.

New Method: In this study, we developed a novel co-culture system of human pluripotent stem cell (hPSC)-derived microglia and neurons to investigate how hPSC-derived microglia influence neuronal morphology and network activity. Using high-content morphological analysis and multi-electrode arrays (MEA), we demonstrate that these microglia successfully incorporate into neuronal networks and modulate key aspects of neuronal function.

Ten-year trends in clinical characteristics and outcome of children hospitalized with severe wasting or nutritional edema in Malawi (2011-2021): Declining admissions but worsened clinical profiles.

Background: Severe acute malnutrition (SAM) constitutes a substantial burden in African hospitals. Despite adhering to international guidelines, high inpatient mortality rates persist and the underlying contributing factors remain poorly understood.

Objective: We evaluated the 10-year trend (2011-2021) in clinical factors and outcomes among children with severe wasting and/or nutritional edema at Malawi's largest nutritional rehabilitation unit (NRU).

Impact of annotation imperfections and auto-curation for deep learning-based organ-at-risk segmentation.

Background And Purpose: Segmentation imperfections (noise) in radiotherapy organ-at-risk segmentation naturally arise from specialist experience and image quality. Using clinical contours can result in sub-optimal convolutional neural network (CNN) training and performance, but manual curation is costly. We address the impact of simulated and clinical segmentation noise on CNN parotid gland (PG) segmentation performance and provide proof-of-concept for an easily implemented auto-curation countermeasure.

DNA methylation analysis on anal swabs for anal cancer screening in people living with HIV.

Introduction: High-resolution anoscopy (HRA) to prevent anal cancer is complex and screening capacity is limited. Previously, we showed that DNA methylation analysis of anal high-grade squamous intraepithelial lesions (HSIL) biopsies can distinguish between HSIL with an increased cancer risk, and HSIL with a low cancer risk, in which treatment may be safely withheld. Here, we assessed the performance of methylation analysis in anal swabs to identify patients with underlying HSIL with an increased cancer risk.