Development of ISB 1442, a CD38 and CD47 bispecific biparatopic antibody innate cell modulator for the treatment of multiple myeloma

Antibody engineering can tailor the design and activities of therapeutic antibodies for better efficiency or other advantageous clinical properties. Here we report the development of ISB 1442, a fully human bispecific antibody designed to re-establish synthetic immunity in CD38+ hematological malignancies. ISB 1442 consists of two anti-CD38 arms targeting two distinct epitopes that preferentially drive binding to tumor cells and enable avidity-induced blocking of proximal CD47 receptors on the same cell while preventing on-target off-tumor binding on healthy cells. The Fc portion of ISB 1442 is engineered to enhance complement dependent cytotoxicity, antibody dependent cell cytotoxicity and antibody dependent cell phagocytosis. ISB 1442 thus represents a CD47-BsAb combining biparatopic targeting of a tumor associated antigen with engineered enhancement of antibody effector function to overcome potential resistance mechanisms that hamper treatment of myeloma with monospecific anti-CD38 antibodies. ISB 1442 is currently in a Phase I clinical trial in relapsed refractory multiple myeloma.

Updates on Management of Biochemical Recurrent Prostate Cancer

OPINION STATEMENT

Patients with biochemical recurrent prostate cancer (BCR) are a heterogeneous group, whereby a personalized approach to management is critical. Patients with high-risk features such as PSA doubling time (PSADT) ≤ 9-12 months warrant earlier imaging for metastasis detection and consideration for intensified therapy (beyond intermittent androgen deprivation alone) during this phase of BCR-only disease. The BCR phase represents a unique opportunity to impact disease survival and delay metastasis progression. There is compelling evidence from the EMBARK trial that ADT monotherapy is no longer the optimal consideration for high-risk BCR patients.

Chimeric Forecasting: An experiment to leverage human judgment to improve forecasts of infectious disease using simulated surveillance data

Forecasts of infectious agents provide public health officials advanced warning about the intensity and timing of the spread of disease. Past work has found that accuracy and calibration of forecasts is weakest when attempting to predict an epidemic peak. Forecasts from a mechanistic model would be improved if there existed accurate information about the timing and intensity of an epidemic. We presented 3000 humans with simulated surveillance data about the number of incident hospitalizations from a current and two past seasons, and asked that they predict the peak time and intensity of the underlying epidemic. We found that in comparison to two control models, a model including human judgment produced more accurate forecasts of peak time and intensity of hospitalizations during an epidemic. Chimeric models have the potential to improve our ability to predict targets of public health interest which may in turn reduce infectious disease burden.

Proteomic-miRNA Biomics Profile Reveals 2D Cultures of Human iPSC-Derived Neural Progenitor Cells More Sensitive than 3D Spheroid System Against the Experimental Exposure to Arsenic

The iPSC-derived 3D models are considered to be a connective link between 2D culture and in vivo studies. However, the sensitivity of such 3D models is yet to be established. We assessed the sensitivity of the hiPSC-derived 3D spheroids against 2D cultures of neural progenitor cells. The sub-toxic dose of Sodium Arsenite (SA) was used to investigate the alterations in miRNA-proteins in both systems. Though SA exposure induced significant alterations in the proteins in both 2D and 3D systems, these proteins were uncommon except for 20 proteins. The number and magnitude of altered proteins were higher in the 2D system compared to 3D. The association of dysregulated miRNAs with the target proteins showed their involvement primarily in mitochondrial bioenergetics, oxidative and ER stress, transcription and translation mechanism, cytostructure, etc., in both culture systems. Further, the impact of dysregulated miRNAs and associated proteins on these functions and ultrastructural changes was compared in both culture systems. The ultrastructural studies revealed a similar pattern of mitochondrial damage, while the cellular bioenergetics studies confirm a significantly higher energy failure in the 2D system than to 3D. Such a higher magnitude of changes could be correlated with a higher amount of internalization of SA in 2D cultures than in 3D spheroids. Our findings demonstrate that a 2D culture system seems better responsive than a 3D spheroid system against SA exposure.

Effects of empagliflozin on progression of chronic kidney disease: a prespecified secondary analysis from the empa-kidney trial

BACKGROUND

Sodium-glucose co-transporter-2 (SGLT2) inhibitors reduce progression of chronic kidney disease and the risk of cardiovascular morbidity and mortality in a wide range of patients. However, their effects on kidney disease progression in some patients with chronic kidney disease are unclear because few clinical kidney outcomes occurred among such patients in the completed trials. In particular, some guidelines stratify their level of recommendation about who should be treated with SGLT2 inhibitors based on diabetes status and albuminuria. We aimed to assess the effects of empagliflozin on progression of chronic kidney disease both overall and among specific types of participants in the EMPA-KIDNEY trial.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA), and included individuals aged 18 years or older with an estimated glomerular filtration rate (eGFR) of 20 to less than 45 mL/min per 1·73 m2, or with an eGFR of 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher. We explored the effects of 10 mg oral empagliflozin once daily versus placebo on the annualised rate of change in estimated glomerular filtration rate (eGFR slope), a tertiary outcome. We studied the acute slope (from randomisation to 2 months) and chronic slope (from 2 months onwards) separately, using shared parameter models to estimate the latter. Analyses were done in all randomly assigned participants by intention to treat. EMPA-KIDNEY is registered at ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and then followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroups of eGFR included 2282 (34·5%) participants with an eGFR of less than 30 mL/min per 1·73 m2, 2928 (44·3%) with an eGFR of 30 to less than 45 mL/min per 1·73 m2, and 1399 (21·2%) with an eGFR 45 mL/min per 1·73 m2 or higher. Prespecified subgroups of uACR included 1328 (20·1%) with a uACR of less than 30 mg/g, 1864 (28·2%) with a uACR of 30 to 300 mg/g, and 3417 (51·7%) with a uACR of more than 300 mg/g. Overall, allocation to empagliflozin caused an acute 2·12 mL/min per 1·73 m2 (95% CI 1·83-2·41) reduction in eGFR, equivalent to a 6% (5-6) dip in the first 2 months. After this, it halved the chronic slope from -2·75 to -1·37 mL/min per 1·73 m2 per year (relative difference 50%, 95% CI 42-58). The absolute and relative benefits of empagliflozin on the magnitude of the chronic slope varied significantly depending on diabetes status and baseline levels of eGFR and uACR. In particular, the absolute difference in chronic slopes was lower in patients with lower baseline uACR, but because this group progressed more slowly than those with higher uACR, this translated to a larger relative difference in chronic slopes in this group (86% [36-136] reduction in the chronic slope among those with baseline uACR <30 mg/g compared with a 29% [19-38] reduction for those with baseline uACR ≥2000 mg/g; ptrend<0·0001).

