bluuebunny/crossref_metadata_2025 huggingface dataset:
High Satisfaction With a Virtual Assistant for Plastic Surgery Frequently Asked Questions
Authors: Avila Francisco R , Boczar Daniel , Spaulding Aaron C , Quest Daniel J , Samanta Arindam , Torres-Guzman Ricardo A , Maita Karla C , Garcia John P , Eldaly Abdullah S , Forte Antonio J
Published: November 2022

Background

Most of a surgeon's office time is dedicated to patient education, preventing an appropriate patient-physician relationship. Telephone-accessed artificial intelligent virtual assistants (AIVAs) that simulate a human conversation and answer preoperative frequently asked questions (FAQs) can be effective solutions to this matter. An AIVA capable of answering preoperative plastic surgery–related FAQs has previously been described by the authors.

Objectives

The aim of this paper was to determine patients’ perception and satisfaction with an AIVA.

Methods

Twenty-six adult patients from a plastic surgery service answered a 3-part survey consisting of: (1) an evaluation of the answers’ correctness, (2) their agreement with the feasibility, usefulness, and future uses of the AIVA, and (3) a section on comments. The first part made it possible to measure the system's accuracy, and the second to evaluate perception and satisfaction. The data were analyzed with Microsoft Excel 2010 (Microsoft Corporation, Redmond, WA).

Results

The AIVA correctly answered the patients’ questions 98.5% of the time, and the topic with the lowest accuracy was “nausea.” Additionally, 88% of patients agreed with the statements of the second part of the survey. Thus, the patients’ perception was positive and overall satisfaction with the AIVA was high. Patients agreed the least with using the AIVA to select their surgical procedure. The comments provided improvement areas for subsequent stages of the project.

Conclusions

The results show that patients were satisfied and expressed a positive experience with using the AIVA to answer plastic surgery FAQs before surgery. The system is also highly accurate.
Metadensity: a background-aware python pipeline for summarizing CLIP signals on various transcriptomic sites
Authors: Her Hsuan-Lin , Boyle Evan , Yeo Gene W
Published: November 2022

Motivation

Cross-linking and immunoprecipitation (CLIP) is a technology to map the binding sites of RNA-binding proteins (RBPs). The region where an RBP binds within RNA is often indicative of its molecular function in RNA processing. As an example, the binding sites of splicing factors are found within or proximal to alternatively spliced exons. To better reveal the function of RBPs, we developed a tool to visualize the distribution of CLIP signals around various transcript features.

Results

Here, we present Metadensity (https://github.com/YeoLab/Metadensity), a software that allows users to generate metagene plots. Metadensity allows users to input features such as branchpoints and preserves the near-nucleotide resolution of CLIP technologies by not scaling the features by length. Metadensity normalizes immunoprecipitated libraries with background controls, such as size-matched inputs, then windowing in various user-defined features. Finally, the signals are averaged across a provided set of transcripts.

Availability and implementation

Metadensity is available at https://github.com/YeoLab/Metadensity, with example notebooks at https://metadensity.readthedocs.io/en/latest/tutorial.html.

Supplementary information

Supplementary data are available at Bioinformatics Advances online.
CAPG: comprehensive allopolyploid genotyper
Authors: Kulkarni Roshan , Zhang Yudi , Cannon Steven B , Dorman Karin S
Published: November 2022

Motivation

Genotyping by sequencing is a powerful tool for investigating genetic variation in plants, but many economically important plants are allopolyploids, where homoeologous similarity obscures the subgenomic origin of reads and confounds allelic and homoeologous SNPs. Recent polyploid genotyping methods use allelic frequencies, rate of heterozygosity, parental cross or other information to resolve read assignment, but good subgenomic references offer the most direct information. The typical strategy aligns reads to the joint reference, performs diploid genotyping within each subgenome, and filters the results, but persistent read misassignment results in an excess of false heterozygous calls.

Results

We introduce the Comprehensive Allopolyploid Genotyper (CAPG), which formulates an explicit likelihood to weight read alignments against both subgenomic references and genotype individual allopolyploids from whole-genome resequencing data. We demonstrate CAPG in allotetraploids, where it performs better than Genome Analysis Toolkit’s HaplotypeCaller applied to reads aligned to the combined subgenomic references.

Availability and implementation

Code and tutorials are available at https://github.com/Kkulkarni1/CAPG.git.

Supplementary information

Supplementary data are available at Bioinformatics online.
Neuromuscular symptoms in patients with RYR1-related malignant hyperthermia and rhabdomyolysis
Authors: van den Bersselaar Luuk R , Jungbluth Heinz , Kruijt Nick , Kamsteeg Erik-Jan , Fernandez-Garcia Miguel A , Treves Susan , Riazi Sheila , Malagon Ignacio , van Eijk Lucas T , van Alfen Nens , van Engelen Baziel G M , Scheffer Gert-Jan , Snoeck Marc M J , Voermans Nicol C
Published: November 2022

