bluuebunny/crossref_metadata_2025 huggingface dataset:
Developing a Machine‐Learning Predictive Model for Retention of Posterior Cruciate Ligament in Patients Undergoing Total Knee Arthroplasty
Authors: Chen Long , Zhang Liyi , Zhou Diange , Dong Shengjie , Xing Dan
Published: May 2024

Objective

Predicting whether the posterior cruciate ligament (PCL) should be preserved during total knee arthroplasty (TKA) procedures is a complex task in the preoperative phase. The choice to either retain or excise the PCL has a substantial effect on the surgical outcomes and biomechanical integrity of the knee joint after the operation. To enhance surgeons' ability to predict the removal and retention of the PCL in patients before TKA, we developed machine learning models. We also identified significant feature factors that contribute to accurate predictions during this process.

Methods

Patients' data on TKA continuously performed by a single surgeon who had intended initially to undergo implantation of cruciate‐retaining (CR) prostheses was collected. During the sacrifice of PCL, we utilized anterior‐stabilized (AS) tibial bearings. The dataset was split into CR and AS categories to form distinct groups. Relevant information regarding age, gender, body mass index (BMI), the affected side, and preoperative diagnosis was extracted by reviewing the medical records of the patients. To ensure the authenticity of the research, an initial step involved capturing X‐ray images before the surgery. These images were then analyzed to determine the height of the medial condyle (MMH) and lateral condyle (LMH), as well as the ratios between MLW and MMH and MLW and LMH. Additionally, the insall‐salvati index (ISI) was calculated, and the severity of any varus or valgus deformities was assessed. Eight machine‐learning methods were developed to predict the retention of PCL in TKA. Risk factor analysis was performed using the SHApley Additive exPlanations method.

Results

A total of 307 knee joints from 266 patients were included, among which there were 254 females and 53 males. A stratified random sampling technique was used to split patients in a 70:30 ratio into a training dataset and a testing dataset. Eight machine‐learning models were trained using data feeding. Except for the AUC of the LGBM Classifier, which is 0.70, the AUCs of other machine learning models are all lower than 0.70. In importance‐based analysis, ISI, MMH, LMH, deformity, and age were confirmed as important predictive factors for PCL retention in operations.

Conclusion

The LGBM Classifier model achieved the best performance in predicting PCL retention in TKA. Among the potential risk factors, ISI, MMH, LMH, and deformity played essential roles in the prediction of PCL retention.
Flexible bronchoscopy in pediatric lung transplantation
Authors: Wannes Daou Antoinette , Wallace Carolyn , Barker Mitzi , Ambrosino Teresa , Towe Christopher , Morales David L. S. , Wikenheiser‐Brokamp Kathryn A. , Hayes Don , Burg Gregory
Published: May 2024

Pediatric lung transplantation represents a treatment option for children with advanced lung disease or pulmonary vascular disorders who are deemed an appropriate candidate. Pediatric flexible bronchoscopy is an important and evolving field that is highly relevant in the pediatric lung transplant population. It is thus important to advance our knowledge to better understand how care for children after lung transplant can be maximally optimized using pediatric bronchoscopy. Our goals are to continually improve procedural skills when performing bronchoscopy and to decrease the complication rate while acquiring adequate samples for diagnostic evaluation. Attainment of these goals is critical since allograft assessment by bronchoscopic biopsy is required for histological diagnosis of acute cellular rejection and is an important contributor to establishing chronic lung allograft dysfunction, a common complication after lung transplant. Flexible bronchoscopy with bronchoalveolar lavage and transbronchial lung biopsy plays a key role in lung transplant graft assessment. In this article, we discuss the application of bronchoscopy in pediatric lung transplant evaluation including historical approaches, our experience, and future directions not only in bronchoscopy but also in the evolving pediatric lung transplantation field. Pediatric flexible bronchoscopy has become a vital modality for diagnosing lung transplant complications in children as well as assessing therapeutic responses. Herein, we review the value of flexible bronchoscopy in the management of children after lung transplant and discuss the application of novel techniques to improve care for this complex pediatric patient population and we provide a brief update about new diagnostic techniques applied in the growing lung transplantation field.
Creating new resources: The impact of new group memberships on posttraumatic growth in China
Authors: Peng Wenya , Yang Kairong , Jiang Jiang
Published: May 2024

The Social Identity Model of Traumatic Identity Change proposes the group membership gain hypothesis, which refers to developing positive new group memberships after trauma that may contribute to posttraumatic adjustment. However, only a few empirical studies conducted in Western societies have provided correlational evidence for the hypothesis. The current research conducted three studies to test the hypothesis in China. Study 1 (N = 315) through survey confirmed the positive association between new group memberships and posttraumatic growth among Chinese adults with traumatic experiences. Study 2 (N = 300) replicated the findings through the hypothetical scenario, discovering that participants expected a hypothetical person who experienced trauma and gained new group membership after this trauma would develop posttraumatic growth. Study 3 (N = 300), in a further refined hypothetical scenario (i.e., replacing the hypothetical vignette and protagonist in Study 2), yielded consistent results, demonstrating the impact of new group memberships on anticipated posttraumatic growth behavioral intention. The current research, for the first time in China, examined the group membership gain hypothesis and emphasized the importance of social group membership management in facilitating posttraumatic growth.
Long live the fault! Double inversion of a Mesozoic rift‐related fault system in the central Apennines
Authors: Mercuri Marco , Tavani Stefano , Fabbi Simone , Lavosi Giovanni , Carminati Eugenio
Published: May 2024

