bluuebunny/crossref_metadata_2025 huggingface dataset:
The patient perspective on transanal irrigation treatment for low anterior resection syndrome after rectal cancer surgery - a qualitative and quantitative study
Authors: Rethy Boglarka , Schandl Anna , Nordenvall Caroline , Palmer Gabriella Jansson , Bergström Charlotta , Williamson Maria , Pieniowski Emil , Johar Asif , Lagergren Pernilla , Abraham-Nordling Mirna
Published: February 2025

Purpose

The aim of the study was to explore long-term experiences of transanal irrigation (TAI) in patients with major low anterior resection syndrome (LARS).

Methods

The study included a qualitative and quantitative analysis of patients who developed major LARS after rectal cancer surgery between 2016 and 2019 and have undergone treatment with TAI. The patients received questionnaires. Mean scores were calculated with time-to-deterioration. Individual semi-structured interviews were performed and analyzed, according to Graneheim and Lundman with patients who performed TAI regularly for more than one year.

Results

In total 28 out of 39 patients responded to the questionnaires and 16 patients participated in the interviews. At mean 6-years follow-up, a 9.4 points difference in mean LARS score was obtained, (21.2 vs. 30.7) indicating less LARS symptoms in favor of the TAI treatment. Patients in the TAI group used less loperamide compared to the control group (36% vs. 79%). The use of bulky agents was similar. The interview text rendered into three main categories: regaining control in everyday life, need for structure and planning and becoming familiar with the procedure.

Conclusions

Treatment with TAI showed the potential to improve the quality of life of patients with major LARS. The improvements in their general well-being were valued over adjustments and time spent on TAI.

Implications for cancer survivors

Bowel dysfunction remains after 6-years with lower LARS scores favoring the TAI treatment. In the absence of a definitive treatment, survivors of rectal cancer coping with LARS have shown appreciation of the TAI treatment.
Regional insights on the prevalence and antimicrobial susceptibility pattern of carbapenem and colistin-resistant gram-negative bacteria: an observational cross-sectional study from Karachi, Pakistan
Authors: Khursheed Nazia , Adnan Fareeha , Khan Moiz Ahmed , Hatif Ramlla
Published: February 2025

Background

Colistin is used to treat multidrug-resistant gram-negative bacteria. Rising colistin resistance worldwide has created challenges in effective treatment and raised treatment costs. Our study aimed to understand the prevalence of colistin resistance in carbapenem-resistant gram-negative bacteria, associated pathogens and their antimicrobial susceptibility pattern at our institute, to help limit further development of resistance.

Methods

An observational, cross-sectional study was conducted at the Microbiology laboratory of Indus Hospital & Health Network, Karachi, Pakistan from January 1, 2022 to December 31, 2023. Variables extracted from the electronic patient care database included the type of patient samples, clinical diagnoses, frequency of carbapenem-resistant gram-negative bacteria and antimicrobial susceptibility profiles. Microsoft Excel software (Microsoft Excel 2013 {15.0.5553.1000} 32-bit) was used for analysis. Susceptibility results were interpreted in accordance with the M100 guidelines of the Clinical and Laboratory Standards Institute.

Results

A total of 1,785 carbapenem-resistant gram-negative bacteria were isolated during the study period. Thirty (1.7%) of these exhibited colistin minimum inhibitory concentrations of ≥ 4 µg/ml and were characterized as colistin-resistant. Most patients with colistin-resistant gram-negative bacterial infections were males (57%), aged 31–49 and ≥ 50 years (37% each), and in-patients (60%). Majority had urinary tract infection (34%), followed by bloodstream infection (30%), ventilator-associated pneumonia (23%), and skin and soft tissue infection (13%). Organisms included Klebsiella species (77%), Acinetobacter baumanii (20%) and Pseudomonas aeruginosa (3%). Tigecycline was the most susceptible antibiotic among isolates (96%) while, fosfomycin (53%), minocycline (50%), doxycycline (45%) and tetracycline (42%) exhibited moderate susceptibility.

Conclusion

Our study highlights a concerning prevalence of colistin resistance (1.7%) among carbapenem-resistant gram-negative bacteria, particularly Klebsiella species, predominantly affecting male in-patients aged 31–49 and ≥ 50 years. This significant therapeutic challenge is underscored by the limited efficacy of available antibiotics, with only tigecycline showing high susceptibility (96%) and others like fosfomycin (53%) and minocycline (50%) offering moderate alternatives.
Conflict-associated wounds and burns infected with GLASS pathogens in the Eastern Mediterranean Region: A systematic review
Authors: Wild Amelia , Shortall Clare , Dewachi Omar , Naim Carine , Green Alex , Hussain Sarah , Abbara Aula
Published: February 2025

Background

While the relationship between conflict-associated injuries and antimicrobial resistance is increasingly being elucidated, data concerning civilian casualties is sparse. This systematic review assesses literature focused on Global Antimicrobial Resistance Surveillance System (GLASS) Priority Pathogens causing infections in civilian wounds and burns in conflict-affected countries within the World Health Organisation’s Eastern Mediterranean Region Office (EMRO).

Methods

A systematic literature review was conducted following Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Five databases and grey literature were searched, identifying studies published from January 2010 to June 2024. Search terms included “wounds”, “burns,” “antimicrobial resistance”, and the twelve countries of interest. Included studies reported resistance of GLASS pathogens. Two reviewers used Covidence to assess papers for inclusion. Data were extracted into a spreadsheet for analysis. Where quantitative data were available, medians, interquartile ranges and percentages were calculated by pathogen and country.