INTERPRETATION

Empagliflozin slowed the rate of progression of chronic kidney disease among all types of participant in the EMPA-KIDNEY trial, including those with little albuminuria. Albuminuria alone should not be used to determine whether to treat with an SGLT2 inhibitor.

FUNDING

Boehringer Ingelheim and Eli Lilly.

Comparative genomics of a vertically transmitted thiotrophic bacterial ectosymbiont and its close free-living relative

Thiotrophic symbioses between sulphur-oxidizing bacteria and various unicellular and metazoan eukaryotes are widespread in reducing marine environments. The giant colonial ciliate Zoothamnium niveum, however, is the only host of thioautotrophic symbionts that has been cultivated along with its symbiont, the vertically transmitted ectosymbiont Candidatus Thiobius zoothamnicola (short Thiobius). Because theoretical predictions posit a smaller genome in vertically transmitted endosymbionts compared to free-living relatives, we investigated whether this is true also for an ectosymbiont. We used metagenomics to recover the high-quality draft genome of this bacterial symbiont. For comparison we have also sequenced a closely related free-living cultured but not formally described strain Milos ODIII6 (short ODIII6). We then performed comparative genomics to assess the functional capabilities at gene, metabolic pathway and trait level. 16S rRNA gene trees and average amino acid identity confirmed the close phylogenetic relationship of both bacteria. Indeed, Thiobius has about a third smaller genome than its free-living relative ODIII6, with reduced metabolic capabilities and fewer functional traits. The functional capabilities of Thiobius were a subset of those of the more versatile ODIII6, which possessed additional genes for oxygen, sulphur and hydrogen utilization and for the acquisition of phosphorus illustrating features that may be adaptive for the unstable environmental conditions at hydrothermal vents. In contrast, Thiobius possesses genes potentially enabling it to utilize lactate and acetate heterotrophically, compounds that may be provided as byproducts by the host. The present study illustrates the effect of strict host-dependence of a bacterial ectosymbiont on genome evolution and host adaptation.

Impact of primary kidney disease on the effects of empagliflozin in patients with chronic kidney disease: secondary analyses of the EMPA-KIDNEY trial

BACKGROUND

The EMPA-KIDNEY trial showed that empagliflozin reduced the risk of the primary composite outcome of kidney disease progression or cardiovascular death in patients with chronic kidney disease mainly through slowing progression. We aimed to assess how effects of empagliflozin might differ by primary kidney disease across its broad population.

METHODS

EMPA-KIDNEY, a randomised, controlled, phase 3 trial, was conducted at 241 centres in eight countries (Canada, China, Germany, Italy, Japan, Malaysia, the UK, and the USA). Patients were eligible if their estimated glomerular filtration rate (eGFR) was 20 to less than 45 mL/min per 1·73 m2, or 45 to less than 90 mL/min per 1·73 m2 with a urinary albumin-to-creatinine ratio (uACR) of 200 mg/g or higher at screening. They were randomly assigned (1:1) to 10 mg oral empagliflozin once daily or matching placebo. Effects on kidney disease progression (defined as a sustained ≥40% eGFR decline from randomisation, end-stage kidney disease, a sustained eGFR below 10 mL/min per 1·73 m2, or death from kidney failure) were assessed using prespecified Cox models, and eGFR slope analyses used shared parameter models. Subgroup comparisons were performed by including relevant interaction terms in models. EMPA-KIDNEY is registered with ClinicalTrials.gov, NCT03594110.

FINDINGS

Between May 15, 2019, and April 16, 2021, 6609 participants were randomly assigned and followed up for a median of 2·0 years (IQR 1·5-2·4). Prespecified subgroupings by primary kidney disease included 2057 (31·1%) participants with diabetic kidney disease, 1669 (25·3%) with glomerular disease, 1445 (21·9%) with hypertensive or renovascular disease, and 1438 (21·8%) with other or unknown causes. Kidney disease progression occurred in 384 (11·6%) of 3304 patients in the empagliflozin group and 504 (15·2%) of 3305 patients in the placebo group (hazard ratio 0·71 [95% CI 0·62-0·81]), with no evidence that the relative effect size varied significantly by primary kidney disease (pheterogeneity=0·62). The between-group difference in chronic eGFR slopes (ie, from 2 months to final follow-up) was 1·37 mL/min per 1·73 m2 per year (95% CI 1·16-1·59), representing a 50% (42-58) reduction in the rate of chronic eGFR decline. This relative effect of empagliflozin on chronic eGFR slope was similar in analyses by different primary kidney diseases, including in explorations by type of glomerular disease and diabetes (p values for heterogeneity all >0·1).

INTERPRETATION

In a broad range of patients with chronic kidney disease at risk of progression, including a wide range of non-diabetic causes of chronic kidney disease, empagliflozin reduced risk of kidney disease progression. Relative effect sizes were broadly similar irrespective of the cause of primary kidney disease, suggesting that SGLT2 inhibitors should be part of a standard of care to minimise risk of kidney failure in chronic kidney disease.

FUNDING

Boehringer Ingelheim, Eli Lilly, and UK Medical Research Council.

Interplay between autotrophic and heterotrophic prokaryotic metabolism in the bathypelagic realm revealed by metatranscriptomic analyses

BACKGROUND

Heterotrophic microbes inhabiting the dark ocean largely depend on the settling of organic matter from the sunlit ocean. However, this sinking of organic materials is insufficient to cover their demand for energy and alternative sources such as chemoautotrophy have been proposed. Reduced sulfur compounds, such as thiosulfate, are a potential energy source for both auto- and heterotrophic marine prokaryotes.

METHODS

Seawater samples were collected from Labrador Sea Water (LSW, ~ 2000 m depth) in the North Atlantic and incubated in the dark at in situ temperature unamended, amended with 1 µM thiosulfate, or with 1 µM thiosulfate plus 10 µM glucose and 10 µM acetate (thiosulfate plus dissolved organic matter, DOM). Inorganic carbon fixation was measured in the different treatments and samples for metatranscriptomic analyses were collected after 1 h and 72 h of incubation.

RESULTS

Amendment of LSW with thiosulfate and thiosulfate plus DOM enhanced prokaryotic inorganic carbon fixation. The energy generated via chemoautotrophy and heterotrophy in the amended prokaryotic communities was used for the biosynthesis of glycogen and phospholipids as storage molecules. The addition of thiosulfate stimulated unclassified bacteria, sulfur-oxidizing Deltaproteobacteria (SAR324 cluster bacteria), Epsilonproteobacteria (Sulfurimonas sp.), and Gammaproteobacteria (SUP05 cluster bacteria), whereas, the amendment with thiosulfate plus DOM stimulated typically copiotrophic Gammaproteobacteria (closely related to Vibrio sp. and Pseudoalteromonas sp.).