Malignant hyperthermia and exertional rhabdomyolysis have conventionally been considered episodic phenotypes that occur in otherwise healthy individuals in response to an external trigger. However, recent studies have demonstrated a clinical and histopathological continuum between patients with a history of malignant hyperthermia susceptibility and/or exertional rhabdomyolysis and RYR1-related congenital myopathies. We hypothesize that patients with a history of RYR1-related exertional rhabdomyolysis or malignant hyperthermia susceptibility do have permanent neuromuscular symptoms between malignant hyperthermia or exertional rhabdomyolysis episodes. We performed a prospective cross-sectional observational clinical study of neuromuscular features in patients with a history of RYR1-related exertional rhabdomyolysis and/or malignant hyperthermia susceptibility (n = 40) compared with healthy controls (n = 80). Patients with an RYR1-related congenital myopathy, manifesting as muscle weakness preceding other symptoms as well as other (neuromuscular) diseases resulting in muscle weakness were excluded. Study procedures included a standardized history of neuromuscular symptoms, a review of all relevant ancillary diagnostic tests performed up to the point of inclusion and a comprehensive, standardized neuromuscular assessment. Results of the standardized neuromuscular history were compared with healthy controls. Results of the neuromuscular assessment were compared with validated reference values. The proportion of patients suffering from cramps (P < 0.001), myalgia (P < 0.001) and exertional myalgia (P < 0.001) was higher compared with healthy controls. Healthcare professionals were consulted because of apparent neuromuscular symptoms by 17/40 (42.5%) patients and 7/80 (8.8%) healthy controls (P < 0.001). Apart from elevated creatine kinase levels in 19/40 (47.5%) patients and mild abnormalities on muscle biopsies identified in 13/16 (81.3%), ancillary investigations were normal in most patients. The Medical Research Council sum score, spirometry and results of functional measurements were also mostly normal. Three of 40 patients (7.5%) suffered from late-onset muscle weakness, most prominent in the proximal lower extremity muscles. Patients with RYR1 variants resulting in malignant hyperthermia susceptibility and/or exertional rhabdomyolysis frequently report additional neuromuscular symptoms such as myalgia and muscle cramps compared with healthy controls. These symptoms result in frequent consultation of healthcare professionals and sometimes in unnecessary invasive diagnostic procedures. Most patients do have normal strength at a younger age but may develop muscle weakness later in life.
First case report of fully robotically assisted lithotripsy in heavily calcified left main stenosis
Authors: Hofmann Felix J , Dörr Oliver , Blachutzik Florian , Boeder Niklas F , Elsässer Albrecht , Möllmann Helge , Nef Holger M
Published: November 2022

Background

Percutaneous coronary intervention (PCI) is the standard-of-care treatment for left main stenosis as an alternative to bypass surgery. In addition, severe coronary lesion calcification can be modified by intravascular lithotripsy (IVL). However, with PCI and debulking treatment options, there are inherent limitations. PCI poses an increased health burden for the treating physician that is associated with wearing a heavy, lead-lined apron and being exposed to radiation. To overcome these issues, a robotically assisted angioplasty system (rPCI) was established that enables the operator to perform PCI remotely in routine clinical procedures. Furthermore, IVL have not been used remotely.

Case summary

Here, we report the use of this technique for treating a heavily calcified left main stenosis in an 82-year-old male with previously diagnosed two-vessel coronary artery disease, progressive symptoms of dyspnoea at high cardio-vascular risk profile. The decision of the local heart team declined surgery. To the best of our knowledge, this is the first report of successful rPCI combined with IVL.

Discussion

In the case presented, rPCI was feasible and safe even in a complex lesion of the left main coronary artery requiring IVL. rPCI is a revolutionary new technique that may be applied to various types of coronary artery lesions.
What helps the successful implementation of digital decision aids supporting shared decision-making in cardiovascular diseases? A systematic review
Authors: Peters Loes J , Torres-Castaño Alezandra , van Etten-Jamaludin Faridi S , Perestelo Perez Lilisbeth , Ubbink Dirk T
Published: November 2022

Aims

Although digital decision aids (DAs) have been developed to improve shared decision-making (SDM), also in the cardiovascular realm, its implementation seems challenging. This study aims to systematically review the predictors of successful implementation of digital DAs for cardiovascular diseases.

Methods and results

Searches were conducted in MEDLINE, Embase, PsycInfo, CINAHL, and the Cochrane Library from inception to November 2021. Two reviewers independently assessed study eligibility and risk of bias. Data were extracted by using a predefined list of variables. Five good-quality studies were included, involving data of 215 patients and 235 clinicians. Studies focused on DAs for coronary artery disease, atrial fibrillation, and end-stage heart failure patients. Clinicians reported DA content, its effectivity, and a lack of knowledge on SDM and DA use as implementation barriers. Patients reported preference for another format, the way clinicians used the DA and anxiety for the upcoming intervention as barriers. In addition, barriers were related to the timing and Information and Communication Technology (ICT) integration of the DA, the limited duration of a consultation, a lack of communication among the team members, and maintaining the hospital’s number of treatments. Clinicians’ positive attitude towards preference elicitation and implementation of DAs in existing structures were reported as facilitators.

Conclusion

To improve digital DA use in cardiovascular diseases, the optimum timing of the DA, training healthcare professionals in SDM and DA usage, and integrating DAs into existing ICT structures need special effort. Current evidence, albeit limited, already offers advice on how to improve DA implementation in cardiovascular medicine.
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with vs. without left ventricular unloading by Impella: a systematic review and meta-analysis
Authors: Cappannoli Luigi , Galli Mattia , Zito Andrea , Restivo Attilio , Princi Giuseppe , Laborante Renzo , Vergallo Rocco , Romagnoli Enrico , Leone Antonio Maria , Aurigemma Cristina , Massetti Massimo , Sanna Tommaso , Trani Carlo , Burzotta Francesco , Savarese Gianluigi , Crea Filippo , D'Amario Domenico
Published: November 2022

Background and aims

The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for the treatment of cardiogenic shock (CS) may result in left ventricle overload and distension. Percutaneous microaxial flow pump Impella in addition to VA-ECMO (ECPELLA) is an emerging option to overcome these collateral effects. Aim of this study is to assess whether the addition of Impella to VA-ECMO is an effective and safe unloading strategy.