The San Potito area in central Apennines (Italy), enclosed within the Latium‐Abruzzi carbonate platform, exposes anomalously pelagic carbonates filling an intraplatform basin formed during Jurassic rifting. Oriented obliquely to the regional NW‐SE trend of Cenozoic thrusts and extensional faults, the basin's eastern boundary fault system, striking N‐S, played a pivotal role in structuring orogenic and post‐orogenic features. Large tracts of the fault experienced double reactivation: positive inversion during Miocene shortening, and negative during post‐orogenic extension. Double reactivation is evidenced by older‐on‐younger extensional contacts, and by the change in orientation of thrusts and recent extensional faults from NW‐SE to NNW‐SSE, the latter being consistent with the trend of Jurassic rift‐related structures of the area. This structural interplay highlights the importance of Jurassic faults and their ability in forcing the structural trends, by surviving across multiple deformation stages, even controlling active extensional seismicity.
Measuring the effectiveness of online search ads on blood donor recruitment and donation
Authors: McElfresh Duncan C. , Bennett Jenn , Enriquez Kay , Pham Tho D.
Published: May 2024

Background

Acutely highlighted during the COVID‐19 pandemic, the tenuousness of the blood supply continues to be a lynchpin of the most important medical procedures. Online advertisements have become a mainstay in donor recruitment. We set out to determine the effectiveness of online search ads and variations thereof on blood donations with an emphasis on first‐time donors.

Study Design and Methods

From September 01, 2022 through March 31, 2023, we performed a campaign comparison experiment through a major search‐ads platform with two distinct messages: one altruistic (“Altruistic”) and one with a prospect of rewards (“Promotion”). We developed a method to track donation outcomes and associated them with impressions, click‐throughs, and conversions. We compared the performance of the Altruistic and Promotion arms to a control group that was not associated with any search‐ads (“Baseline”).

Results

Analyzing 34,157 donations during the study period, the Promotion group, and not Altruistic, had a significant difference of first‐time donors over Baseline (24% vs. 12%, p = 7e‐6). We analyzed 49,305 appointments and discovered that appointments made from the Altruistic arm resulted in a significantly higher percentage of donations when compared to Baseline (57% vs. 53%, p = .009); however, the Promotion group had a higher percentage of donations from first‐time donors when compared to Baseline (12% vs. 8%, p = .006).

Conclusion

We developed a method for determining the effectiveness of online search ads on donation outcomes. Rewards/promotions messaging was most effective at recruiting first‐time donors. Our methodology is generalizable to different blood centers to explore messaging effectiveness among their unique communities.
Survival of transfused red blood cells from a donor with alpha‐thalassemia trait in a recipient with sickle cell disease
Authors: Yee Marianne E. M. , Covington Mischa L. , Zerra Patricia E. , McCoy James W. , Easley Kirk A. , Joiner Clinton H. , Bryksin Janetta , Francis Richard O. , Lough Christopher M. , Patel Niren , Kutlar Abdullah , Josephson Cassandra D. , Roback John D. , Stowell Sean R. , Fasano Ross M.
Published: May 2024

Background

Post‐transfusion survival of donor red blood cells (RBCs) is important for effective chronic transfusion therapy in conditions including sickle cell disease (SCD). Biotin labeling RBCs allows direct in vivo measurement of multiple donor RBC units simultaneously post‐transfusion.

Study Design and Methods

In an observational trial of patients with SCD receiving monthly chronic transfusion therapy, aliquots of RBCs from one transfusion episode were biotin‐labeled and infused along with the unlabeled RBC units. Serial blood samples were obtained to measure RBC survival. Donor units were tested for RBC indices, hemoglobin fractionation, and glucose‐6‐phosphate dehydrogenase (G6PD) enzyme activity. For microcytic donor RBCs (MCV < 70 fL), HBA1 and HBA2 genetic testing was performed on whole blood.

Results

We present one recipient, a pediatric patient with SCD and splenectomy who received two RBC units with aliquots from each unit labeled at distinct biotin densities (2 and 18 μg/mL biotin). One donor unit was identified to have microcytosis (MCV 68.5 fL after biotinylation); whole blood sample obtained at a subsequent donation showed 2‐gene deletion alpha‐thalassemia trait (ɑ–3.7kb/ɑ–3.7kb) and normal serum ferritin. G6PD activity was >60% of normal mean for both. The RBCs with alpha‐thalassemia RBC had accelerated clearance and increased surface phosphatidylserine post‐transfusion, as compared with the normocytic RBC (half life 65 vs. 86 days, respectively).