CONCLUSIONS

The gene expression pattern of thiosulfate utilizing microbes specifically of genes involved in energy production via sulfur oxidation and coupled to CO2 fixation pathways coincided with the change in the transcriptional profile of the heterotrophic prokaryotic community (genes involved in promoting energy storage), suggesting a fine-tuned metabolic interplay between chemoautotrophic and heterotrophic microbes in the dark ocean. Video Abstract.

Influencing Best Practices for Genomic and Germline Testing in Urology

INTRODUCTION

We evaluated germline and somatic testing practices and compared results from tissue and liquid biopsy specimens in a large community urology setting.

METHODS

A retrospective analysis was performed on advanced prostate cancer patients from a single community practice between June 2016 and September 2021. Clinical data and sequencing results from tissue and liquid biopsy specimens were available for 389 patients. Genomic data were available for 81 tissues and 74 liquid biopsy specimens. Comparison of genomic findings included 81 tissues and 27 liquid biopsy specimens. The number of actionable biomarkers and patients screened and enrolled in clinical trials was assessed from germline and somatic testing. Frequency of pathogenically altered genes, alteration types, and biomarkers were assessed from tissue and liquid specimens. Alteration frequency was compared between specimen types for the top 25 altered genes.

RESULTS

Clinically relevant alterations were found from germline and somatic testing in both tissue and liquid biopsy specimens. The frequency of microsatellite instability-high, tumor mutational burden-high, or alterations in homologous recombination repair genes was consistent with published findings. Concordance between tissue and liquid findings varied with low circulating tumor DNA.

CONCLUSIONS

Germline and somatic testing is critical for treatment decisions and should be standard of care for community practices. Liquid biopsy is a viable alternative when circulating tumor DNA is high.

Disease Burden and Treatment Patterns Among US Patients with Hidradenitis Suppurativa: A Retrospective Cohort Study

INTRODUCTION

Hidradenitis suppurativa (HS) is a chronic, autoinflammatory skin disease associated with many comorbidities. One biologic (adalimumab) is approved for HS. This study assessed the sociodemographic characteristics, comorbidities, treatment patterns, healthcare resource utilization (HCRU) and associated costs of patients with HS following biologic approval.

METHODS

This non-interventional, retrospective cohort study involved adult (≥ 18 years) and adolescent (12-17 years) patients diagnosed with HS in the United States (US) using Optum's de-identified Clinformatics® Data Mart Database during the period 1 January 2016 to 31 December 2018.

RESULTS

Of 42,843 identified patients, 10,909 met the incident HS patient criteria (10,230 adults, 628 adolescents, 51 patients aged <12 years). Patients were mostly diagnosed by a general practitioner/pediatrician (adults: 41.6%; adolescents: 39.6%) or dermatologist (adults: 22.1%; adolescents: 30.6%). Commonly reported Charlson comorbidities at pre-index in adult patients were diabetes without complications (20.4%), chronic pulmonary disease (16.4%) and diabetes with complications (9.0%), and the most frequent Elixhauser comorbidities were uncomplicated hypertension (38.3%), obesity (22.5%), uncomplicated diabetes (19.0%) and depression (17.4%). The burden of comorbidities generally increased over time after diagnosis in both adults and adolescents. HS-related surgical procedures were uncommon in the 2-years post-index period: an incision and drainage procedure was reported in 7.6% of adults and 6.4% of adolescents. Patients were predominantly treated with both topical and systemic antibiotic treatments (adults: 25.0% and 65.1%, respectively; adolescents: 41.7% and 74.5%, respectively). Biologic prescription was higher in adults than adolescents (3.5% vs. 1.8%). Total healthcare costs for adult and adolescent patients in the 2-years post-index period were US$42,143 and US$16,057, respectively, with outpatient costs accounting for the majority of these costs (US$20,980 and US$8408, respectively).

CONCLUSION

In adult and adolescent patients with HS, comorbidity burden continues to increase after diagnosis. All-cause and HS-specific HCRU and costs are high in adults and adolescents with HS. These findings support the need for a multidisciplinary comprehensive care strategy for patients with HS.

Impact of Listening to Indian Classical Music, or Rāgas, on the Electroencephalogram: A Meta-Analysis

Ancient Indian classical music (ICM) has long been lauded and recognized for influencing emotional responses by influencing the human body's resonance. A meta-analysis of prospective case studies published in the last ten years on the effect of ancient Indian music rāgas on brain waves is investigated. This meta-analysis aimed to analyze published prospective studies investigating the effect of ancient Indian rāgas on EEG in healthy subjects. The present study included prospective studies published since 2012. Studies were obtained by searching four databases, such as PsychINFO, PubMed, Google Scholar, and JSTOR, and searching related journals. Eligibility criteria included studies assessing the impact of listening to Indian classical music on the EEG. Primary outcomes were changes in the brain waves, frequency, and power and their relationship to activity-related arousal, attention, and mental tasks. The studies were analyzed according to the PRISMA guidelines. There were a total of five included studies with 71 participants in the age range of 19-30, and the conditions for the test groups were generally similar except for varying types of rāgas used and time of day. Analysis of the data collected from 71 participants revealed that music interventions had statistically significant effects on increasing alpha activity and attention scores. Fractal analysis was sensitive enough to detect EEG brainwave changes while and after listening to the rāga musical intervention. Rāgas stimulate arousal in different areas of the brain, depending on the emotions they are designed to evoke. However, the synchronized studies together could not highlight a significant relationship between rāgas and EEG fractal dimension values. Although the meta-analysis failed to reproduce the same results from the individual studies, potentially due to the small sample size and study variation, the meta-analysis opens doors to the potential of rāgas to elicit distinct emotions and serve as robust predictors of emotional response. Future studies can explore the therapeutic potential of various rāgas in the clinical setting, such as in the management of cognitive disorders and stress or in modulating heart rate variability and cognitive performance.

Impact of Variant Histology on Oncological Outcomes in Upper Tract Urothelial Carcinoma: Results From the ROBUUST Collaborative Group

INTRODUCTION

Oncologic implications of variant histology (VH) have been extensively studied in bladder cancer; however, further investigation is needed in upper tract urothelial carcinoma (UTUC). Our study aims to evaluate the impact of VH on oncological outcomes in UTUC patients treated with radical nephroureterectomy (RNU).

METHODS

A retrospective analysis was performed on patients who underwent a robotic or laparoscopic RNU for UTUC using the ROBUUST database, a multi-institutional collaborative including 17 centers worldwide. Logistic regression was used to assess the effect of VH on urothelial recurrence (bladder, contralateral upper tract), metastasis, and survival following RNU.

RESULTS

A total of 687 patients were included in this study. Median (IQR) age was 71 (64-78) years and 470 (68%) had organ confined disease. VH was present in 70 (10.2%) patients. In a median follow-up of 16 months, the incidence of urothelial recurrence, metastasis, and mortality was 26.8%, 15.3%, and 11.8%, respectively. VH was associated with increased risk of metastasis (HR 4.3, P <.0001) and death (HR 2.0, P =.046). In multivariable analysis, VH was noted to be an independent risk factor for metastasis (HR 1.8, P =.03) but not for urothelial recurrence (HR 0.99, P =.97) or death (HR 1.4, P =.2).