Results

621 records were identified; 19 studies met inclusion criteria. Nine of the papers were from Iraq, three from Libya, three from Lebanon, one each from Yemen and Gaza; two reported on conflict affected refugees in Jordan. A total of 1,942 distinct microbiological isolates were reported, representing all four critical and high priority GLASS pathogen categories. Among the isolates, Staphylococcus aureus was the most prevalent (36.3%). Median resistances identified: Methicillin resistant Staphylococcus aureus (n = 680): 55.6% (IQR:49.65–90.3%); carbapenem resistant Pseudomonas aeruginosa (n = 372): 22.14% (7.43–52.22%); carbapenem resistant Acinetobacter baumannii (n = 366): 60.3% (32.1–85%); carbapenem resistant Klebsiella pneumoniae (n = 75): 12.65% (9.73–34.25%); ceftriaxone resistant Escherichia coli (n = 63): 76% (69–84.65%); ceftriaxone resistant Klebsiella pneumoniae (n = 40): 81.45% (76.73–86.18%). Only three studies had a low risk of bias.

Discussion

Findings imply high rates of GLASS priority pathogens among wounded civilians in conflict-affected EMRO countries. However, evidence was heterogeneous, low quality and sparse in certain countries, highlighting the necessity of effective surveillance including standardised data collection. Improving primary data will facilitate the production of large, high-quality studies throughout the EMRO, including under-represented countries.

Conclusion

Laboratory diagnostic capacity building and improved surveillance in conflict-affected settings in the Eastern Mediterranean Region are required to assess the burden of GLASS priority pathogens in vulnerable non-combatant populations.
Evaluation of three novel antigens and costimulatory agents for improvement of M. Tuberculosis specific interferon gamma release assays
Authors: Schwarzlose-Schwarck Sandra , Reinwald Mark , Bauer Torsten , Hentschel Florian , Kiderlen Til , Zapf Dorinja , Herbst Victor , Lüth Stefan , Krieger David , Dammermann Werner
Published: February 2025

Background

Mycobacterium tuberculosis (MT) infections represent a global health problem and latent tuberculosis infection (LTBI) affects an estimated 25% of the world population. 10.6 million people fell ill with tuberculosis (TB) worldwide in 2021 and a total of 1.6 million TB-associated deaths were reported. Thus, reliable diagnosis of LTBI is crucial to ensure adequate treatment. We tested three novel MT antigens of the dormancy survival regulator (DosR) complex, ACR, Rv1733, Rv2626, for improvement of MT specific interferon gamma release assays (IGRA) for diagnosing TB. Furthermore, we specifically investigated the potential of the complement factor C5a and the toll like receptor (TLR) agonists CpG ODN as well as Poly(I: C) as costimulators in order to increase diagnostic quality of MT IGRAs. Three MT IGRAs were evaluated, i.e. our in-house IGRA, a prototypic EUROIMMUN Quan-T-Cell TB assay and the gold standard QuantiFERON Tb-Gold Plus assay.

Methods

In this single-center, prospective trial, whole blood from 71 patients with tuberculosis disease was stimulated using our in-house IGRA with ACR, Rv1733, Rv2626 compared to the current gold standard MT antigen formulation encompassing MT antigens ESAT-6, CFP-10 and TB10.4. Further, C5a, CpG ODN and Poly(I: C) were tested as co-stimulators. IFN-γ levels in plasma were quantified using ELISA.

Results

The three novel antigens ACR, Rv1733 and Rv2626 failed to elicit equal or stronger IFN-γ-responses compared to the gold standard antigen formulation with ESAT-6, CFP-10 and TB10.4. The TLR9 agonist CpG ODN increased IFN-γ responses in whole blood of tuberculosis patients using our in-house assays (6,768 ± 21,097 mlU/ml vs. 2,971 ± 4,780 mlU/ml, p = 0.31), yet not significantly. The same trend was found for the prototypic EUROIMMUN Quan-T-Cell TB assay (3,355 ± 5,425 mlU/ml vs. 2,548 ± 4,145 mlU/ml, p = 0.1) and the QuantiFERON Tb-Gold Plus assay (3,627 ± 5,992 mlU/ml vs. 2,635 m ± 4,475 mlU/ml, p = 0.08, for tube 1; 3,257 ± 5,349 vs. 2,759 ± 4,446 mIU/ml, p = 0.25, for tube 2). No increase of IFN-γ release was seen using Poly(I: C) or C5a in all three assays.

Conclusions

ACR, Rv1733 and Rv2626 failed to elicit equal or even better IFN-γ responses in our in-house IGRA compared to ESAT-6, CFP-10 and TB10.4 in patients with MT infection. The TLR9 agonist CpG ODN might be useful as co-stimulator in MT IGRAs.
Neuroborreliosis with encephalitis: a broad spectrum of clinical manifestations
Authors: Hudasch Dominica , Konen Franz Felix , Möhn Nora , Grote-Levi Lea , Wurster Ulrich , Welte Gabriel , Conzen Josef , Mahmoudi Nima , Skripuletz Thomas , Schwenkenbecher Philipp
Published: February 2025

Background

Lyme neuroborreliosis is the disseminated stage of an infectious disease caused by Borrelia burgdorferi (BB). The most prevalent clinical manifestations include meningoradiculitis and involvement of the cranial nerves with lymphocytic meningitis. Facial nerve is the most frequently affected cranial nerve. Neuroborreliosis presenting as encephalitis is only scarcely described in the literature.