Methods and results

We performed a systematic literature review of studies comparing ECPELLA vs. ECMO alone in patients with CS. The primary endpoint was early mortality (in-hospital or 30-day mortality). The secondary endpoints were bleeding, need for kidney replacement therapy, haemolysis, infections, and limb ischaemia. A total of 3469 potentially relevant articles were screened and eight retrospective studies including 11.137 patients were selected. There was no significant difference in early mortality (Risk Ratio, RR 0.90, 95% CI 0.78–1.03) between ECPELLA and ECMO. Nevertheless, there was a borderline significant reduction in early mortality with ECPELLA (RR 0.74, 95% CI 0.55–1.00) at sensitivity analysis selectively including studies reporting propensity matched analysis. ECPELLA was associated with increased bleeding (RR 1.45, 95% CI 1.20–1.75), need for kidney replacement therapy (RR 1.54, 95% CI 1.19–1.99), haemolysis (RR 1.71, 95% CI 1.41–2.07) and limb ischaemia (RR 1.43, 95% CI 1.17–1.75) and with a non-significant increase in severe infections (RR 1.26, 95% CI 0.84–1.89), compared with ECMO alone.

Conclusion

Among patients with cardiogenic shock, ECPELLA is associated with increased complications compared with ECMO. Whether reducing ventricular overload with Impella among patients treated with ECMO reduces early mortality needs to be confirmed by further investigations.
High-quality genome assembles from key Hawaiian coral species
Authors: Stephens Timothy G , Lee JunMo , Jeong YuJin , Yoon Hwan Su , Putnam Hollie M , Majerová Eva , Bhattacharya Debashish
Published: November 2022

Background

Coral reefs house about 25% of marine biodiversity and are critical for the livelihood of many communities by providing food, tourism revenue, and protection from wave surge. These magnificent ecosystems are under existential threat from anthropogenic climate change. Whereas extensive ecological and physiological studies have addressed coral response to environmental stress, high-quality reference genome data are lacking for many of these species. The latter issue hinders efforts to understand the genetic basis of stress resistance and to design informed coral conservation strategies.

Results

We report genome assemblies from 4 key Hawaiian coral species, Montipora capitata, Pocillopora acuta, Pocillopora meandrina, and Porites compressa. These species, or members of these genera, are distributed worldwide and therefore of broad scientific and ecological importance. For M. capitata, an initial assembly was generated from short-read Illumina and long-read PacBio data, which was then scaffolded into 14 putative chromosomes using Omni-C sequencing. For P. acuta, P. meandrina, and P. compressa, high-quality assemblies were generated using short-read Illumina and long-read PacBio data. The P. acuta assembly is from a triploid individual, making it the first reference genome of a nondiploid coral animal.

Conclusions

These assemblies are significant improvements over available data and provide invaluable resources for supporting multiomics studies into coral biology, not just in Hawaiʻi but also in other regions, where related species exist. The P. acuta assembly provides a platform for studying polyploidy in corals and its role in genome evolution and stress adaptation in these organisms.
Accurate gene consensus at low nanopore coverage
Authors: Espada Rocío , Zarevski Nikola , Dramé-Maigné Adèle , Rondelez Yannick
Published: November 2022

Background

Nanopore technologies allow high-throughput sequencing of long strands of DNA at the cost of a relatively large error rate. This limits its use in the reading of amplicon libraries in which there are only a few mutations per variant and therefore they are easily confused with the sequencing noise. Consensus calling strategies reduce the error but sacrifice part of the throughput on reading typically 30 to 100 times each member of the library.

Findings

In this work, we introduce SINGLe (SNPs In Nanopore reads of Gene Libraries), an error correction method to reduce the noise in nanopore reads of amplicons containing point variations. SINGLe exploits that in an amplicon library, all reads are very similar to a wild-type sequence from which it is possible to experimentally characterize the position-specific systematic sequencing error pattern. Then, it uses this information to reweight the confidence given to nucleotides that do not match the wild-type in individual variant reads and incorporates it on the consensus calculation.

Conclusions

We tested SINGLe in a mutagenic library of the KlenTaq polymerase gene, where the true mutation rate was below the sequencing noise. We observed that contrary to other methods, SINGLe compensates for the systematic errors made by the basecallers. Consequently, SINGLe converges to the true sequence using as little as 5 reads per variant, fewer than the other available methods.
Integration of semi-in vivo assays and multi-omics data reveals the effect of galloylated catechins on self-pollen tube inhibition in Camellia oleifera
Authors: Chang Yihong , Gong Wenfang , Xu Jinming , Gong Han , Song Qiling , Xiao Shixin , Yuan Deyi
Published: November 2022