Discussion

Post‐transfusion RBC survival may be lower for units from donors with alpha‐thalassemia trait, although the impact of thalassemia trait donors on transfusion efficacy requires further study.
Prevention of post‐operative adhesions: Model development and pilot outcomes of human placental stem cell‐based interventions
Authors: Carmichael Samuel P. , Chandra Prafulla K. , Vaughan John W. , Kline David M. , Ip Edward H. , Holcomb John B. , Atala Anthony
Published: May 2024

Background

Abdominal adhesions are the most common surgical complication and without reliable prophylactics. This study presents a novel rat model for abdominal adhesions and reports pilot results of human placental stem cell (hPSC)‐based therapies.

Methods

Forty‐four (n = 44) male Sprague–Dawley rats (250‐350 g) were used in the experiment. Of these, thirty‐eight (n = 38) were included in a preliminary data set to determine a minimum treatment effect. Adhesions were created in a reproducible model to the abdominal wall and between organs. Experimental groups included the control group (Model No Treatment, MNT), Plasmalyte A (Media Alone, MA, 10 mL), hPSC (5 × 106 cells/10 mL Plasmalyte A), hPSC‐CM (hPSC secretome, conditioned media) in 10 mL Plasmalyte A, Seprafilm™ (Baxter, Deerfield, IL), and sham animals (laparotomy only). Treatments were inserted intraperitoneally (IP) and the study period was 14 days post‐operation. Results are reported as the difference between means of an index statistic (AIS, Animal Index Score) and compared by ANOVA with pairwise comparison.

Results

The overall mean AIS was 23 (SD 6.16) for the MNT group with an average of 75% of ischemic buttons involved in abdominal adhesions. Treatment groups MA (mean overall AIS 17.33 SD 6.4), hPSC (mean overall AIS 13.86 SD 5.01), hPSC‐CM (mean overall AIS 13.13 SD 6.15), and Seprafilm (mean overall AIS 13.43 SD 9.11) generated effect sizes of 5.67, 9.14, 9.87, and 9.57 decrease in mean overall AIS, respectively, versus the MNT.

Discussion

The presented rat model and scoring system represent the clinical adhesion disease process. hPSC‐based interventions significantly reduce abdominal adhesions in this pilot dataset.
Chemical pneumonitis secondary to accidental pulmonary polyethylene glycol–electrolyte solution infusion in a cat
Authors: Mastrocco Alicia , Prittie Jennifer , Zollo Ann Marie
Published: May 2024

Objective

To describe the successful conservative management of chemical pneumonitis and presumed acute respiratory distress syndrome in a cat secondary to inadvertent pulmonary polyethylene glycol–electrolyte solution (PEG‐ELS) instillation.

Case Summary

PEG‐ELS is commonly used in small animals for bowel cleansing and to treat constipation. There have been several instances of aspiration or accidental instillation of this solution into the lungs of both people and dogs. PEG‐ELS was inadvertently infused into the lungs of the cat in the current report. After 10 days in the ICU, during which time treatment with oxygen therapy, antibiosis, diuretics, and corticosteroids was provided, the cat was successfully discharged.

New or Unique Information Provided

To the authors’ knowledge, this is the first report of instillation of PEG‐ELS in a cat resulting in chemical pneumonitis and lung injury. We describe the successful management of this condition with conservative management and without the need for invasive interventions such as bronchoscopy and lavage or mechanical ventilation.
Convex co‐compact representations of 3‐manifold groups
Authors: Islam Mitul , Zimmer Andrew
Published: May 2024

A representation of a finitely generated group into the projective general linear group is called convex co‐compact if it has finite kernel and its image acts convex co‐compactly on a properly convex domain in real projective space. We prove that the fundamental group of a closed irreducible orientable 3‐manifold can admit such a representation only when the manifold is geometric (with Euclidean, Hyperbolic or Euclidean Hyperbolic geometry) or when every component in the geometric decomposition is hyperbolic. In each case, we describe the structure of such examples.
Genetic code expansion, an emerging tool in the Ca2+ ion channel field
Authors: Söllner Julia , Derler Isabella
Published: May 2024

Various methods for characterizing binding forces as well as for monitoring and remote control of ion channels are still emerging. A recent innovation is the direct incorporation of unnatural amino acids (UAAs) with corresponding biophysical or biochemical properties, which are integrated using genetic code expansion technology. Minimal changes to natural amino acids, which are achieved by chemical synthesis of corresponding UAAs, are valuable tools to provide insight into the contributions of physicochemical properties of side chains in binding events. To gain unique control over the conformational changes or function of ion channels, a series of light‐sensitive, chemically reactive and posttranslationally modified UAAs have been developed and utilized. Here, we present the existing UAA tools, their mode of action, their potential and limitations as well as their previous applications to Ca2+‐permeable ion channels.

image
Insights about the publicness of public space from the Kamppi area of Helsinki
Authors: Tamašauskaitė Žieda
Published: May 2024