Methods

Medical records of patients between 2014 and 2024 were screened and reviewed for neuroborreliosis. Patients were only included if they met the diagnostic criteria for definite neuroborreliosis.

Results

A total of seven patients with neuroborreliosis induced encephalitis were identified. The median age was 72 years, and except for one man, all patients were women. Clinical manifestations ranged from cognitive impairments resembling primary dementia to movement disorders mimicking Parkinson's disease, tremor, and epileptic seizures. In 5/7 patients (71%) they occurred between August to September. In addition to central nervous system involvement, all patients exhibited characteristic features of neuroborreliosis like painful meningoradiculitis or peripheral facial palsy. An elevated cell count in cerebrospinal fluid (CSF), positive oligoclonal bands, and blood-CSF barrier dysfunction indicated by an elevated albumin quotient (QAlb) was found in all patients. Advanced age, in which immunosenescence can occur, might contribute in developing encephalitis caused by neuroborreliosis in the patients of this cohort.

Conclusion

Neuroborreliosis can present with symptoms that mimic various neurological disorders, such as dementia, movement disorders, and epilepsy. Radiculitis, peripheral facial palsy or meningitis are an additional hint for this infectious disease. Analysis of CSF, which includes testing for intrathecally produced BB antibodies, is crucial for the diagnosis.
Exploring RNA cargo in extracellular vesicles for pleural mesothelioma detection
Authors: Kraft Agnieszka , Kirschner Michaela B. , Orlowski Vanessa , Ronner Manuel , Bodmer Caroline , Boeva Valentina , Opitz Isabelle , Meerang Mayura
Published: February 2025

Background

Pleural Mesothelioma (PM) is a highly aggressive cancer, for which effective early detection remains a challenge due to limited screening options and low sensitivity of biomarkers discovered so far. While extracellular vesicles (EVs) have emerged as promising candidates for blood-based biomarkers, their role in PM has not been studied yet. In this study, we characterized the transcriptomic profile of EVs secreted by PM primary cells and explored their potential as a biomarker source for PM detection.

Methods

We collected cell culture supernatant from early-passage PM cell cultures derived from the pleural effusion of 4 PM patients. EVs were isolated from the supernatant using Qiagen exoEasy Maxi kit. RNA isolation from EVs was done using the mirVana PARIS kit. Finally, single-end RNA sequencing was done with Illumina Novaseq 6000.

Results

We identified a range of RNA species expressed in EVs secreted by PM cells, including protein-coding RNA (80%), long non-coding RNA (13%), pseudogenes (4.5%), and short non-coding RNA (1.6%). We detected a subset of genes associated with the previously identified epithelioid (32 genes) and sarcomatoid molecular components (36 genes) in PM-EVs. To investigate whether these markers could serve as biomarkers for PM detection in blood, we compared the RNA content of PM-EVs with the cargo of EVs isolated from the plasma of healthy donors (publicly available data). Majority of upregulated genes in PM-EVs were protein-coding and long non-coding RNAs. Interestingly, 25 of them were the sarcomatoid and epithelioid marker genes. Finally, functional analysis revealed that the PM-EV RNA cargo was associated with Epithelial-Mesenchymal transition, glycolysis, and hypoxia.

Conclusions

This is the first study to characterize the transcriptomic profile of EVs secreted by PM primary cell cultures, demonstrating their potential as biomarker source for early detection. Further investigation of the functional role of PM-EVs will provide new insights into disease biology and therapeutic avenues.
Improving NGOs’ participation in implementing HIV preventive interventions: a case of adolescents with high-risk behaviors in Iran
Authors: Sajadi Haniye Sadat , Ghadirian Laleh , Sayarifard Azadeh , Rajabi Fatemeh , Nazari Maryam , Rostamigooran Narges , Loori Nina , Abolhasan Memar Haniyeh Haji , Farshadi Mojgan , Kazerooni Parvin Afsar , Sargolzaeemoghaddam Maryam , Majdzadeh Reza
Published: February 2025

Background

The study aimed to identify the obstacles that NGOs face in their participation in implementing HIV preventive interventions among adolescents with high-risk behaviors in Iran and to propose interventions to enhance their involvement.

Methods

The study employed a qualitative approach in three phases to identify barriers and solutions to NGOs’ participation in HIV preventive interventions. First, 56 semi-structured interviews, four focus group discussions (FGDs), and a document review were conducted with diverse stakeholders, using a purposive sampling strategy combining maximum variation sampling with a snowballing approach. Participants were sampled from relevant backgrounds in health policymaking, public participation, or communicable disease. Data from interviews and FGDs were audio-recorded, transcribed, and analyzed using an inductive content analysis. Second, a scoping review was performed, utilizing databases such as PubMed, Web of Science, ProQuest, and Google Scholar. A policy brief from the first two phases informed a one-day multi-stakeholder policy dialogue with 16 selected policy actors. This session was audio-recorded, transcribed, and analyzed through content analysis.

Results

We identified various challenges faced by NGOs, including those related to the unique features of HIV services, such as difficulty in case finding and constant provision of preventive care. Severe challenges included weak NGOs’ performance, insufficient capabilities, and insufficient support from the government, resulting in undesirable constructive collaboration. Tailored strategies were developed, such as the empowerment of NGOs, enhancing public health literacy, modifying the process of identifying eligible NGOs, clarifying key processes for NGOs’ involvement, response to COVID-19, increasing adolescent engagement, advocating for removing the stigma from active NGOs, increasing support for active NGOs, organizing communication networks and collaboration, and strengthening governance arrangements.