Camellia oil extracted from the seeds of Camellia oleifera Abel. is a popular and high-quality edible oil, but its yield is limited by seed setting, which is mainly caused by self-incompatibility (SI). One of the obvious biological features of SI plants is the inhibition of self-pollen tubes; however, the underlying mechanism of this inhibition in C. oleifera is poorly understood. In this study, we constructed a semi-in vivo pollen tube growth test (SIV-PGT) system that can screen for substances that inhibit self-pollen tubes without interference from the genetic background. Combined with multi-omics analysis, the results revealed the important role of galloylated catechins in self-pollen tube inhibition, and a possible molecular regulatory network mediated by UDP-glycosyltransferase (UGT) and serine carboxypeptidase-like (SCPL) was proposed. In summary, galloylation of catechins and high levels of galloylated catechins are specifically involved in pollen tube inhibition under self-pollination rather than cross-pollination, which provides a new understanding of SI in C. oleifera. These results will contribute to sexual reproduction research on C. oleifera and provide theoretical support for improving Camellia oil yield in production.
Stability–Maneuverability Tradeoffs Provided Diverse Functional Opportunities to Shelled Cephalopods
Authors: Peterman David J , Ritterbush Kathleen A
Published: November 2022

Synopsis

Stability–maneuverability tradeoffs impose various constraints on aquatic locomotion. The fossil record houses a massive morphological dataset that documents how organisms have encountered these tradeoffs in an evolutionary framework. Externally shelled cephalopods (e.g., ammonoids and nautiloids) are excellent targets to study physical tradeoffs because they experimented with numerous conch morphologies during their long-lived evolutionary history (around 0.5 billion years). The tradeoff between hydrostatic stability and maneuverability was investigated with neutrally buoyant biomimetic models, engineered to have the same mass distributions computed for their once-living counterparts. Monitoring rocking behavior with 3D motion tracking reveals how stability influenced the life habits of these animals. Cephalopods with short body chambers and rapid whorl expansion (oxycones) more quickly attenuate rocking, while cephalopods with long body chambers (serpenticones and sphaerocones) had improved pitch maneuverability. Disparate conch morphologies presented broad functional opportunities to these animals, imposing several advantages and consequences across the morphospace. These animals navigated inescapable physical constraints enforced by conch geometry, illuminating key relationships between functional diversity and morphological disparity in aquatic ecosystems. Our modeling techniques correct for differences in material properties between physical models and those inferred for their living counterparts. This approach provides engineering solutions to the obstacles created by buoyancy, mass distributions, and moments of inertia, permitting more lifelike, free-swimming biomechanical models and aquatic robots.
Univariate and Multivariate Determination of Dapagliflozin and Saxagliptin in Bulk and Dosage Form
Authors: Elhassan Manar M , Mahmoud Amr M , Hegazy Maha A , Mowaka Shereen
Published: November 2022

Background

Dapagliflozin is a sodium glucose cotransporter-II inhibitor while saxagliptin is a dipeptidyl peptidase-4 inhibitor. Both are used to manage type 2 diabetes mellitus.

Objective

The aim of this work is to develop four simple, accurate, and precise UV-spectrophotometric methods, three univariate and one multivariate, for the estimation of dapagliflozin and saxagliptin in their pure and marketed dosage forms.

Methods

Method (A) is based on the ratio difference method; Method (B) is ratio subtraction with constant multiplication; while Method (C) is a second derivative method and Method (D) is a partial least-squares method.

Results

The calibration curves for dapagliflozin and saxagliptin were linear within the concentration range of 2.50–50.0 μg/mL and 5.0–60.0 μg/mL, respectively. The specificity of the proposed methods was studied by analyzing different laboratory-prepared mixtures and their combined pharmaceutical dosage form. According to the International Council for Harmonisation guidelines, the three proposed methods were validated regarding the accuracy, precision, and specificity. Method (D), partial least-squares, was employed for the determination of the same mixture over a wavelength range of 205–300 nm. A statistical comparison was performed between the results of the proposed methods and those of a reported spectrophotometric method and no statistically significant difference was detected at 95% confidence limit regarding both precision and accuracy.

Conclusion

Four accurate, specific, and precise UV-spectrophotometric methods for dapagliflozin and saxagliptin testing and estimation were successfully utilized and validated.

Highlights

The examined methods are simple and do not involve sophisticated and expensive instruments. They could be effectively employed in quality control laboratories for routine examination of the investigated drugs in their pure powdered or combined pharmaceutical formulations.
Rapid Determination of Polysaccharides in Cistanche Tubulosa Using Near-Infrared Spectroscopy Combined with Machine Learning
Authors: Wang Yu , Tian Zhan-Ping , Xie Jia-Jia , Luo Ying , Yao Jun , Shen Jing
Published: November 2022

Background

Cistanche tubulosa, as a homology of medicine and food, not only has a unique medicinal value but also is widely used in healthcare products. Polysaccharide is one of its important quality indicators.

Objective

In this study, an analytical model based on near-infrared (NIR) spectroscopy combined with machine learning was established to predict the polysaccharide content of C. tubulosa.

Methods

The polysaccharide content in the samples determined by the phenol–sulfuric acid method was used as a reference value, and machine learning was applied to relate the spectral information to the reference value. Dividing the samples into a calibration set and a prediction set using the Kennard–Stone algorithm. The model was optimized by various preprocessing methods, including Savitzky–Golay (SG), standard normal variate (SNV), multiple scattering correction (MSC), first-order derivative (FD), second-order derivative (SD), and combinations of them. Variable selection was performed through the successive projections algorithm (SPA) and stability competitive adaptive reweighted sampling (sCARS). Four machine learning models were used to build quantitative models, including the random forest (RF), partial least-squares (PLS), principal component regression (PCR), and support vector machine (SVM). The evaluation indexes of the model were the coefficient of determination (R2), root-mean-square error (RMSE), and residual prediction deviation (RPD).