Undergoing dramatic changes in its form, structure and purpose, public space has recently drawn sharp criticisms from its investigators and its theorists. At the same time, for the public who use it, public space has continued to be meaningful and attractive. To understand what public space is and what constitutes its publicness in the city of today, I conducted a multiple-case study and prepared a doctoral dissertation Publicness of Public Space in the Contemporary City: Insights from Helsinki (Tamašauskaitė 2024). On March 1st, 2024, during the public defence of my dissertation, I gave a lectio praecursoria, which this short article is based on. In my lectio, I overviewed contestations over the concepts public space and publicness, suggesting that the publicness of contemporary public space shall be conceived through use and treated as a phenomenon that comprises three dimensions, namely activities, users and control. The focus of the lectio was on my main findings from the three publicly usable spaces within the Kamppi area of Helsinki: Narinkka Square, Tennispalatsi Square and Kamppi Shopping Centre. First, I highlighted that from my study, I learnt that the publicness of the three spaces is primarily activity-based, whereby their publicness is strikingly similar when the spaces are used in comparable ways. Next, I suggested that even if the diversity of user groups is highly important in ensuring a wide variety of activities, it is all those activities that intermix and combine with one another that produces an ecosystem out of activities and that reveal the dynamics of activity-based publicness to be situational. Finally, I argued that various means of control are but some of the matters that affect the actual and the possible use of public space, for the publicness of adjacent public spaces may also complement each other.
Darwin meets Dickinson
Natural Magic: Emily Dickinson, Charles Darwin, and the Dawn of Modern Science
Renée Bergland
Princeton University Press, 2024. 440 pp.
Authors: Mondello Kaitlin
Published: May 2024

The biologist and the poet shared deep sensibilities about the natural world
A single cell atlas of sexual development in
Plasmodium falciparum
Authors: Dogga Sunil Kumar , Rop Jesse C. , Cudini Juliana , Farr Elias , Dara Antoine , Ouologuem Dinkorma , Djimdé Abdoulaye A. , Talman Arthur M. , Lawniczak Mara K. N.
Published: May 2024

The developmental decision made by malaria parasites to become sexual underlies all malaria transmission. Here, we describe a rich atlas of short- and long-read single-cell transcriptomes of over 37,000
Plasmodium falciparum
cells across intraerythrocytic asexual and sexual development. We used the atlas to explore transcriptional modules and exon usage along sexual development and expanded it to include malaria parasites collected from four Malian individuals naturally infected with multiple
P. falciparum
strains. We investigated genotypic and transcriptional heterogeneity within and among these wild strains at the single-cell level, finding differential expression between different strains even within the same host. These data are a key addition to the Malaria Cell Atlas interactive data resource, enabling a deeper understanding of the biology and diversity of transmission stages.
B cell trajectories influence cancer outcomes
Authors: Tellier Julie , Nutt Stephen L.
Published: May 2024

Two types of B cell in the tumor microenvironment modulate antitumor immunity
Bird flu appears entrenched in U.S. dairy herds
Authors: Cohen Jon , Enserink Martin
Published: May 2024

New measures to control H5N1 in cows are “a drop in the bucket,” scientists say
Micrococcal nuclease regulates biofilm formation and dispersal in methicillin-resistant
Staphylococcus aureus
USA300
Authors: Kaplan Jeffrey B. , Horswill Alexander R.
Published: May 2024

Biofilm formation is an important virulence factor for methicillin-resistant
Staphylococcus aureus
(MRSA). The extracellular matrix of MRSA biofilms contains significant amounts of double-stranded DNA that hold the biofilm together. MRSA cells secrete micrococcal nuclease (Nuc1), which degrades double-stranded DNA. In this study, we used standard methodologies to investigate the role of Nuc1 in MRSA biofilm formation and dispersal. We quantified biofilm formation and extracellular DNA (eDNA) levels in broth and agar cultures. In some experiments, cultures were supplemented with sub-MIC amoxicillin to induce biofilm formation. Biofilm erosion was quantitated by culturing biofilms on rods and enumerating detached colony-forming units (CFUs), and biofilm sloughing was investigated by perfusing biofilms cultured in glass tubes with fresh broth and measuring the sizes of the detached cell aggregates. We found that an MRSA

nuc1
−

mutant strain produced significantly more biofilm and more eDNA than a wild-type strain, both in the absence and presence of sub-MIC amoxicillin.

nuc1
−

mutant biofilms grown on rods detached significantly less than wild-type biofilms. Detachment was restored by exogenous DNase or complementing the

nuc1
−

mutant. In the sloughing assay,

nuc1
−

mutant biofilms released cell aggregates that were significantly larger than those released by wild-type biofilms. Our results suggest that Nuc1 modulates biofilm formation, biofilm detachment, and the sizes of detached cell aggregates. These processes may play a role in the spread and subsequent survival of MRSA biofilms during biofilm-related infections.