Conclusions

NGOs’ participation in HIV prevention can facilitate the alignment of interventions with the specific needs of at-risk populations. However, there are obstacles to full NGOs’ participation from both NGO and government perspectives, necessitating several measures to address these challenges. These measures are imperative for fostering constructive and sustained collaboration between NGOs and the government. The significance of this study lies in its emphasis on such collaboration, particularly in low-resource settings, which is crucial for nations committed to authentically realizing the goal of ‘health for all, by all,’ alongside genuine community participation.

Trial registration

NA.
How does the rise in contraceptive usage predict pregnancy termination among young women in Kenya? an in-depth multilevel analysis
Authors: Chukwudeh Stephen Okechukwu , Bolarinwa Obasanjo Afolabi , Alawode Oluwatobi Abel , Olawade David , Shongwe Sinegugu , Tiwari Ritika
Published: February 2025

Background

Young women were less likely to practise consistent contraceptive use and are also known to exhibit risky sexual behaviours, which could lead to unintended pregnancy. Studies have also shown that about half of the Kenyan population is young, an age bracket that predominantly experiences unwanted pregnancy. However, adequate attention has not been given to the relationship between pregnancy termination and contraceptive use among this teeming population in Kenya. Thus, this study examined the association between pregnancy termination history and contraceptive use among women aged 15–24 years old in Kenya.

Methods

A total of 12,166 women aged 15–24 years old from Kenya were drawn using a secondary dataset from the most recent Kenya Demographic Health Surveys conducted in the year 2022. Frequency distribution and multilevel logistic regression analyses were employed to determine the association between contraceptive use and pregnancy termination history among young women aged 15–24 years old with covariates at p < 0.05.

Results

The results showed that the higher percentage of contraceptive users among young women are those aged 15–19 years (50.1%); consequently, a higher percentage of pregnancy termination was also found among women who reported the use of contraceptive methods (6.2%) compared to 2.9% among non-users. The main findings of the study showed that young women who reported using contraceptives were more likely to have a history of pregnancy termination [aOR = 1.03; 95% CI: 0.80–1.26] compared to those who were non-users. Also, age, marital status, and parity are significantly associated with the history of pregnancy termination.

Conclusion

Our analyses established an association between history of contraceptive use and termination of pregnancy among young women between 20 and 24 years in Kenya. Place of residence, age, wealth index, level of education, and met needs of children have been identified as risk factors. Intervention to reduce pregnancy termination in Kenya should focus on women aged 20–24 years, those with no formal education, urban residence, and women with met need for children.
Neglected tropical diseases in Yemen: a systematic review of epidemiology and public health challenges
Authors: Alhothily Ibrahim Ahmed Ahmed , Dapari Rahmat , Dom Nazri Che
Published: February 2025

Background

Yemen has experienced a dramatic increase in neglected tropical diseases (NTDs) amidst ongoing conflict and humanitarian crises. This systematic review aims to consolidate and analyse the available literature on NTDs in Yemen, focusing on aetiology, geographic distribution, and associated risk factors.

Methods

A comprehensive literature search was conducted across five international databases and one national database, resulting in 3,652 identified records. After screening and applying eligibility criteria, 230 articles were included in this review. Data extraction focused on publication year, study design, sample types, diagnostic methods, reported pathogens, and geographic distribution. The aetiology of reported NTDs was categorized into four groups: viruses, bacteria, protozoa, and helminths.

Results

Viral NTDs were the most frequently reported, accounting for 39% of the articles, followed by bacterial (26%), helminthic (21%), and protozoal NTDs (15%). Dengue virus, hepatitis B and C viruses were the most prominent viral pathogens, while bacterial NTDs were primarily caused by Escherichia coli, cholera, and Salmonella. Schistosomiasis and ascariasis were the most reported helminth infections, whereas leishmaniasis and malaria were the leading protozoal NTDs. Geographically, over 69% of the reported studies focused on northern Yemen, with the highest concentrations in Sana’a, Al Hudaydah, and Taiz. The review identified multiple risk factors, including poor sanitation, inadequate water quality, and urbanization, exacerbating NTD prevalence.

Conclusions

The findings highlight the significant burden and regional disparities of NTDs in Yemen, emphasizing the need for targeted interventions. Prioritizing improvements in sanitation, water quality, and vector control measures, alongside community engagement, is critical. Policymakers must allocate resources effectively to address the root causes of NTDs and strengthen Yemen’s healthcare infrastructure.
Exploring the role of spiritual leadership among nurse colleagues: an associative analysis of its impact on passion and altruism
Authors: Hamzaa Huda Gaber , Atta Mohamed Hussein Ramadan , Taha Heba Mostafa Ali , Sayed Mervat Amin , Ahmed Asmaa Kamal , Othman Ahmed Abdellah , Wahba Nadia Mohamed Ibrahim
Published: February 2025

Background

Spiritual leadership emphasizes that nurses encounter situations that require compassion, empathy, and a deep understanding of the human experience. Passion can drive nurses' motivation, engagement, and commitment to patient care. Altruism is a core value in nursing that involves selfless concern for the well-being of others. Spiritual leadership might be an essential organizational resource in enhancing followers’ inspiring vision, compassion for others, and passion for their work.

Aim of the study

To investigate the role of spiritual leadership in the relationship between altruism and passion for work among nurse colleagues.