Results

RF performs best among the four machine learning models. R2c （calibration set coefficient of determination） and RMSEC （root mean square error of the calibration set）, %, were 0.9763. and 0.3527 for calibration, respectively. R2p （prediction set coefficient of determination）, RMSEP （root mean square error of the prediction set）, %, and RPD were 0.9230, 0.5130, and 3.33 for prediction, respectively.

Conclusion

The results indicate that NIR combined with the RF is an effective method applied to the quality evaluation of the polysaccharides of C. tubulosa.

Highlights

Four quantitative models were developed to predict the polysaccharide content in C. tubulosa, and good results were obtained. The characteristic variables were basically determined by the sCARS algorithm, and the corresponding characteristic groups were analyzed.
Aberrant elevation of FTO levels promotes liver steatosis by decreasing the m6A methylation and increasing the stability of SREBF1 and ChREBP mRNAs
Authors: Tang Zhili , Sun Chao , Yan Ying , Niu Zhoumin , Li Yuying , Xu Xi , Zhang Jing , Wu Yuting , Li Yan , Wang Li , Hu Cheng , Li Zhuoyang , Jiang Jingjing , Ying Hao
Published: November 2022

Previous studies have indicated an association of fat mass and obesity-associated (FTO) with nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease worldwide. This study aimed to decipher the complex role of FTO in hepatic lipid metabolism. We found that a decrease in N6-methyladenosine (m6A) RNA methylation in the liver of mice fed with a high-fat diet (HFD) was accompanied by an increase in FTO expression. Overexpression of FTO in the liver promoted triglyceride accumulation by upregulating the expression of lipogenic genes. Mechanistical studies revealed that FTO could stabilize the mRNAs of sterol regulatory element binding transcription factor 1 (SREBF1) and carbohydrate responsive element binding protein (ChREBP), two master lipogenic transcription factors, by demethylating m6A sites. Knockdown of either SREBF1 or ChREBP attenuated the lipogenic effect of FTO, suggesting that they are bona fide effectors for FTO in regulating lipogenesis. Insulin could stimulate FTO transcription through a mechanism involving the action of intranuclear insulin receptor beta, while knockdown of FTO abrogated the lipogenic effect of insulin. Inhibition of FTO by entacapone decreased the expression of SREBF1, ChREBP, and downstream lipogenic genes, ameliorating liver steatosis in HFD-fed mice. Thus, our study established a critical role of FTO in both the insulin-regulated hepatic lipogenesis and the pathogenesis of NAFLD and provided a potential strategy for treating NAFLD.
Incidence Trends of Kaposi Sarcoma Among Young Non-Hispanic Black Men by US Regions, 2001-2018
Authors: Suk Ryan , White Donna L , Knights Sheena , Nijhawan Ank , Deshmukh Ashish A , Chiao Elizabeth Y
Published: November 2022

Despite the overall national decline in Kaposi sarcoma (KS) incidence in the United States among persons living with HIV, previous studies suggest there might be specific subgroups of the US population that are associated with higher KS incidence rates than others. Using the 2001-2018 National Program of Cancer Registries and Surveillance, Epidemiology, and End Results Program database, we assessed KS incidence trends among young men aged 20-34 years by race and ethnicity and geographic region. Statistical significance is 2-sided. The KS incidence rate increased nationally by 1.5% per year in non-Hispanic Black men, whereas the rate decreased statistically significantly by 3.5% per year in non-Hispanic White men. A statistically significant 3.3% per year increase among young non-Hispanic Black men in the South and no change among those living in non-South regions were observed. Targeted HIV prevention and treatment in young non-Hispanic Black men in the South and further research addressing the increased KS incidence and burden in this vulnerable population are needed.
Sustained Hemostasis With the Padlock™ Over-the-scope Clip for Gastric Fundus Dieulafoy’s Lesion in the Setting of Anticoagulation Following Hemorrhagic Shock From Two Dieulafoy’s Lesions
Authors: Cho Jonathan J , Forbes Chelsea M , Fiore Benjamin D , McCarron Joshua D , Padilla Leybelis
Published: November 2022

Dieulafoy’s lesions (DLs) are a rare and difficult-to-identify cause of acute gastrointestinal bleeding that can lead to hemorrhagic shock. We present a case of a 23-year-old previously healthy male presenting with melenic stools and hemorrhagic shock. Computed tomography of abdomen and pelvis with oral and intravenous contrast showed a possible source of hemorrhage as a hyperdense intraluminal material within the stomach. Initial urgent esophagogastroduodenoscopy showed a large, nonbleeding distal esophageal DL, which was treated successfully with 10 mL of 1:10,000 epinephrine and bipolar cauterization with 10 Fr Gold Probe™. Hemorrhage recurred 2 d later, prompting another esophagogastroduodenoscopy, which found another DL within the gastric fundus. Treatment with epinephrine, Gold Probe™, and through-the-scope Hemoclips was unsuccessful because of difficult visualization and positioning. A subsequent attempt was made using the over-the-scope clip (OTSC) Padlock™ Clip Defect Closure System with successful hemostasis and stabilization of the patient. His hospital course was complicated by left lower lobe segmental pulmonary embolism without right heart strain for which he was discharged on 3 months of anticoagulation with apixaban. On follow-up, there was no recurrence of gastrointestinal bleeding (GIB) despite 3 months of anticoagulation. He did not complete the Basic Underwater Demolition/SEAL (BUD/S) Training. This case report demonstrates the evaluation and management of a patient with hemorrhagic shock from two DLs and sustained hemostasis with the Padlock™ OTSC in the setting of apixaban anticoagulation.
Platelet RNA enables accurate detection of ovarian cancer: an intercontinental, biomarker identification study
Authors: Gao Yue , Liu Chun-Jie , Li Hua-Yi , Xiong Xiao-Ming , Li Gui-Ling , In ‘t Veld Sjors G J G , Cai Guang-Yao , Xie Gui-Yan , Zeng Shao-Qing , Wu Yuan , Chi Jian-Hua , Liu Jia-Hao , Zhang Qiong , Jiao Xiao-Fei , Shi Lin-Li , Lu Wan-Rong , Lv Wei-Guo , Yang Xing-Sheng , Piek Jurgen M J , de Kroon Cornelis D , Lok C A R , Supernat Anna , Łapińska-Szumczyk Sylwia , Łojkowska Anna , Żaczek Anna J , Jassem Jacek , Tannous Bakhos A , Sol Nik , Post Edward , Best Myron G , Kong Bei-Hua , Xie Xing , Ma Ding , Wurdinger Thomas , Guo An-Yuan , Gao Qing-Lei
Published: November 2022