IMPORTANCE

Infections caused by antibiotic-resistant bacteria known as methicillin-resistant
Staphylococcus aureus
(MRSA) are a significant problem in hospitals. MRSA forms adherent biofilms on implanted medical devices such as catheters and breathing tubes. Bacteria can detach from biofilms on these devices and spread to other parts of the body such as the blood or lungs, where they can cause life-threatening infections. In this article, researchers show that MRSA secretes an enzyme known as thermonuclease that causes bacteria to detach from the biofilm. This is important because understanding the mechanism by which MRSA detaches from biofilms could lead to the development of procedures to mitigate the problem.
Clinical characteristics and antibiotic treatment of peritoneal dialysis-associated peritonitis caused by
Pseudomonas
species: a review of 15 years’ experience from southern China
Authors: Dong Xiao , Xie Chao , Yi Chunyan , Ye Peiyi , Ye Hongjian , Guo Qunying , Huang Fengxian , Kong Yao-Zhong , Yang Xiao
Published: May 2024

Pseudomonas
can lead to peritoneal dialysis-associated peritonitis, which is characterized by a poor prognosis, such as a substantial failure rate and a high death rate. This study aimed to provide an overview of
Pseudomonas
peritonitis’s clinical features, the regimens of antibiotic, antibiotic resistance, and outcomes in peritoneal dialysis (PD) patients. This study observed patients with
Pseudomonas
peritonitis in two large PD centers in South China from January 2008 to December 2022. The demographics, symptomatology, antibiotics regimens, resistance to common antibiotics, and clinical outcomes of all included patients were reviewed. A total of 3,459 PD patients were included, among them 57 cases of peritonitis caused by
Pseudomonas
, including 48 cases (84.2%) of
Pseudomonas aeruginosa
. The incidence rate of
Pseudomonas
peritonitis was 0.0041 episode per patient-year. Of them, 28.1% (16 cases) of the patients were accompanied by exit site infection (ESI), and all had abdominal pain and turbid ascites at the time of onset. The most commonly used antibiotic combination was ceftazidime combined with amikacin. Approximately 89% of
Pseudomonas
species were sensitive to ceftazidime, and 88% were sensitive to amikacin. The overall primary response rate was 28.1% (16 patients), and the complete cure rate was 40.4% (23 patients). There was no significant difference in the complete cure rate of peritonitis using three and other antibiotic treatment regimens (44.8% vs 46.4%;
P
= 0.9). The successful treatment group had higher baseline albumin level (35.9 ± 6.2;
P
= 0.008) and residual urine volume (650.7 ± 375.5;
P
= 0.04). Although the incidence of peritonitis caused by
Pseudomonas
was low, the symptoms were serious, and prognosis was very poor.
Pseudomonas
was still highly susceptible to first-line antibiotics currently in use against Gram-negative bacteria. Patients with successful treatment had higher albumin levels and higher urine output.

IMPORTANCE

Although the incidence of peritoneal dialysis-associated peritonitis caused by
Pseudomonas
is very low, it seriously affects the technique survival of peritoneal dialysis patients. However, there are few studies and reports on
Pseudomonas
peritonitis in the Chinese mainland area. Therefore, the purpose of this study is to describe the clinical characteristics, the regimens of antibiotic, drug resistance, and outcome of peritoneal dialysis patients in southern China in the past 15 years and summarize the clinical experience in the treatment of
Pseudomonas
peritonitis.
Potential coupling of microbial methane, nitrogen, and sulphur cycling in the Okinawa Trough cold seep sediments
Authors: Chen Ye , Dong Xiyang , Sun Zhilei , Xu Cuiling , Zhang Xilin , Qin Shuangshuang , Geng Wei , Cao Hong , Zhai Bin , Li Xuecheng , Wu Nengyou
Published: May 2024

The Okinawa Trough (OT) is a back-arc basin with a wide distribution of active cold seep systems. However, our understanding of the metabolic function of microbial communities in the cold seep sediments of the OT remains limited. In this study, we investigated the vertical profiles of functional genes involved in methane, nitrogen, and sulphur cycling in the cold seep sediments of the OT. Furthermore, we explored the possible coupling mechanisms between these biogeochemical cycles. The study revealed that the majority of genes associated with the nitrogen and sulphur cycles were most abundant in the surface sediment layers. However, only the key genes responsible for sulphur disproportionation (
sor
), nitrogen fixation (
nifDKH
), and methane metabolism (
mcrABG
) were more prevalent within sulfate-methane transition zone (SMTZ). Significant positive correlations (
P
< 0.05) were observed between functional genes involved in sulphur oxidation, thiosulphate disproportionation with denitrification, and dissimilatory nitrate reduction to ammonium (DNRA), as well as between AOM/methanogenesis and nitrogen fixation, and between sulphur disproportionation and AOM. A genome of
Filomicrobium
(class Alphaproteobacteria) has demonstrated potential in chemoautotrophic activities, particularly in coupling DNRA and denitrification with sulphur oxidation. Additionally, the characterized sulfate reducers such as Syntrophobacterales have been found to be capable of utilizing nitrate as an electron acceptor. The predominant methanogenic/methanotrophic groups in the OT sediments were identified as H
2
-dependent methylotrophic methanogens (Methanomassiliicoccales and Methanofastidiosales) and ANME-1a. This study offered a thorough understanding of microbial ecosystems in the OT cold seep sediments, emphasizing their contribution to nutrient cycling.