CONCLUSION

Variant histology can be found in 10% of patients with UTUC and is an independent risk factor for metastasis following RNU. Overall survival rates and the risk of urothelial recurrence in the bladder or contralateral kidney are not affected by the presence of VH.

The SPEAK study rationale and design: A linguistic corpus-based approach to understanding thought disorder

AIM

Psychotic symptoms are typically measured using clinical ratings, but more objective and sensitive metrics are needed. Hence, we will assess thought disorder using the Research Domain Criteria (RDoC) heuristic for language production, and its recommended paradigm of "linguistic corpus-based analyses of language output". Positive thought disorder (e.g., tangentiality and derailment) can be assessed using word-embedding approaches that assess semantic coherence, whereas negative thought disorder (e.g., concreteness, poverty of speech) can be assessed using part-of-speech (POS) tagging to assess syntactic complexity. We aim to establish convergent validity of automated linguistic metrics with clinical ratings, assess normative demographic variance, determine cognitive and functional correlates, and replicate their predictive power for psychosis transition among at-risk youths.

METHODS

This study will assess language production in 450 English-speaking individuals in Australia and Canada, who have recent onset psychosis, are at clinical high risk (CHR) for psychosis, or who are healthy volunteers, all well-characterized for cognition, function and symptoms. Speech will be elicited using open-ended interviews. Audio files will be transcribed and preprocessed for automated natural language processing (NLP) analyses of coherence and complexity. Data analyses include canonical correlation, multivariate linear regression with regularization, and machine-learning classification of group status and psychosis outcome.

CONCLUSIONS

This prospective study aims to characterize language disturbance across stages of psychosis using computational approaches, including psychometric properties, normative variance and clinical correlates, important for biomarker development. SPEAK will create a large archive of language data available to other investigators, a rich resource for the field.

A user-friendly graphical user interface for dynamic light scattering data analysis

Dynamic light scattering (DLS) is a commonly used analytical tool for characterizing the size distribution of colloids in a dispersion or a solution. Typically, the intensity of a scattering produced from the sample at a fixed angle from an incident laser beam is recorded as a function of time and converted into time autocorrelation data, which can be inverted to estimate the distribution of colloid diffusivity to estimate the colloid size distribution. For polydisperse samples, this inversion problem, being a Fredholm integral equation of the first kind, is ill-posed and is typically handled using cumulant expansions or regularization methods. Here, we introduce a user-friendly graphical user interface (GUI) for analyzing the measured scattering intensity time autocorrelation data using both the cumulant expansion method and regularization methods, with the latter implemented using various commonly employed algorithms, including NNLS, CONTIN, REPES, and DYNALS. The GUI allows the user to modulate any and all of the fit parameters, offering extreme flexibility. Additionally, the GUI also enables a comparison of the size distributions generated by various algorithms and an evaluation of their performance. We present the fit results obtained from the GUI for model monomodal and bimodal dispersions to highlight the strengths, limitations, and scope of applicability of these algorithms for analyzing time autocorrelation data from DLS.

An Efficient Multi-Scale Fusion Network for 3D Organs at Risk (OARs) Segmentation

Accurate segmentation of organs-at-risks (OARs) is a precursor for optimizing radiation therapy planning. Existing deep learning-based multi-scale fusion architectures have demonstrated a tremendous capacity for 2D medical image segmentation. The key to their success is aggregating global context and maintaining high resolution representations. However, when translated into 3D segmentation problems, existing multi-scale fusion architectures might underperform due to their heavy computation overhead and substantial data diet. To address this issue, we propose a new OAR segmentation framework, called OARFocalFuseNet, which fuses multi-scale features and employs focal modulation for capturing global-local context across multiple scales. Each resolution stream is enriched with features from different resolution scales, and multi-scale information is aggregated to model diverse contextual ranges. As a result, feature representations are further boosted. The comprehensive comparisons in our experimental setup with OAR segmentation as well as multi-organ segmentation show that our proposed OARFocalFuseNet outperforms the recent state-of-the-art methods on publicly available OpenKBP datasets and Synapse multi-organ segmentation. Both of the proposed methods (3D-MSF and OARFocalFuseNet) showed promising performance in terms of standard evaluation metrics. Our best performing method (OARFocalFuseNet) obtained a dice coefficient of 0.7995 and hausdorff distance of 5.1435 on OpenKBP datasets and dice coefficient of 0.8137 on Synapse multi-organ segmentation dataset. Our code is available at https://github.com/NoviceMAn-prog/OARFocalFuse.

Recent advances in conducting polymer-based magnetic nanosorbents for dyes and heavy metal removal: fabrication, applications, and perspective

Globally, treating and disposing of industrial pollutants is a techno-economic challenge. Industries' large production of harmful heavy metal ions (HMIs) and dyes and inappropriate disposal worsen water contamination. Much attention is required on the development of efficient and cost-effective technologies and approaches for removing toxic HMIs and dyes from wastewater as they pose a severe threat to public health and aquatic ecosystems. Due to the proven superiority of adsorption over other alternative methods, various nanosorbents have been developed for the efficient removal of HMIs and dyes from wastewater and aqueous solutions. Being a good adsorbent, conducting polymer-based magnetic nanocomposites (CP-MNCPs) has drawn more attention for HMIs and dye removal. Conductive polymers' pH-responsiveness makes CP-MNCP ideal for wastewater treatment. The composite material absorbed dyes and/or HMIs from contaminated water could be removed by changing the pH. Here, we review the production strategies and applications of CP-MNCPs for HMIs and dye removal. The review also sheds light on the adsorption mechanism, adsorption efficiency, kinetic and adsorption models, and regeneration capacity of the various CP-MNCPs. To date, various modifications to conducting polymers (CPs) have been explored to improve the adsorption properties. It is evident from the literature survey that the combination of SiO₂, graphene oxide (GO), and multi-walled carbon nanotubes (MWCNTs) with CPs-MNCPs enhances the adsorption capacity of nanocomposites to a large extent, so future research should lean toward the development of cost-effective hybrid CPs-nanocomposites.

A65 VISCERAL FAT INDICES: DO THEY HELP DIFFERENTIATE CROHN’S DISEASE AND INTESTINAL TUBERCULOSIS IN CHILDREN?

Background

Crohn’s disease (CD) and Intestinal tuberculosis (ITB) mimic each other and are often difficult to differentiate. A correct and prompt diagnosis is essential for a good outcome. Mesenteric fat hypertrophy is a feature of CD and studies in adults have shown higher visceral fat in CD than ITB. There is no published data in children.