Platelets are reprogrammed by cancer via a process called education, which favors cancer development. The transcriptional profile of tumor-educated platelets (TEPs) is skewed and therefore practicable for cancer detection. This intercontinental, hospital-based, diagnostic study included 761 treatment-naïve inpatients with histologically confirmed adnexal masses and 167 healthy controls from nine medical centers (China, n = 3; Netherlands, n = 5; Poland, n = 1) between September 2016 and May 2019. The main outcomes were the performance of TEPs and their combination with CA125 in two Chinese (VC1 and VC2) and the European (VC3) validation cohorts collectively and independently. Exploratory outcome was the value of TEPs in public pan-cancer platelet transcriptome datasets. The AUCs for TEPs in the combined validation cohort, VC1, VC2, and VC3 were 0.918 (95% CI 0.889–0.948), 0.923 (0.855–0.990), 0.918 (0.872–0.963), and 0.887 (0.813–0.960), respectively. Combination of TEPs and CA125 demonstrated an AUC of 0.922 (0.889–0.955) in the combined validation cohort; 0.955 (0.912–0.997) in VC1; 0.939 (0.901–0.977) in VC2; 0.917 (0.824–1.000) in VC3. For subgroup analysis, TEPs exhibited an AUC of 0.858, 0.859, and 0.920 to detect early-stage, borderline, non-epithelial diseases and 0.899 to discriminate ovarian cancer from endometriosis. TEPs had robustness, compatibility, and universality for preoperative diagnosis of ovarian cancer since it withstood validations in populations of different ethnicities, heterogeneous histological subtypes, and early-stage ovarian cancer. However, these observations warrant prospective validations in a larger population before clinical utilities.
Can bee propolis help us fight against methicillin-resistant Staphylococcus aureus (MRSA)?
Authors: Ripari Nicolas , Beatriz Toti Maria , Kenupp Bastos Jairo , Sforcin José Maurício
Published: November 2022

Objectives

Methicillin-resistant Staphylococcus aureus (MRSA) is a multidrug-resistant pathogen in nosocomial infections. Since the 1950s, MRSA has acquired several resistance factors including efflux pumps and drug target modifications. Some studies investigated the anti-MRSA capacity of propolis samples collected in different regions and their immunomodulatory action. The aim of this review is to gather the data published up to August 2022 about propolis action on MRSA strains and its modulatory action on phagocytes.

Methods

The PubMed database was used to look for articles containing the keywords ‘propolis’, ‘immunomodulation’, ‘MRSA’ and the name of each compound. As propolis contains a variety of compounds making it impossible to isolate the major bioactive components, we reviewed the main compounds found in several propolis samples and their mechanisms towards the resistance factors displayed by MRSA. Some perspectives for using propolis-based medications and the formulation of new antimicrobial/immunomodulatory agents are discussed.

Key findings

Propolis extracts and active compounds exert antibacterial action over MRSA strains acting on resistance factors. Moreover, propolis modulates pro-inflammatory markers in phagocytes.

Conclusions

Because propolis compounds may act synergistically, it’s crucial to understand how these components interact to synthesize standardized formulations and enhance their bioavailability for clinical applications to combat MRSA.
Effect of altitude and acetazolamide on sleep and nocturnal breathing in healthy lowlanders 40 y of age or older. Data from a randomized trial
Authors: Graf Laura C , Furian Michael , Bitos Konstantinos , Mademilov Maamed , Abdraeva Ainura , Buenzli Jana , Buenzli Simone , Aidaralieva Shaira , Sheraliev Ulan , Mayer Laura C , Schneider Simon R , Sooronbaev Talant M , Ulrich Silvia , Bloch Konrad E
Published: November 2022

Study Objectives

To assess altitude-induced sleep and nocturnal breathing disturbances in healthy lowlanders 40 y of age or older and the effects of preventive acetazolamide treatment.

Methods

Clinical examinations and polysomnography were performed at 760 m and in the first night after ascent to 3100 m in a subsample of participants of a larger trial evaluating altitude illness. Participants were randomized 1:1 to treatment with acetazolamide (375 mg/day) or placebo, starting 24 h before and while staying at 3100 m. The main outcomes were indices of sleep structure, oxygenation, and apnea/hypopnea index (AHI).