IMPORTANCE

The Okinawa Trough (OT) is a back-arc basin formed by extension within the continental lithosphere behind the Ryukyu Trench arc system. Cold seeps are widespread in the OT. While some studies have explored microbial communities in OT cold seep sediments, their metabolic potential remains largely unknown. In this study, we used metagenomic analysis to enhance comprehension of the microbial community's role in nutrient cycling and proposed hypotheses on the coupling process and mechanisms involved in biogeochemical cycles. It was revealed that multiple metabolic pathways can be performed by a single organism or microbes that interact with each other to carry out various biogeochemical cycling. This data set provided a genomic road map on microbial nutrient cycling in OT sediment microbial communities.
Efficacy of dual checkpoint inhibitors in a patient with a mixed hepatocellular cholangiocarcinoma
Authors: Sucre Santiago , Bullock Andrea , Peters Mary Linton
Published: May 2024

A woman in her 60s was diagnosed with a metastatic, unresectable rare histological type of liver cancer; combined hepatocellular cholangiocarcinoma. She had palliative chemotherapy, initially with gemcitabine and cisplatin, and then with oxaliplatin, L-folinic acid and fluorouracil. Both treatment strategies demonstrated disease progression, and somatic mutation profiling revealed no actionable mutations. The patient was started on immuno-oncology (IO) with nivolumab and ipilimumab, followed by maintenance nivolumab. She has achieved a sustained ongoing partial response since the start of this therapy for at least 12 months. The outcome in this patient is in keeping with the growing evidence of the role that IO agents have in metastatic biliary tract cancer and also serves to highlight their importance in mixed histology liver tumours.
Subacute sclerosing panencephalitis presenting as severe depression in an adult
Authors: Karthik Vijayakumar , Koshy Kiren George , Asok Arsha , Chettiar Selvarajan
Published: May 2024

Subacute sclerosing panencephalitis (SSPE) is a fatal disorder that occurs as a rare complication of childhood measles. Symptoms typically manifest between the ages of 5 and 15. While the incidence of SSPE is declining globally, it is still prevalent in regions where measles remains common and vaccination rates are low due to poverty and lack of health education. Diagnosing SSPE can be challenging, particularly when patients exhibit unusual symptoms. A thorough clinical evaluation, including vaccination history, physical examination, electroencephalogram (EEG) and Cerebrospinal fluid (CSF) analysis, can help in making a diagnosis. We present the case of a young woman in her early 20s who initially experienced depressive symptoms, followed by myoclonus, dementia and visual impairment. The patient was ultimately diagnosed with SSPE based on characteristic EEG findings, neuroimaging results, CSF analysis and elevated serum measles antibody levels.
Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study
Authors: Oyugi Boniface , Audi-Poquillon Zilper , Kendall Sally , Peckham Stephen
Published: May 2024

Background

Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya.

Methods

We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns.

Results

The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care.

Conclusions

Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.
Hospital at home for elderly acute patients: a study protocol for a randomised controlled trial
Authors: Thomsen Anne Marie Ladehoff , Tayyari Nasrin , Duvald Iben , Kirkegaard Hans , Obel Børge , Nielsen Camilla Palmhøj
Published: May 2024

Introduction

The increasing elderly population has led to a growing demand for healthcare services. A hospital at home treatment model offers an alternative to standard hospital admission, with the potential to reduce readmission and healthcare consumption while improving patients’ quality of life. However, there is little evidence regarding hospital at home treatment in a Danish setting. This article describes the protocol for a randomised controlled trial (RCT) comparing standard hospital admission to hospital at home treatment. The main aim of the intervention is to reduce 30-day acute readmission after discharge and improve the quality of life of elderly acute patients.

Methods and analysis

A total of 849 elderly acute patients will be randomised in a 1:2 ratio to either the control or intervention group in the trial. The control group will receive standard hospital treatment in a hospital emergency department while the intervention group will receive treatment at home. The primary outcomes of the trial are the rate of 30-day acute readmission and quality of life, assessed using the European Quality of Life-5 Dimensions-5-Level instrument. Primary analyses are based on the intention-to-treat principle. Secondary outcomes are basic functional mobility, resource use in healthcare, primary and secondary healthcare cost, incremental cost-effectiveness ratio, and the mortality rate 3 months after discharge.

Ethics and dissemination

The RCT was approved by the Ethical Committee, Central Denmark Region (no. 1-10-72-67-20). Results will be presented at relevant national and international meetings and conferences and will be published in international peer-reviewed journals. Furthermore, we plan to communicate the results to relevant stakeholders in the Danish healthcare system.

Trial registration number

NCT05360914.
Saxon Epidemiological Study in General Practice-6 (SESAM-6): protocol of a cross-sectional study
Authors: Gräfe Willy , Liebig Lukas , Deutsch Tobias , Schübel Jeannine , Bergmann Antje , Bleckwenn Markus , Frese Thomas , Brütting Christine , Riemenschneider Henna
Published: May 2024

Introduction

General practitioners (GPs) are mostly the first point of contact for patients with health problems in Germany. There is only a limited epidemiological overview data that describe the GP consultation hours based on other than billing data. Therefore, the aim of Saxon Epidemiological Study in General Practice-6 (SESAM-6) is to examine the frequency of reasons for encounter, prevalence of long-term diagnosed diseases and diagnostic and therapeutic decisions in general practice. This knowledge is fundamental to identify the healthcare needs and to develop strategies to improve the GP care. The results of the study will be incorporated into the undergraduate, postgraduate and continuing medical education for GP.