Purpose

This study evaluated the utility of visceral fat indices in differentiating CD and ITB in children.

Method

Symptomatic children diagnosed to have CD or ITB based on standard recommended criteria were enrolled. The clinical and laboratory details were noted. Abdominal fat was measured on Computed Tomography in supine position at the level of L4 vertebrae. Visceral fat (VF) and subcutaneous fat (SF) area was measured separately by an experienced radiologist, blinded to the diagnosis. Sum of VF and SF was taken as total fat (TF). VF/SF and VF/TF ratio was calculated.

Result(s)

34 children [14 boys, median age 14.0 (inter quartile range 10.8-17.0)] years were recruited, of which 12 (29%) had CD [7 boys, age 13.0 (IQR 9.25-16.5) years] and 22 (71%) had ITB [7 boys, age-14.5 (IQR 11-17) years]. Visceral fat area (VF) was significantly higher in CD compared to ITB (table 1). However, there was no significant difference in the SF (2199.5 (1537.6-3881.6) vs 2176.5 (671.0-6651.5) mm²; p=0.958) and TF (3096.1 (2108.2-5373.5) vs 4518.2 (2677.6-8456.3) mm²; p=0.245) in ITB and CD respectively. The ratio of VF/SF and VF/TF was significantly higher in CD as compared to ITB for all cases (table1). When comparing CD and ITB in boys and girls separately the same trend was observed but the difference was statistically significant only for boys. On ROC analysis, VF:SF ratio of 0.609 predicted CD with the sensitivity of 75% and specificity of 86.4% (area under curve [AUC]-0.795, 95% CI 0.636-0.955; p=0.005). VF:TF ratio of 0.379 had similar sensitivity of 75% and specificity of 86.4% (AUC-0.795, 95% CI 0.636-0.955; p=0.005). The VF area of 1485.26 mm² had a sensitivity of 83.3% and specificity of 72.7% for CD (AUC-0.758, 95% CI 0.590-0.925; p=0.01).

Image

Conclusion(s)

The VF/SF ratio is a simple, non-invasive, objective parameter to differentiate CD and ITB in children with a good sensitivity and specificity.

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Disclosure of Interest

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Harmonizing Definitions for Diagnostic Criteria and Prognostic Assessment of Transplantation-Associated Thrombotic Microangiopathy: A Report on Behalf of the European Society for Blood and Marrow Transplantation, American Society for Transplantation and Cellular Therapy, Asia-Pacific Blood and Marrow Transplantation Group, and Center for International Blood and Marrow Transplant Research

Transplantation-associated thrombotic microangiopathy (TA-TMA) is an increasingly recognized complication of hematopoietic cell transplantation (HCT) associated with significant morbidity and mortality. However, TA-TMA is a clinical diagnosis, and multiple criteria have been proposed without universal application. Although some patients have a self-resolving disease, others progress to multiorgan failure and/or death. Poor prognostic features also are not uniformly accepted. The lack of harmonization of diagnostic and prognostic markers has precluded multi-institutional studies to better understand incidence and outcomes. Even current interventional trials use different criteria, making it challenging to interpret the data. To address this urgent need, the American Society for Transplantation and Cellular Therapy, Center for International Bone Marrow Transplant Research, Asia-Pacific Blood and Marrow Transplantation, and European Society for Blood and Marrow Transplantation nominated representatives for an expert panel tasked with reaching consensus on diagnostic and prognostic criteria. The panel reviewed literature, generated consensus statements regarding diagnostic and prognostic features of TA-TMA using the Delphi method, and identified future directions of investigation. Consensus was reached on 4 key concepts: (1) TA-TMA can be diagnosed using clinical and laboratory criteria or tissue biopsy of kidney or gastrointestinal tissue; however, biopsy is not required; (2) consensus diagnostic criteria are proposed using the modified Jodele criteria with additional definitions of anemia and thrombocytopenia. TA-TMA is diagnosed when ≥4 of the following 7 features occur twice within 14 days: anemia, defined as failure to achieve transfusion independence despite neutrophil engraftment; hemoglobin decline by ≥1 g/dL or new-onset transfusion dependence; thrombocytopenia, defined as failure to achieve platelet engraftment, higher-than-expected transfusion needs, refractory to platelet transfusions, or ≥50% reduction in baseline platelet count after full platelet engraftment; lactate dehydrogenase (LDH) exceeding the upper limit of normal (ULN); schistocytes; hypertension; soluble C5b-9 (sC5b-9) exceeding the ULN; and proteinuria (≥1 mg/mg random urine protein-to-creatinine ratio [rUPCR]); (3) patients with any of the following features are at increased risk of nonrelapse mortality and should be stratified as high-risk TA-TMA: elevated sC5b-9, LDH ≥2 times the ULN, rUPCR ≥1 mg/mg, multiorgan dysfunction, concurrent grade II-IV acute graft-versus-host disease (GVHD), or infection (bacterial or viral); and (4) all allogeneic and pediatric autologous HCT recipients with neuroblastoma should be screened weekly for TA-TMA during the first 100 days post-HCT. Patients diagnosed with TA-TMA should be risk-stratified, and those with high-risk disease should be offered participation in a clinical trial for TA-TMA-directed therapy if available. We propose that these criteria and risk stratification features be used in data registries, prospective studies, and clinical practice across international settings. This harmonization will facilitate the investigation of TA-TMA across populations diverse in race, ethnicity, age, disease indications, and transplantation characteristics. As these criteria are widely used, we expect continued refinement as necessary. Efforts to identify more specific diagnostic and prognostic biomarkers are a top priority of the field. Finally, an investigation of the impact of TA-TMA-directed treatment, particularly in the setting of concurrent highly morbid complications, such as steroid-refractory GVHD and infection, is critically needed.

Proteome architecture of human-induced pluripotent stem cell-derived three-dimensional organoids as a tool for early diagnosis of neuronal disorders

BACKGROUND AND OBJECTIVES

Induced pluripotent stem cells (iPSCs) derived three-dimensional (3D) model for rare neurodegenerative disorders such as amyotrophic lateral sclerosis (ALS) is emerging as a novel alternative to human diseased tissue to explore the disease etiology and potential drug discovery. In the interest of the same, we have generated a TDP-43-mutated human iPSCs (hiPSCs) derived 3D organoid model of ALS disease. The high-resolution mass spectrometry (MS)-based proteomic approach is used to explore the differential mechanism under disease conditions and the suitability of a 3D model to study the disease.

MATERIALS AND METHODS

The hiPSCs cell line was procured from a commercial source, grown, and characterized following standard protocols. The mutation in hiPSCs was accomplished using CRISPR/Cas-9 technology and predesigned gRNA. The two groups of organoids were produced by normal and mutated hiPSCs and subjected to the whole proteomic profiling by high-resolution MS in two biological replicates with three technical replicas of each.