Results

Per protocol analysis included 86 participants (mean ± SE 53 ± 7 y old, 66% female). In 43 individuals randomized to placebo, mean nocturnal pulse oximetry (SpO2) was 94.0 ± 0.4% at 760 m and 86.7 ± 0.4% at 3100 m, with mean change (95%CI) −7.3% (−8.0 to −6.5); oxygen desaturation index (ODI) was 5.0 ± 2.3 at 760 m and 29.2 ± 2.3 at 3100 m, change 24.2/h (18.8 to 24.5); AHI was 11.3 ± 2.4/h at 760 m and 23.5 ± 2.4/h at 3100 m, change 12.2/h (7.3 to 17.0). In 43 individuals randomized to acetazolamide, altitude-induced changes were mitigated. Mean differences (Δ, 95%CI) in altitude-induced changes were: ΔSpO2 2.3% (1.3 to 3.4), ΔODI -15.0/h (−22.6 to −7.4), ΔAHI -11.4/h (−18.3 to −4.6). Total sleep time, sleep efficiency, and N3-sleep fraction decreased with an ascent to 3100 m under placebo by 40 min (17 to 60), 5% (2 to 8), and 6% (2 to 11), respectively. Acetazolamide did not significantly change these outcomes.

Conclusions

During a night at 3100 m, healthy lowlanders aged 40 y or older revealed hypoxemia, sleep apnea, and disturbed sleep. Preventive acetazolamide treatment improved oxygenation and nocturnal breathing but had no effect on sleep duration and structure.

Trial registration

The trial is registered at Clinical Trials, https://clinicaltrials.gov, NCT03561675
Comparison of Pregnancy Outcomes of Previable and Periviable Rupture of Membranes After Laser Photocoagulation for Twin–Twin Transfusion Syndrome
Authors: Forde Braxton , Fresch Robert , Masters Heather , DeFranco Emily A. , McKinney David N. , Tabbah Sammy , Lim Foong , Habli Mounira
Published: November 2022

OBJECTIVE:

To describe the pregnancy outcomes of patients who experienced previable and periviable prelabor rupture of membranes (PROM) after the treatment of twin–twin transfusion syndrome.

METHODS:

We conducted a retrospective cohort study of patients whose pregnancies were complicated by twin–twin transfusion syndrome who were treated with fetoscopic laser photocoagulation at a single fetal center and subsequently experienced PROM from April 2010 to June 2019. Outcomes were infant survival and latency from PROM to delivery. Patients were grouped by gestational age at PROM (before 26 weeks of gestation and 26 weeks or later). The group with PROM before 26 weeks of gestation was stratified by gestational age at PROM for further description of outcomes.

RESULTS:

Two-hundred fifty of 653 patients (38%) developed PROM, 81 before 26 weeks of gestation and 169 after 26 weeks of gestation. In the setting of PROM before 26 weeks of gestation, the rate of survival of both twins to neonatal intensive care unit (NICU) discharge was 46.3%, compared with 76.9% in the setting of PROM at 26 weeks of gestation or later (P<.001); the survival rate of at least one twin was 61.2% and 98.5%, respectively (P<.001). Fourteen, 22, and 45 patients experienced PROM at 16–19 6/7, 20–22 6/7, and 23–25 6/7 weeks of gestation, respectively. Survival of both twins and at least one twin to NICU discharge was 25.0%, 47.4%, 52.8% (for two) and 33.3%, 47.4%, and 77.8% (for at least one), respectively, among those groups. Fifty-seven of the 81 patients with PROM before 26 weeks of gestation experienced a latency longer than 48 hours. In the setting of PROM before 26 weeks of gestation, when latency lasted longer than 48 hours, overall survival was improved (69.6% vs 53.7%, respectively, P=.017). With latency longer than 48 hours and PROM at 16–19 6/7, 20–22 6/7, and 23–25 6/7 weeks of gestation, survival of both twins to NICU discharge was 60.0%, 61.5%, and 60.7%, respectively, and survival of at least one twin was 80.0%, 61.5%, and 85.7%, respectively.

CONCLUSION:

Earlier gestational age at PROM after laser photocoagulation is associated with longer latency but lower rates of survival. When PROM occurs before 26 weeks of gestation and latency exceeds 48 hours, rates of neonatal survival are significantly improved.
Timing of Positive Hepatitis C Virus Test Results During and 1 Year Before Pregnancy
Authors: Woodworth Kate R. , Newton Suzanne M. , Olsen Emily O. , Tannis Ayzsa , Sizemore Lindsey , Wingate Heather , Orkis Lauren , Reynolds Bethany , Longcore Nicole , Thomas Nadia , Bocour Angelica , Wills Aprielle , Kim Shin Y. , Panagiotakopoulos Lakshmi , Wester Carolyn , Delman Meaney Dana , Gilboa Suzanne M. , Tong Van T.
Published: November 2022

The incidence of hepatitis C virus (HCV) infection in reproductive-aged adults quadrupled during the past decade. Hepatitis C can progress to advanced liver disease and be transmitted perinatally. Highly effective curative hepatitis C treatment is available but is not recommended in pregnancy. Using the Surveillance for Emerging Threats to Mothers and Babies Network, we describe timing of positive RNA testing among pregnant people with HCV (HCV RNA detected during or within one year prior to pregnancy). Four US jurisdictions reported 1161 pregnancies during 2018–2021 among people with hepatitis C: 75.9% were multiparous; and 21.4% had their first peri-pregnancy HCV RNA detected prior to pregnancy, indicating potential missed treatment opportunities to improve maternal health and prevent perinatal transmission.
Identifying Components of Autism Friendly Health Care: An Exploratory Study Using a Modified Delphi Method
Authors: O'Hagan Belinda , Krauss Shari B. , Friedman Alexander J. , Bartolotti Lauren , Abubakare Oluwatobi , Broder-Fingert Sarabeth , Augustyn Marilyn
Published: November 2022

Objectives:

Autistic individuals report lower health care satisfaction. However, there is currently no set of “best practice” standards about caring for autistic individuals. In this exploratory study, we aim to identify features of Autism Friendly practice according to a sample consisting of mainly professionals whose interests include autism using a modified 3-round Delphi—a method that identifies a consensus view across subject participants.