Methods and analysis

This cross-sectional study SESAM-6 is conducted in general practices in the state of Saxony, Germany. The study design is based on previous SESAM studies. Participating physicians are assigned to 1 week per quarter (over a survey period of 12 months) in which every fifth doctor–patient contact is recorded for one-half of the day (morning or afternoon). To facilitate valid statements, a minimum of 50 GP is required to document a total of at least 2500 doctor–patient contacts. Univariable, multivariable and subgroup analyses as well as comparisons to the previous SESAM data sets will be conducted.

Ethics and dissemination

The study was approved by the Ethics Committee of the Technical University of Dresden in March 2023 (SR-EK-7502023). Participation in the study is voluntary and will not be remunerated. The study results will be published in peer-reviewed scientific journals, preferably with open access. They will also be disseminated at scientific and public symposia, congresses and conferences. A final report will be published to summarise the central results and provided to all study participants and the public.
Optimal approach for ultrasound-guided transversus abdominis plane (TAP) blocks for abdominal surgeries: a protocol for systematic review and meta-analysis
Authors: Zhu Qiuyu , Zhang Donghang , Wei Yiyong
Published: May 2024

Introduction

Transversus abdominis plane (TAP) blocks are commonly used for postoperative analgesia after various abdominal surgeries. There are several different approaches for performing TAP blocks, mainly including posterior, lateral and subcostal approaches. An increasing number of randomised controlled trials (RCTs) have compared the analgesic effects of different TAP block approaches, but the results have not been consistent. This protocol aims to determine the optimal approach of ultrasound-guided TAP blocks for postoperative analgesia after abdominal surgery.

Methods and analysis

Four databases, including Web of Science, PubMed, EMBASE and the Cochrane Library will be systematically searched to identify RCTs that compared the analgesic effects of different ultrasound-guided TAP block approaches. The search interval will range from the inception of the databases to 30 July 2024. The postoperative opioid consumption over 24 hours will be defined as the primary outcome. The secondary outcomes will include the analgesia duration, postoperative pain scores at rest and during movement at different timepoints and the incidence of adverse effects. All the statistical analyses will be conducted using RevMan V.5.4. The quality of evidence will be evaluated by the Grading of Recommendations Assessment, Development and Evaluation approach.

Ethics and dissemination

Ethical approval will not be needed. The results will be submitted to one peer-reviewed journal when completed.

PROSPERO registration number

CRD42024510141.
Checking all the boxes: a checklist for when and how to use checklists effectively
Authors: Alfred Myrtede , Barg-Walkow Laura H , Keebler Joseph R , Chaparro Alex
Published: May 2024

Checklists are a type of cognitive aid used to guide task performance; they have been adopted as an important safety intervention throughout many high-risk industries. They have become an ubiquitous tool in many medical settings due to being easily accessible and perceived as easy to design and implement. However, there is a lack of understanding for when to use checklists and how to design them, leading to substandard use and suboptimal effectiveness of this intervention in medical settings. The design of a checklist must consider many factors including what types of errors it is intended to address, the experience and technical competencies of the targeted users, and the specific tools or equipment that will be used. Although several taxonomies have been proposed for classifying checklist types, there is, however, little guidance on selecting the most appropriate checklist type, nor how differences in user expertise can influence the design of the checklist. Therefore, we developed an algorithm to provide guidance on checklist use and design. The algorithm, intended to support conception and content/design decisions, was created based on the synthesis of the literature on checklists and our experience developing and observing the use of checklists in clinical environments. We then refined the algorithm iteratively based on subject matter experts’ feedback provided at each iteration. The final algorithm included two parts: the first part provided guidance on the system safety issues for which a checklist is best suited, and the second part provided guidance on which type of checklist should be developed with considerations of the end users’ expertise.
Singing for lung health in COPD: a multicentre randomised controlled trial of online delivery
Authors: Philip Keir E J , Buttery Sara C , Bowen Sarah , Lewis Adam , Jeffery Edmund , Alghamdi Saeed M , Williams Parris , Alasmari Ali M , Alsulayyim Abdullah S , Orton Christopher M , Conway Francesca , Chan Ley , Vijayakumar Bavithra , Tana Anand , Tonkin James , Perkins Alexis , Garner Justin L , Srikanthan Karthikan , Sadaka Ahmed , Pavitt Matthew J , Banya Winston , Lound Adam , Elkin Sarah , Polkey Michael I , Man William D-C , Lewis Keir , Cave Phoene , Fancourt Daisy , Hopkinson Nicholas S
Published: May 2024

Background

Singing for lung health (SLH) is an arts-based breathing control and movement intervention for people with long-term respiratory conditions, intended to improve symptoms and quality of life. Online, remotely delivered programmes might improve accessibility; however, no previous studies have assessed the effectiveness of this approach.

Methods

We conducted an assessor-blind randomised controlled trial comparing the impact of 12 weeks of once-weekly online SLH sessions against usual care on health-related quality of life, assessed using the RAND 36-Item Short Form Health Survey (SF-36) Mental Health Composite (MHC) and Physical Health Composite (PHC) scores.