RESULTS

The proteomic analysis of normal and mutated organoids revealed the proteins associated with pathways of neurodegenerative disorders, proteasomes, autophagy, and hypoxia-inducible factor-1 signaling. Differential proteomic analysis revealed that the mutation in TDP-43 gene caused proteomic deregulation, which impaired protein quality mechanisms. Furthermore, this impairment may contribute to the generation of stress conditions that may ultimately lead to the development of ALS pathology.

CONCLUSION

The developed 3D model represents the majority of candidate proteins and associated biological mechanisms altered in ALS disease. The study also offers novel protein targets that may uncloud the precise disease pathological mechanism and be considered for future diagnostic and therapeutic purposes for various neurodegenerative disorders.

Use of intra-operative internal distraction for the application of magnetically controlled growth rods (MCGR): a technique for maximizing correction in the rigid immature spine during index surgery

OBJECTIVE

Operative treatment of early onset scoliosis (EOS) with Magnetically Controlled Growing Rod (MCGR) in moderate-to-severe curves poses a challenge due to the limited amount of force and length available with the implant. The purpose of this study was to assess the use of the intra-operative internal spine distraction using Harrington Outrigger, before definitive implantation of MCGR, with regard to initial correction, maintenance of correction, truncal balance, and complication rates.

PATIENTS AND METHODS

16 EOS patients treated with the application of MCGR using the intra-operative internal distractor technique were included in the study. More than 50% of cases were congenital scoliosis with multiple vertebral anomalies. All patients were followed up for a minimum of 2 years. Radiological measurement of change in Cobb angle, thoracic kyphosis, lumbar lordosis, T1-S1 length, T1-T12l length, and sagittal balance were done at pre-op, immediate post-op, after 1 year, and 2 years. All the complications were noted and documented.

RESULTS

The mean age of the operated patients was 8 ± 1.7 years, range (4-10 years). Mean pre-operative Cobb angle was 70.4 degrees. The mean correction of major Cobb angle was 34.6°. The percentage correction achieved in post-operative Cobb angle was about 51%. Mean change in post-operative thoracic kyphosis was 18.5° (40%). The average gain in immediate post-operative spinal length (T1-S1) and thoracic height (T1-T12) was 46.7 mm (18.3%) and 41 mm (23%), respectively.

CONCLUSION

Large and rigid curves in EOS can achieve a significant correction of Cobb angle and coronal imbalance during the index operation, by the use of intra-operative internal distraction at the time of MCGR insertion.

LEVEL AND TYPE OF STUDY

Retrospective clinical study, level 4.

Enhancement of CO gas sensing performance by Mn-doped porous ZnSnO3 microspheres

This work reports the synthesis of Mn-doped ZnSnO3 microspheres (Zn1-x Mn x SnO3) using a simple co-precipitation method with (x = 0 to 0.15) and characterized for structural, morphological, surface area, and sensing properties. X-ray diffraction (XRD) analysis revealed the face-centered cubic structure of Mn-doped ZnSnO3 samples. Brunauer-Emmett-Teller (BET) analysis demonstrated the variation in surface area from 15.229 m2 g-1 to 42.999 m2 g-1 with x = 0 to 0.15 in Zn1-x Mn x SnO3. XPS indicates the change in the defect levels by Mn doping, which plays a crucial role in chemical sensors. Indeed a significant increase (≈311.37%) in CO gas sensing response was observed in the x = 0.10 sample compared to pure ZnSnO3 with a simultaneous reduction in operating temperature from 250 to 200 °C. Moreover, remarkable enhancements in response/recovery times (≈6.6/34.1 s) were obtained in the x = 0.10 sample. The Mn-doped ZnSnO3 could be a promising candidate for CO gas sensing devices used for maintaining air quality.

The complete and closed genome of the facultative generalist Candidatus Endoriftia persephone from deep-sea hydrothermal vents

The mutualistic interactions between Riftia pachyptila and its endosymbiont Candidatus Endoriftia persephone (short Endoriftia) have been extensively researched. However, the closed Endoriftia genome is still lacking. Here, by employing single-molecule real-time sequencing we present the closed chromosomal sequence of Endoriftia. In contrast to theoretical predictions of enlarged and mobile genetic element-rich genomes related to facultative endosymbionts, the closed Endoriftia genome is streamlined with fewer than expected coding sequence regions, insertion-, prophage-sequences and transposase-coding sequences. Automated and manually curated functional analyses indicated that Endoriftia is more versatile regarding sulphur metabolism than previously reported. We identified the presence of two identical rRNA operons and two long CRISPR regions in the closed genome. Additionally, pangenome analyses revealed the presence of three types of secretion systems (II, IV and VI) in the different Endoriftia populations indicating lineage-specific adaptations. The in depth mobilome characterization identified the presence of shared genomic islands in the different Endoriftia drafts and in the closed genome, suggesting that the acquisition of foreign DNA predates the geographical dispersal of the different endosymbiont populations. Finally, we found no evidence of epigenetic regulation in Endoriftia, as revealed by gene screenings and absence of methylated modified base motifs in the genome. As a matter of fact, the restriction-modification system seems to be dysfunctional in Endoriftia, pointing to a higher importance of molecular memory-based immunity against phages via spacer incorporation into CRISPR system. The Endoriftia genome is the first closed tubeworm endosymbiont to date and will be valuable for future gene oriented and evolutionary comparative studies.

Risk of stroke in patients with type 2 diabetes receiving semaglutide or a dipeptidyl peptidase-4 inhibitor: a real-world US claims database analysis

Introduction

People with type 2 diabetes (T2D) have a higher risk of stroke than those without, are likely to experience stroke at a younger age, and have worse outcomes. The cardiovascular benefits of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in T2D have been demonstrated in randomized controlled trials. A meta-analysis of these data has shown that GLP-1 RAs are associated with a significant reduction in the risk of stroke; however, there remains an evidence gap for the real-world effect of semaglutide specifically on stroke risk.

Purpose

To compare real-world risk of stroke in patients with T2D or T2D + atherosclerotic cardiovascular disease (ASCVD) initiating either semaglutide or a dipeptidyl peptidase-4 inhibitor (DPP-4i).

Methods

For inclusion, adults (≥18 years) in a US claims database required a claim indicating initiation of either semaglutide or a DPP-4i (index date) during the index period (1/1/18–30/9/20), a diagnosis code for T2D on or before the index date, and 12 months' continuous enrolment pre-index. Exclusion criteria were a claim for semaglutide, DPP-4i or injectable glucose-lowering medication, or diagnosis code for type 1 or secondary diabetes in the 12 months pre-index; or a claim associated with pregnancy or gestational diabetes any time during the study period. Patients were propensity score matched 1:1 on 27 baseline demographic and clinical characteristics. Patients who also had a diagnosis code for ASCVD pre-index were matched separately on 26 variables. Primary outcome was time to first stroke event during follow-up, defined as a medical claim with stroke as primary diagnosis during inpatient or emergency room visit. Patients with no event were censored at end of enrolment or end of study period (30/9/20), whichever was earliest.