Subjects & method

A multicenter descriptive, cross-sectional research study was conducted at six Nursing Egyptian faculties affiliated with Alexandria, Port-Said, Fayoum, Damanhur, Assiut, and Sohag Universities, with 391 nurse colleagues.

Data collection tools

Personal and Job-related Data Questionnaire, Spiritual Leadership Questionnaire (SLQ), Passion Scale, and 9- Self-Report Altruism Scale (9- SRA) were utilized to collect data.

Results

The current study verified that nurse colleagues had high levels of perceived spiritual leadership, passion, and altruism (50.9, 47.6, and 40.2, respectively). The results revealed noteworthy positive correlations between spiritual leadership, passion, and altruism (r = 0.644, 0.519, & 0.509). Furthermore, mediation analysis highlighted that spiritual leadership could mediate the effect of altruism on the passion level.

Conclusion

This study delivers valued insights into the crucial role of spiritual leadership in augmenting nurse colleagues’ altruistic tendencies and passion.

Recommendations

Cultivating workplace spirituality on a daily agenda is a key component of management that requires spiritual competencies from nurse leaders. These competencies ultimately enhance passion for work, performance, and altruistic behaviors.
Knowing how, arguing why: nurse anaesthetists’ experiences of nursing when caring for the surgical patient
Authors: Lekens Aina L. Bjerkeli , Drageset Sigrunn , Hansen Britt Sætre
Published: February 2025

Background

Patients undergoing surgery and anaesthesia are in a vulnerable situation, requiring advanced treatment and care. Nurse anaesthetists are specially trained to meet their needs when administering and monitoring anaesthesia, ensuring patient safety and comfort throughout the entire perioperative care. However, there is a growing concern that efficiency requirements might take precedence over humanistic care when having to prioritize. Most people have a limited understanding of the extended role of nurse anaesthetists in maintaining quality and safety in anaesthesia services. This study aimed to explore how nurse anaesthetists describe their practice as being nursing when caring for surgical patients.

Methods

We applied a qualitative inductive design. Twenty nurse anaesthetists working in small or large hospitals in different regions of Norway were recruited. Semi-structured individual interviews were carried out. Data were analysed using qualitative content analysis. This study was conducted and reported in accordance with the Consolidated Criteria for Reporting Qualitative Research Checklist.

Results

We identified three categories and eight subcategories. The category Continuously attending to physical and psychological needs involved reading the patient and responding accordingly and the ethical and moral obligation to maintain patients’ well-being and dignity. The category Providing a concerned presence involved the importance of the nursing process and nurse anaesthetists’ self-confidence in their professional abilities and readiness to act when caring for the surgical patient. The category Aspiring towards excellence involved expectations towards nurse anaesthetists as professionals who display professional courage and undertake professional development through continuous learning.

Conclusion

Nurse anaesthetists experience themselves as being highly qualified to address the needs of surgical patients. Their nursing background and extensive training have prepared them to know how and argue why. Knowledge from this study could be expected to add to the field of describing and understanding nurse anaesthetists’ practice in the perioperative context and support supervision in postgraduate education.
Patient safety culture through the lenses of surgical patients: a qualitative study
Authors: Vikan Magnhild , Haugen Arvid S. , Valeberg Berit T. , Bjørnnes Ann K. , Husby Vigdis K. S. , Deilkås Ellen CT. , Danielsen Stein O.
Published: February 2025

Background

Patient engagement and learning from patients’ experiences may increase patient safety and reduce the occurrence of adverse events. Most adverse events are related to surgery, and patient outcomes are positively associated with patient safety culture. This study aimed to explore former surgical patients’ perspectives and experiences of adverse events and patient safety culture during their surgical pathway and identify themes relevant to adverse event causes and quality improvement projects.

Methods

The design of this qualitative study was explorative, utilizing an abductive approach. We purposefully recruited former surgical patients from Norwegian user organizations based on group characteristics sampling. The participants were 57% men and 43% women, aged 35 to 64 years. We conducted 14 individual semi-structured interviews between 18/01/24 and 07/03/24 using Zoom’s video audio software, with an average duration of 65 min. We analyzed the data using Braun and Clarke’s method for reflexive thematic analysis, and generated themes by examining patterns of meaning throughout the dataset.

Results

Data analysis generated three themes concerning the former surgical patients’ perspectives of patient safety culture and adverse events: (1) “Personalized care and predictable pathways increase patients’ sense of safety”; (2) “Surgical patients’ involvement: Aspire to be a resource – Not a threat”; and (3) “Time to cultivate a culture that fosters improvements and reconciliation.”

Conclusions

This study provided insight into patients’ perspectives on adverse events and patient safety culture in the surgical context. The patients underscored the value of predictable plans in caregiving, tailored information, personalized care, and dialogue on equal terms. They considered the demand for efficiency, professional hierarchy, status, prestige, and authority to be barriers to patient engagement and safety. Interventions to improve a culture of openness, psychological safety, and organizational learning in the surgical context could increase the safety of patients and healthcare professionals. Finally, acknowledgment of adverse events, information, and follow-up were essential for patients and next of kin to move on after an adverse event.
Mapping chromatin remodelling in glioblastoma identifies epigenetic regulation of key molecular pathways and novel druggable targets
Authors: Vinel Claire , Boot James , Jin Weiwei , Pomella Nicola , Hadaway Alexandra , Mein Charles , Zabet Nicolae Radu , Marino Silvia
Published: February 2025

Background

Glioblastoma is the most common and aggressive malignant brain tumour in the adult population and its prognosis is dismal. The heterogeneous nature of the tumour, to which epigenetic dysregulation significantly contributes, is among the main therapeutic challenges of the disease.