Methods:

Statements about components of an Autism Friendly health care practice were compiled in consultation with the steering committee of an Autism Friendly Initiative at a single, urban academic safety-net hospital. Participants were recruited through our national network of professionals and patients/families mailing list. Examples of invited professionals included researchers, health care workers, and educators. In the first 2 rounds, we distributed electronic surveys to participants, who scored statements from 1 to 9 regarding importance. In round 2, statements that were scored low by all stakeholder groups were eliminated. Seventy-eight participants responded to the first-round survey, and 51 participants responded to the second-round survey. In the third round, 38 participants ranked 16 statements from most to least important. Statements are summarized and presented in the Results section.

Results:

Topics that emerged from highly ranked statements include environmental/operational modifications (e.g., longer appointment times) and staff training to support autistic patients.

Conclusion:

Highly ranked statements represented previously reported barriers, including the need for staff training and inclusive engagement with the autistic community. The findings can help inform health care organizations to determine priorities when building an Autism Friendly health care practice.
Low-dose aspirin as primary prevention for adults without cardiovascular disease
Authors: Klausner Shira
Published: November 2022

Background:

Cardiovascular disease is the leading cause of death in the United States. Patients with cardiovascular disease risk factors are often put on low-dose aspirin to prevent future cardiovascular events and cardiovascular death. However, the evidence supporting this practice is limited.

Objective:

To examine whether adults without a history of cardiovascular disease benefit from taking daily low-dose aspirin as primary prevention for cardiovascular disease and death.

Data sources:

The four databases of PubMed, CINAHL, Scopus, and Ovid were used, and a total of 67 nonduplicate articles were reviewed. After examining those articles, four studies were included. Of the four studies, three were randomized controlled trials, and one was a retrospective cohort study.

Conclusions:

All four studies concluded that daily low-dose aspirin used for primary prevention does not lower the risk of death from cardiovascular disease.

Implications for practice:

Further research needs to be conducted to determine whether daily low-dose aspirin is beneficial in individuals without a history of cardiovascular disease. Nurse practitioners need to know the most current evidence-based practice recommendations to appropriately counsel patients about whether they should be taking low-dose aspirin to prevent cardiovascular disease.
Infection control in the bronchoscopy suite: effective reprocessing and disinfection of reusable bronchoscopes
Authors: Chhabria Mamta S. , Maldonado Fabien , Mehta Atul C.
Published: November 2022

Purpose of review

With advancements in technology, flexible bronchoscopes have become thinner in diameter and in need of more thorough reprocessing to prevent infection transmission than ever before. Many experienced bronchoscopists are not aware of the critical steps involved in effective bronchoscope reprocessing and we hope to bridge this gap by describing this process in detail.

Recent findings

Bronchoscope reprocessing includes several distinct steps (precleaning, leak testing, manual cleaning, visual inspection, terminal reprocessing, rinsing and drying). Each step is comprehensive and needs to be carried out systematically by trained personnel. Failure of any step can lead to serious downstream events such as outbreaks and pseudo-outbreaks. Some experts now recommend sterilization when feasible, although high-level disinfection remains the minimum standard. We also will review some literature on the utility of borescopes, automated endoscope reprocessors and disposable bronchoscopes.

Our article will focus on the most recent recommendations for effective reprocessing and disinfection of reusable bronchoscopes.
Overcoming challenges in patient selection and monitoring in combined heart and kidney transplantation
Authors: Bertelli Michele , Russo Antonio , Suarez Sofia Martin , Pacini Davide , Ravaioli Matteo , Siniscalchi Antonio , Comai Giorgia , Mancini Elena , Potena Luciano
Published: November 2022

Combined heart-kidney transplantation (HKT) is a growing therapeutic strategy in patients with advanced heart failure (HF) and concomitant chronic kidney disease (CKD). Although patients with advanced HF and need for chronic haemodialysis have a clear indication for combined HKT, challenges to current practice lie in identifying those patients with severely depressed kidney function, which will not recover kidney function after restoration of appropriate haemodynamic conditions following heart transplantation (HT) alone. Because of the paucity of available organs, maximisation of kidney graft utility whilst minimising the operative risks associated with combined transplantation is mandatory. The benefits of HKT go beyond the mere restoration of kidney function. Data from registry analysis show that HKT improves overall survival in patients with CKD, as compared to heart transplant only, and it is associated with reduced incidence of heart allograft rejection, likely through the promotion of host immune tolerance mechanisms. In patients not requiring chronic dialysis, kidney-after-heart strategy may be explored, instead of combined HKT, in particular when the aetiology of CKD is unclear. This indeed allows for monitoring and gaging of indications for combined transplantation in the postoperative period. This approach however should be matched with priority listing for kidney transplantation given the high waitlist mortality in heart transplant recipients with associated CKD. The use of kidney machine perfusion may represent an additional tool to optimise the outcome of HKT, allowing more time to stabilise the patient after HT surgery.