Results

Post-matching, there were 17,920 pairs with T2D and 4234 pairs with T2D+ASCVD. The groups were well matched on baseline characteristics (Table). For T2D, patients initiating semaglutide had a lower risk of stroke than those initiating a DPP-4i (hazard ratio [HR], 0.63; 95% confidence interval [CI]: 0.41–0.95; p=0.029). This trend was more pronounced for T2D+ASCVD (HR, 0.45 [0.24–0.86]; p=0.015). Overall, 34 patients with T2D receiving semaglutide (0.2%) experienced a stroke event (incidence rate [IR] per 100 person-years, 0.25), compared with 60 patients receiving a DPP-4i (0.3%; IR, 0.40; IR ratio [IRR], 0.62; 95% CI: 0.40–0.95). For the groups with T2D+ASCVD, 13 patients receiving semaglutide (0.3%; IR, 0.40) and 32 receiving a DPP-4i (0.8%; IR, 0.90) experienced a stroke event (IRR, 0.44 [0.23–0.85]). The Figure shows cumulative incidence of stroke over follow-up (median 237–258 days).

Conclusion

This analysis provides initial insights into the potential of semaglutide to reduce real-world stroke risk in patients with T2D. Analyses with additional comparison groups and longer follow-up are needed to determine the broader clinical and economic implications.

Funding Acknowledgement

Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was funded by Novo Nordisk A/S. Medical writing support was provided by Oxford PharmaGenesis, Oxford, UK with funding from Novo Nordisk A/S.

Addressing sustainability during and post-COVID-19 pandemic crisis: a literature review and bibliometric analysis to explore the future avenues

Purpose

This paper aims to identify the current research trends in sustainability through an extensive literature review and propose future research agenda under the ambit of the ongoing coronavirus disease 2019 (COVID-19) pandemic. Specifically, the present study aims to uncover the current state of the literature and thereby develop an understanding of how the pandemic has impacted the dimensions of sustainability.

Design/methodology/approach

To achieve the objective, the authors adopted a five-step literature review process, combined with bibliometric and network analysis. The authors also considered news articles and reports of international organizations to comprehensively achieve the research objective.

Findings

The study results show how the pandemic has impacted the social, economic and environmental dimensions of sustainability. The results also highlight the list of authors, countries and institutions that have proactively worked towards eliminating the disruption caused by the COVID-19 pandemic.

Research limitations/implications

The study provides an in-depth understanding of the scholarly contributions to the field of sustainability since the COVID-19 outbreak. The study is useful for policymakers and businesses interested in understanding how the pandemic has impacted the dimensions of sustainability and possible mitigation strategies. Furthermore, the study also provides future research directions in the intersection of pandemic and sustainability dimensions. Specific research questions (RQs) are also proposed to help future research.

Originality/value

To the best of the authors' knowledge, this study is a pioneer attempt to provide a comprehensive understanding of the existing and rapidly growing literature on COVID-19 and its relationship with the various dimensions of sustainability.

Transition metal oxides as a cathode for indispensable Na-ion batteries

The essential requirement to harness well-known renewable energy sources like wind energy, solar energy, etc. as a component of an overall plan to guarantee global power sustainability will require highly efficient, high power and energy density batteries to collect the derived electrical power and balance out variations in both supply and demand. Owing to the continuous exhaustion of fossil fuels, and ever increasing ecological problems associated with global warming, there is a critical requirement for searching for an alternative energy storage technology for a better and sustainable future. Electrochemical energy storage technology could be a solution for a sustainable source of clean energy. Sodium-ion battery (SIB) technology having a complementary energy storage mechanism to the lithium-ion battery (LIB) has been attracting significant attention from the scientific community due to its abundant resources, low cost, and high energy densities. Layered transition metal oxide (TMO) based materials for SIBs could be a potential candidate for SIBs among all other cathode materials. In this paper, we discussed the latest improvement in the various structures of the layered oxide materials for SIBs. Moreover, their synthesis, overall electrochemical performance, and several challenges associated with SIBs are comprehensively discussed with a stance on future possibilities. Many articles discussed the improvement of cathode materials for SIBs, and most of them have pondered the use of Na x MO2 (a class of TMOs) as a possible positive electrode material for SIBs. The different phases of layered TMOs (Na x MO2; TM = Co, Mn, Ti, Ni, Fe, Cr, Al, V, and a combination of multiple elements) show good cycling capacity, structural stability, and Na+ ion conductivity, which make them promising cathode material for SIBs. This review discusses and summarizes the electrochemical redox reaction, structural transformations, significant challenges, and future prospects to improve for Na x MO2. Moreover, this review highlights the recent advancement of several layered TMO cathode materials for SIBs. It is expected that this review will encourage further development of layered TMOs for SIBs.

Video Capsule Endoscopy Classification using Focal Modulation Guided Convolutional Neural Network

Video capsule endoscopy is a hot topic in computer vision and medicine. Deep learning can have a positive impact on the future of video capsule endoscopy technology. It can improve the anomaly detection rate, reduce physicians' time for screening, and aid in real-world clinical analysis. Computer-Aided diagnosis (CADx) classification system for video capsule endoscopy has shown a great promise for further improvement. For example, detection of cancerous polyp and bleeding can lead to swift medical response and improve the survival rate of the patients. To this end, an automated CADx system must have high throughput and decent accuracy. In this study, we propose FocalConvNet, a focal modulation network integrated with lightweight convolutional layers for the classification of small bowel anatomical landmarks and luminal findings. FocalConvNet leverages focal modulation to attain global context and allows global-local spatial interactions throughout the forward pass. Moreover, the convolutional block with its intrinsic inductive/learning bias and capacity to extract hierarchical features allows our FocalConvNet to achieve favourable results with high throughput. We compare our FocalConvNet with other state-of-the-art (SOTA) on Kvasir-Capsule, a large-scale VCE dataset with 44,228 frames with 13 classes of different anomalies. We achieved the weighted F1-score, recall and Matthews correlation coefficient (MCC) of 0.6734, 0.6373 and 0.2974, respectively, outperforming SOTA methodologies. Further, we obtained the highest throughput of 148.02 images/second rate to establish the potential of FocalConvNet in a real-time clinical environment. The code of the proposed FocalConvNet is available at https://github.com/NoviceMAn-prog/FocalConvNet.