Results

We have leveraged SYNGN, an experimental pipeline enabling the syngeneic comparison of glioblastoma stem cells and expanded potential stem cell (EPSC)-derived neural stem cells to identify regulatory features driven by chromatin remodelling specifically in glioblastoma stem cells.

Conclusions

We show epigenetic regulation of the expression of genes and related signalling pathways contributing to glioblastoma development. We also identify novel epigenetically regulated druggable target genes on a patient-specific level, including SMOX and GABBR2.
Cardiac magnetic resonance quantified epicardial fat volume is associated with complex coronary artery disease among diabetics
Authors: Khidr Shimaa Sayed , Bakeer Bakeer Mohamed , Helmy Hatem Abdel-Rahman , El-Naggar Heba Mahmoud
Published: February 2025

Background

Epicardial and pericardial adipose tissues are two distinct types of visceral fat in close adherence to the heart and were found to be increased among diabetics.

Aim

To investigate the correlation between cardiac magnetic resonance (CMR)-quantified epicardial (EFV) and pericardial fat (PFV) volumes and the complexity of coronary artery disease (CAD) among diabetic and non-diabetic patients.

Methods

This was a cross-sectional study that included 111 patients having CAD as indicated by coronary angiography and who underwent CMR. Epicardial and pericardial fat volumes were measured along short-axis CMR-derived images. CAD severity and complexity were evaluated using the syntax score (SS). Patients were classified into diabetic and non-diabetic groups based on their HbA1c and were compared regarding clinical, angiographic, and CMR data. Those with high SS were compared against low/intermediate SS. The correlation of measured EFV and PFV with the SS was evaluated, and possible predictors for high-SS were assessed.

Results

Diabetic patients (n = 64, 57.7%) had significantly high syntax scores, and significantly larger absolute and indexed EFV and PFV compared to non-diabetics. Both EFV and PFV showed a significant positive correlation with HbA1c and SS. EFV ≥ 119.55 ml significantly predicted high-SS (AUC = 0.84, 95%CI = 0.76–0.91, sensitivity = 77% and specificity = 82.5%) among the study population. Different cutoff points of EFV significantly predicted high SS among diabetics and non-diabetics with respective reasonable sensitivity and specificity. Age and EFV were consistently predictive of high SS on different multivariable regression models.

Conclusion

Increased epicardial adipose tissue was a significant independent predictor of severe and complex CAD, representing a possible risk marker and potential therapeutic target, particularly among diabetics.
Challenges in the diagnosis of heart failure with preserved ejection fraction in individuals with obesity
Authors: van Dalen Bas M. , Chin Jie Fen , Motiram Praveen A. , Hendrix Anneke , Emans Mireille E. , Brugts Jasper J. , Westenbrink B. Daan , de Boer Rudolf A.
Published: February 2025

The rising prevalence of obesity and its association with heart failure with preserved ejection fraction (HFpEF) highlight an urgent need for a diagnostic approach tailored to this population. Diagnosing HFpEF is hampered by the lack of a single non-invasive diagnostic criterion. While this makes a firm diagnosis of HFpEF already notoriously difficult in the general population, it is even more challenging in individuals with obesity. The challenges stem from a range of factors, including the use of body mass index as a conceptually suboptimal indicator of health risks associated with increased body mass, symptom overlap between HFpEF and obesity, limitations in physical examination, difficulties in electrocardiographic and echocardiographic evaluation, and reduced diagnostic sensitivity of natriuretic peptides in individuals with obesity. In this review, we examine these diagnostic challenges and propose a diagnostic algorithm specifically tailored to improve the accuracy and reliability of HFpEF diagnosis in this growing patient demographic.

Graphical abstract

Proposed obesity-adjusted HFpEF score. HFpEF, Heart failure with preserved ejection fraction. Created with BioRender.com.
Ultramodern natural and synthetic polymer hydrogel scaffolds for articular cartilage repair and regeneration
Authors: Li Chun-Sheng , Xu Yan , Li Juan , Qin Shu-Hao , Huang Shao-Wen , Chen Xue-Mei , Luo Yi , Gao Cheng-Tao , Xiao Jian-Hui
Published: February 2025

Articular cartilage injury is a serious bone disease that can result in disabilities. With the rapid increase in the aging population, this disorder has become an increasingly important public health issue. Recently, stem cell-based cartilage tissue engineering has emerged as a promising therapeutic option for treating articular cartilage damage. Cellular scaffolds, which are among three key elements of tissue engineering, play significant roles in the repair of damaged articular cartilage by regulating cellular responses and promoting cartilage tissue regeneration. Biological macromolecules are commonly used as scaffold materials owing to their unique properties. For example, natural and synthetic polymer hydrogel scaffolds can effectively mimic the microenvironment of the natural extracellular matrix; exhibit high cytocompatibility, biocompatibility, and biodegradability; and have attracted increasing attention in bone and cartilage tissue engineering and regeneration medicine. Several types of hydrogel scaffolds have been fabricated to treat articular cartilage abnormalities. This article outlines the recent progress in the field of hydrogel scaffolds manufactured from various biomaterials for repairing damaged articular cartilage, discusses their advantages and disadvantages, and proposes directions for their future development.
The effect of depth data and upper limb impairment on lightweight monocular RGB human pose estimation models
Authors: Boudreault-Morales Gloria-Edith , Marquez-Chin Cesar , Liu Xilin , Zariffa José
Published: February 2025

Background and objectives

Markerless vision-based human pose estimation (HPE) is a promising avenue towards scalable data collection in rehabilitation. Deploying this technology will require self-contained systems able to process data efficiently and accurately. The aims of this work are to (1) Determine how depth data affects lightweight monocular red–green–blue (RGB) HPE performance (accuracy and speed), to inform sensor selection and (2) Validate HPE models using data from individuals with physical impairments.