Results

We enrolled 115 people with stable chronic obstructive pulmonary disease (COPD), median (IQR) age 69 (62–74), 56.5% females, 80% prior pulmonary rehabilitation, Medical Research Council dyspnoea scale 4 (3–4), forced expiratory volume in 1 s % predicted 49 (35–63). 50 participants in each arm completed the study. The intervention arm experienced improvements in physical but not mental health components of RAND SF-36; PHC (regression coefficient (95% CI): 1.77 (95% CI 0.11 to 3.44); p=0.037), but not MHC (0.86 (95% CI −1.68 to 3.40); p=0.504). A prespecified responder analysis based on achieving a 10% improvement from baseline demonstrated a response rate for PHC of 32% in the SLH arm and 12.7% for usual care (p=0.024). A between-group difference in responder rate was not found in relation to the MHC (19.3% vs 25.9%; p=0.403).

Discussion and conclusion

A 12-week online SLH programme can improve the physical component of quality of life for people with COPD, but the overall effect is relatively modest compared with the impact seen in research using face-to-face group sessions. Further work on the content, duration and dose of online interventions may be useful.

Trial registration number

NCT04034212.
Novel, braided, self-expandable stent designed for the treatment of pulsatile tinnitus caused by intracranial venous stenosis: first-in-human experience and long-term outcomes
Authors: Consoli Arturo , Cancelliere Nicole M , Charbonnier Guillaume , Nishi Hidehisa , Vanek Irene , Marotta Thomas R , Spears Julian , Pereira Vitor M
Published: May 2024

Background

Pulsatile tinnitus (PT) can be a disabling clinical condition, which may be caused by a sigmoid/transverse sinus stenosis (STSS). Intracranial venous stenting with off-label carotid or peripheral venous stents has been used successfully to treat this condition. We present the results of a cohort of patients presenting with PT treated with a novel, dedicated, braided stent for the endovascular treatment of STSS.

Methods

Twelve patients presenting with PT and associated STSS were treated at our institution (December 2022–June 2023). All clinical and procedural variables were prospectively collected. We used the Tinnitus Function Index (TFI) and the Tinnitus Handicap Inventory (THI) scores to assess the impact of PT on quality of life before and after the treatment (mean follow-up: 10.3 months).

Results

Twelve women (mean age: 44±16.5 years) presenting with PT and STSS were treated. Mean pretreatment TFI/THI scores were 78.8/77. The BosStent was successfully deployed in all patients. We experienced no intraprocedural/postoperative complications. Intra-stent angioplasty was performed in three cases. All patients reported a complete resolution of PT symptoms within 1 month and remained stable and PT-free at the last follow-up (mean posttreatment TFI/THI score: 7.1/5, p<0001).

Conclusions

The BosStent was successfully used in a cohort of patients with PT without any intraprocedural complications. All the patients experienced a complete resolution of PT symptoms after 1 month, which was stable during the follow-up period. Further studies with larger populations will be necessary to investigate the safety and effectiveness of this novel stent for the treatment of PT with STSS.
Association of blood pressure and outcomes differs upon cerebral perfusion post-thrombectomy in patients with acute ischemic stroke
Authors: Liu Jinjie , Nie Ximing , Zhang Zhe , Duan Wanying , Liu Xin , Yan Hongyi , Zheng Lina , Fang Changgeng , Chen Jiaping , Wang Yuyi , Wen Zhixuan , Cai Shuning , Wen Miao , Yang Zhonghua , Pan Yuesong , Liu Sibo , Liu Liping
Published: May 2024

Background

The relationship between post-endovascular thrombectomy (EVT) blood pressure (BP) and outcomes in patients with acute ischemic stroke (AIS) remains contentious. We aimed to explore whether this association differs with different cerebral perfusion statuses post-EVT.

Methods

In a multicenter observational study of patients with AIS with large vessel occlusion who underwent EVT, we enrolled those who accepted CT perfusion (CTP) imaging within 24 hours post-EVT. We recorded post-EVT systolic (SBP) and diastolic BP. Patients were stratified into favorable perfusion and unfavorable perfusion groups based on the hypoperfusion intensity ratio (HIR) on CTP. The primary outcome was good functional outcome (90-day modified Rankin Scale score of ≤3). Secondary outcomes included early neurological deterioration, infarct size growth, and symptomatic intracranial hemorrhage.

Results

Of the 415 patients studied (mean age 62 years, 75% male), 233 (56%) achieved good functional outcomes. Logistic regression showed that post-EVT HIR and 24-hour mean SBP were significantly associated with functional outcomes. Among the 326 (79%) patients with favorable perfusion, SBP <140 mmHg was associated with a higher percentage of good functional outcomes compared with SBP ≥140 mmHg (68% vs 52%; aOR 1.70 (95% CI 1.00 to 2.89), P=0.04). However, no significant difference was observed between SBP and functional outcomes in the unfavorable perfusion group. There was also no discernible difference between SBP and secondary outcomes across the different perfusion groups.

Conclusions

In patients with favorable perfusion post-EVT, SBP <140 mmHg was associated with good functional outcomes, which underscores the need for further investigations with larger sample sizes or a more individualized BP management strategy.

Clinical trial registration

ChiCTR1900022154.