Automatic Polyp Segmentation with Multiple Kernel Dilated Convolution Network

The detection and removal of precancerous polyps through colonoscopy is the primary technique for the prevention of colorectal cancer worldwide. However, the miss rate of colorectal polyp varies significantly among the endoscopists. It is well known that a computer-aided diagnosis (CAD) system can assist endoscopists in detecting colon polyps and minimize the variation among endoscopists. In this study, we introduce a novel deep learning architecture, named MKDCNet, for automatic polyp segmentation robust to significant changes in polyp data distribution. MKDCNet is simply an encoder-decoder neural network that uses the pre-trained ResNet50 as the encoder and novel multiple kernel dilated convolution (MKDC) block that expands the field of view to learn more robust and heterogeneous representation. Extensive experiments on four publicly available polyp datasets and cell nuclei dataset show that the proposed MKDCNet outperforms the state-of-the-art methods when trained and tested on the same dataset as well when tested on unseen polyp datasets from different distributions. With rich results, we demonstrated the robustness of the proposed architecture. From an efficiency perspective, our algorithm can process at (≈ 45) frames per second on RTX 3090 GPU. MKDCNet can be a strong benchmark for building real-time systems for clinical colonoscopies. The code of the proposed MKDCNet is available at https://github.com/nikhilroxtomar/MKDCNet.

Decision-making framework for identifying regions vulnerable to transmission of COVID-19 pandemic

At the beginning of 2020, the World Health Organization (WHO) identified an unusual coronavirus and declared the associated COVID-19 disease as a global pandemic. We proposed a novel hybrid fuzzy decision-making framework to identify and analyze these transmission factors and conduct proactive decision-making in this context. We identified thirty factors from the extant literature and classified them into six major clusters (climate, hygiene and safety, responsiveness to decision-making, social and demographic, economic, and psychological) with the help of domain experts. We chose the most relevant twenty-five factors using the Fuzzy Delphi Method (FDM) screening from the initial thirty. We computed the weights of those clusters and their constituting factors and ranked them based on their criticality, applying the Fuzzy Analytic Hierarchy Process (FAHP). We found that the top five factors were global travel, delay in travel restriction, close contact, social cohesiveness, and asymptomatic. To evaluate our framework, we chose ten different geographically located cities and analyzed their exposure to COVID-19 pandemic by ranking them based on their vulnerability of transmission using Fuzzy Technique for Order of Preference by Similarity To Ideal Solution (FTOPSIS). Our study contributes to the disciplines of decision analytics and healthcare risk management during a pandemic through these novel findings. Policymakers and healthcare officials will benefit from our study by formulating and improving existing preventive measures to mitigate future global pandemics. Finally, we performed a sequence of sensitivity analyses to check for the robustness and generalizability of our proposed hybrid decision-making framework.

Early versus late acute graft pyelonephritis: A retrospective analysis of graft and patient outcomes

BACKGROUND

Acute graft pyelonephritis (AGPN) is thought to affect graft and patient survival among renal transplant recipients. The objective was to compare outcomes among early AGPN (<6 months from transplant) versus late AGPN (>6 months from transplant).

METHODS

This retrospective study analysed 150 patients with AGPN dividing them into early and late AGPN from 2008 to 2016. Predictors of graft loss and mortality were compared using logistic regression analysis. Graft survival and patient survival were analysed using Kaplan-Meyer survival plots.

RESULTS

55.3% (n = 83) had early AGPN and 44.7% (n = 67) had late AGPN. In an early AGPN group, 13.3% had CMV disease on the follow-up, compared to only 3% in the late AGPN group (p > 0.05). Furthermore, 38.6% had prolonged DJ stent in-situ (> 2 weeks) following transplant surgery in the early AGPN compared to only 19.4% in the late AGPN group (p < 0.05). Recurrent GPN was more common in the late AGPN group - (35.8% versus 18.1%). The presence of renal abscess was predictive of graft loss in Univariate analysis (HR-6.12, p < 0.004). There was decreased death-censored graft survival in the early AGPN group (p = 0.035), without a significant difference in the patient survival among the two groups.

CONCLUSION

The occurrence of early AGPN had a significant impact on long-term graft survival in renal transplant recipients, with no significant effect on patient survival. This study underlines the paramount importance of the prevention of urinary tract infection (UTI) in renal transplant recipients.

Identification and analysis of adoption barriers of disruptive technologies in the logistics industry

Purpose

Recently, disruptive technologies (DTs) have proposed several innovative applications in managing logistics and promise to transform the entire logistics sector drastically. Often, this transformation is not successful due to the existence of adoption barriers to DTs. This study aims to identify the significant barriers that impede the successful adoption of DTs in the logistics sector and examine the interrelationships amongst them.

Design/methodology/approach

Initially, 12 critical barriers were identified through an extensive literature review on disruptive logistics management, and the barriers were screened to ten relevant barriers with the help of Fuzzy Delphi Method (FDM). Further, an Interpretive Structural Modelling (ISM) approach was built with the inputs from logistics experts working in the various departments of warehouses, inventory control, transportation, freight management and customer service management. ISM approach was then used to generate and examine the interrelationships amongst the critical barriers. Matrics d’Impacts Croises-Multiplication Applique a Classement (MICMAC) analysed the barriers based on the barriers' driving and dependence power.

Findings

Results from the ISM-based technique reveal that the lack of top management support (B6) was a critical barrier that can influence the adoption of DTs. Other significant barriers, such as legal and regulatory frameworks (B1), infrastructure (B3) and resistance to change (B2), were identified as the driving barriers, and industries need to pay more attention to them for the successful adoption of DTs in logistics. The MICMAC analysis shows that the legal and regulatory framework and lack of top management support have the highest driving powers. In contrast, lack of trust, reliability and privacy/security emerge as barriers with high dependence powers.

Research limitations/implications

The authors' study has several implications in the light of DT substitution. First, this study successfully analyses the seven DTs using Adner and Kapoor's framework (2016a, b) and the Theory of Disruptive Innovation (Christensen, 1997; Christensen et al., 2011) based on the two parameters as follows: emergence challenge of new technology and extension opportunity of old technology. Second, this study categorises these seven DTs into four quadrants from the framework. Third, this study proposes the recommended paths that DTs might want to follow to be adopted quickly.

Practical implications

The authors' study has several managerial implications in light of the adoption of DTs. First, the authors' study identified no autonomous barriers to adopting DTs. Second, other barriers belonging to any lower level of the ISM model can influence the dependent barriers. Third, the linkage barriers are unstable, and any preventive action involving linkage barriers would subsequently affect linkage barriers and other barriers. Fourth, the independent barriers have high influencing powers over other barriers.

Originality/value

The contributions of this study are four-fold. First, the study identifies the different DTs in the logistics sector. Second, the study applies the theory of disruptive innovations and the ecosystems framework to rationalise the choice of these seven DTs. Third, the study identifies and critically assesses the barriers to the successful adoption of these DTs through a strategic evaluation procedure with the help of a framework built with inputs from logistics experts. Fourth, the study recognises DTs adoption barriers in logistics management and provides a foundation for future research to eliminate those barriers.