Methods

Two HPE models were investigated: Dite-HRNet and MobileHumanPose (capable of 2D and 3D HPE, respectively). The models were modified to include depth data as an input using three different fusion techniques: an early fusion method, a simple intermediate fusion method (using concatenation), and a complex intermediate fusion method (using specific fusion blocks, additional convolutional layers, and concatenation). All fusion techniques used RGB-D data, in contrast to the original models which only used RGB data. The models were trained, validated and tested using the CMU Panoptic and Human3.6 M data sets as well as a custom data set. The custom data set includes RGB-D and optical motion capture data of 15 uninjured and 12 post-stroke individuals, while they performed movements involving their upper limbs. HPE model performances were monitored through accuracy and computational efficiency. Evaluation metrics include Mean per Joint Position Error (MPJPE), Floating Point Operations (FLOPs) and frame rates (frames per second).

Results

The early fusion architecture consistently delivered the lowest MPJPE in both 2D and 3D HPE cases while achieving similar FLOPs and frame rates to its RGB counterpart. These results were consistent regardless of the data used for training and testing the HPE models. Comparisons between the uninjured and stroke groups did not reveal a significant effect (all p values > 0.36) of motor impairment on the accuracy of any model.

Conclusions

Including depth data using an early fusion architecture improves the accuracy–efficiency trade-off of the HPE model. HPE accuracy is not affected by the presence of physical impairments. These results suggest that using depth data with RGB data is beneficial to HPE, and that models trained with data collected from uninjured individuals can generalize to persons with physical impairments.
Parents’ use of coercive and indulgent feeding practices for children with avid eating behaviour: an Ecological Momentary Assessment study
Authors: Pickard Abigail , Edwards Katie L. , Farrow Claire , Haycraft Emma , Herle Moritz , Llewellyn Clare , Croker Helen , Kininmonth Alice , Blissett Jacqueline
Published: February 2025

Background

Children with avid eating behaviour display high food responsiveness, high emotional overeating and low sensitivity to fullness; behaviours which may increase the risk of obesity and are challenging for parents to manage. This study explores the situational predictors of coercive or indulgent feeding practices among parents of children with avid eating behaviours using Ecological Momentary Assessment (EMA).

Methods

The study involved 109 parents of 3-5-year-old children exhibiting avid eating behaviour. Over 10 days, participants completed EMA surveys via a mobile app to report on their mood, stress, feeding goals, and feeding practices during eating occasions. Multilevel modelling was used to assess how parental mood, goals, and the eating context (e.g., meal versus snack, public versus private setting) influenced feeding practices.

Results

Parents were more likely to use specific coercive or indulgent feeding practices when experiencing higher stress, when aiming to avoid mealtime conflict, and during meals versus snacks. A negative meal atmosphere and a public setting also increased the likelihood of certain indulgent practices. Notably, parents were more likely to report giving their child food to calm them down or help manage their behaviour when the meal atmosphere was perceived as negative and if they aimed to reduce conflict at the meal. The findings highlight that the context of feeding occasions significantly drives the use of coercive or indulgent feeding practices.

Conclusions

Parental stress, goals, and the eating context are key determinants of coercive or indulgent feeding practices with children exhibiting avid eating behaviours. Interventions to support parents should consider these dynamic factors, promoting healthier feeding strategies tailored to real-life contexts.
External validation and revision of the Lafontaine criteria for unstable distal radius fractures: a retrospective study
Authors: Dissaneewate Pornpanit , Thanavirun Phatklao , Tangjaroenpaisan Yanin , Dissaneewate Kantapon
Published: February 2025

Background

The Lafontaine criteria are the most commonly cited criteria for predicting unstable distal radius fractures. However, formal validation of the performance of these criteria remains limited. Therefore, we aimed to evaluate the Lafontaine criteria as a diagnostic prediction rule for distal radius fractures, assess the inter-rater reliability and predictive ability of various parameters for distal radius instability, and develop new criteria for fracture instability using reliable and highly predictive factors.

Methods

This retrospective study included 274 adult patients with acute distal radius fractures treated with closed reduction and immobilisation between January 2019 and December 2022. Patients who underwent immediate surgery, were lost to follow-up before 4 weeks, or had unacceptable alignment after reduction were excluded. The Lafontaine criteria were validated using the area under the receiver operating characteristic curve (AUROC). Criteria with an AUROC > 0.7 were considered acceptable. The criteria were updated using risk factors with stronger associations in the multivariable logistic regression analysis, and the inter-rater reliability of potential predictors was evaluated.

Results

The median age of the patients was 63 years; 78% were female. Redisplacement occurred in 39% of the cases. The AUROC for the Lafontaine criteria was 0.65 (95% confidence interval [CI] 0.57–0.74). Multivariable logistic regression showed that age 56–74 years (odds ratio [OR] 3.92, 95% CI 1.82–9.16, p < 0.001) age > 74 years (OR 6.34, 95% CI 2.66–16.2, p < 0.001), associated ulna fracture (OR 1.61, 95% CI 0.92–2.84, p = 0.10), and initial radial shortening > 3 mm (OR 5.78, 95% CI 3.11–11.2, p < 0.001) were the strongest predictive factors of fracture instability. These predictors demonstrated substantial inter-rater reliability, making them suitable for clinical use. Updating the model with these risk factors resulted in an AUROC of 0.74 (95% CI 0.66–0.82).

Conclusions

The performance of the Lafontaine criteria in discriminating unstable distal radius fractures was unacceptable in our study cohort. The updated criteria using age group (< 56 years, 56–74 years, and > 74 years), associated ulnar fractures, and initial radial shortening > 3 mm was found to have moderate discrimination; however, further research is warranted to improve the prediction and measurement reliability of fracture instability.
Genomic analysis of the SMN1 gene region in patients with clinically diagnosed spinal muscular atrophy: a retrospective observational study
Authors: Kato Tamaki , Yokomura Mamoru , Osawa Yutaka , Matsuo Kensuke , Kubo Yuji , Homma Taihei , Saito Kayoko
Published: February 2025

Background

Spinal muscular atrophy (SMA) is an autosomal recessive neuromuscular disease. Most patients with SMA have a mutation in the survival motor neuron 1 (SMN1) gene on chromosome 5q. With current genetic testing, SMN1 copy number is determined; a diagnosis is reached when the copy number is zero. When the SMN1 copy number is 1, exons and intron/exon boundaries of the allele are examined for single-nucleotide variants (SNVs). Genetically undiagnosed cases of SMA exist when 2 copies of SMN1 exist or when a SNV is in the deep intron. Furthermore, SMN1 is highly homologous to SMN2; therefore, it is expected that many SNVs have not been elucidated.

Methods

This retrospective observational study conducted in Japan used pre-collected DNA samples from patients with clinically diagnosed SMA. Enrollment period was January 28, 2020 to September 30, 2021. SNV analysis of SMN1 (exon 1–8 and intron 1–7) was conducted by long-range polymerase chain reaction and next-generation sequencing.

Results

From 336 DNA samples collected from patients, 62 patient samples were included in the SNV analysis. Two patients have been genetically diagnosed (a heterozygous variant in intron 6 with 1 copy of SMN1; a homozygous missense mutation in exon 3 with 2 copies of SMN1). Three SNVs in intron 6, c.834+1506A>G (n = 9), c.834+1751G>A (n = 2), and c.835-367C>A (n = 5) were identified; all were numerically, and c.834+1506A>G and c.835-367C>A were significantly, more frequent in patients with 0 copies versus those with ≥ 1 copy of exon 7 in SMN1. We confirmed 3 hybrid SMN gene types in 5 patients that contained SMN2 gene sequence (aaTgg) flanked by upstream “t” and downstream “G” SMN1 sequence.

Conclusions

In this study of patients with clinically diagnosed SMA, 2 cases with genetic SMN types were identified that would not have been identified through current genetic testing, which examines SMN1 deletions only. Furthermore, for 1 patient with a homozygous SMN1 missense mutation, SMA was not suspected by the current copy number screening method. This study demonstrated the importance of performing full-length sequencing for clinically diagnosed SMA to complement current screening methods.

Trial registration: University Hospital Medical Information Network Clinical Trials Registry (Number: UMIN000040095).
VSIG4+ tumor-associated macrophages mediate neutrophil infiltration and impair antigen-specific immunity in aggressive cancers through epigenetic regulation of SPP1
Authors: Pan Zongfu , Chen Jinming , Xu Tong , Cai Anqi , Han Bing , Li Ying , Fang Ziwen , Yu Dingyi , Wang Shanshan , Zhou Junyu , Gong Yingying , Che Yulu , Zou Xiaozhou , Cheng Lei , Tan Zhuo , Ge Minghua , Huang Ping
Published: February 2025

V-set and immunoglobulin domain-containing 4 (VSIG4) positive tumor-associated macrophage (VSIG4+ TAM) is an immunosuppressive subpopulation newly identified in aggressive cancers. However, the mechanism how VSIG4+ TAMs mediate immune evasion in aggressive cancers have not been fully elucidated. In our study, we found targeting VSIG4+ TAMs by VSIG4 deficiency or blockade remarkably limited tumor growth and metastasis, especially those derived from anaplastic thyroid cancer (ATC) and pancreatic cancer, two extremely aggressive types. Moreover, the combination of VSIG4 blockade with a BRAF inhibitor synergistically enhanced anti-tumor activity in ATC-tumor bearing mice. VSIG4 deficiency recovered the antigen presentation (B2m, H2-k1, H2-d1) of TAMs and activated antigen-specific CD8+ T cells by promoting their in vivo proliferation and intratumoral infiltration. Notably, loss of VSIG4 in TAMs significantly reduced the production of lactate and histone H3 lysine 18 lactylation, resulting the decreased transcription of SPP1 mediated by STAT3, which collectively disrupted the cell-cell interactions between TAMs and neutrophils. Further combination of VSIG4 with SPP1 blockade synergistically boosted anti-tumor activity. Overall, our studies demonstrate the epigenetic regulation function of VSIG4 confers on TAMs an alternative pattern, beyond the checkpoint role of VSIG4, to shape the immunosuppressive tumor microenvironment and impair antigen-specific immunity against aggressive cancers.

Graphical abstract