bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of high temperatures on sex ratio and differential expression analysis (RNA-seq) of sex-determining genes in Oreochromis niloticus from different river basins in Benin
Authors: Fagbémi Mohammed Nambyl A , Nivelle Renaud , Muller Marc , Mélard Charles , Lalèyè Philippe , Rougeot Carole
Published: January 2024

The high temperature sex reversal process leading to functional phenotypic masculinization during development has been widely described in Nile tilapia (Oreochromis n iloticus) under laboratory or aquaculture conditions and in the wild. In this study, we selected five wild populations of O. niloticus from different river basins in Benin and produced twenty full-sib families of mixed-sex (XY and XX) by natural reproduction. Progenies were exposed to room temperature or high (36.5°C) temperatures between 10 and 30 days post-fertilization (dpf). In control groups, we observed sex ratios from 40% to 60% males as expected, except for 3 families from the Gobé region which showed a bias towards males. High temperature treatment significantly increased male rates in each family up to 88%. Transcriptome analysis was performed by RNA-sequencing (RNA-seq) on brains and gonads from control and treated batches of six families at 15 dpf and 40 dpf. Analysis of differentially expressed genes, differentially spliced genes, and correlations with sex reversal was performed. In 40 dpf gonads, genes involved in sex determination such as dmrt1, cyp11c1, amh, cyp19a1b, ara, and dax1 were upregulated. In 15 dpf brains, a negative correlation was found between the expression of cyp19a1b and the reversal rate, while at 40 dpf a negative correlation was found between the expression of foxl2, cyp11c1, and sf1 and positive correlation was found between dmrt1 expression and reversal rate. Ontology analysis of the genes affected by high temperatures revealed that male sex differentiation processes, primary male sexual characteristics, autophagy, and cilium organization were affected. Based on these results, we conclude that sex reversal by high temperature treatment leads to similar modifications of the transcriptomes in the gonads and brains in offspring of different natural populations of Nile tilapia, which thus may activate a common cascade of reactions inducing sex reversal in progenies.
The relationship between intraflagellar transport and upstream protein trafficking pathways and macrocyclic lactone resistance in Caenorhabditis elegans
Authors: Brinzer Robert A , Winter Alan D , Page Antony P
Published: January 2024

Parasitic nematodes are globally important and place a heavy disease burden on infected humans, crops, and livestock, while commonly administered anthelmintics used for treatment are being rendered ineffective by increasing levels of resistance. It has recently been shown in the model nematode Caenorhabditis elegans that the sensory cilia of the amphid neurons play an important role in resistance toward macrocyclic lactones such as ivermectin (an avermectin) and moxidectin (a milbemycin) either through reduced uptake or intertissue signaling pathways. This study interrogated the extent to which ciliary defects relate to macrocyclic lactone resistance and dye-filling defects using a combination of forward genetics and targeted resistance screening approaches and confirmed the importance of intraflagellar transport in this process. This approach also identified the protein trafficking pathways used by the downstream effectors and the components of the ciliary basal body that are required for effector entry into these nonmotile structures. In total, 24 novel C. elegans anthelmintic survival-associated genes were identified in this study. When combined with previously known resistance genes, there are now 46 resistance-associated genes that are directly involved in amphid, cilia, and intraflagellar transport function.
Late-Life Metabolic Dysfunction-Associated Steatotic Liver Disease and its Association With Physical Disability and Dementia
Authors: Clayton-Chubb Daniel , Kemp William W , Majeed Ammar , Woods Robyn L , Ryan Joanne , Murray Anne M , Chong Trevor T J , Lubel John S , Tran Cammie , Hodge Alexander D , Schneider Hans G , McNeil John J , Roberts Stuart K
Published: January 2024

Background

The burden of metabolic dysfunction-associated steatotic liver disease (MASLD) is growing rapidly, including among older adults. The number of older adults is also rising with concomitantly increasing rates of age-related physical and cognitive dysfunction. However, data on whether MASLD affects physical and cognitive function in older adults is limited. As such, we aimed to identify whether prevalent MASLD influences the risk of incident physical disability or dementia in initially healthy older adults.

Methods

A post-hoc analysis of participants from the ASPREE-XT cohort study, which recruited community-dwelling older adults without a history of cardiovascular disease, dementia, or independence-limiting functional impairment. The Fatty Liver Index (to identify MASLD) was calculated in those with complete data. Cox proportional-hazards models were used to investigate the outcomes of dementia and persistent physical disability in participants with MASLD vs those without.

Results

Of the 9 097 individuals included (mean age 75.1 ± 4.2 years; 45.0% men), 341 (3.7%) developed persistent physical disability and 370 (4.1%) developed dementia over a median follow-up of 6.4 years (IQR 5.3–7.5 years). When adjusting for known contributors including age, gender, education, comorbidity, and functional measures, MASLD was associated with an increased risk of persistent physical disability (HR 1.41 [95% CI: 1.07–1.87]) and reduced risk of incident dementia (HR 0.63 [95% CI: 0.48–0.83]).

Conclusions

Prevalent MASLD is associated with reduced rates of incident dementia but increased risk of persistent physical disability in initially relatively healthy older adults. Understanding the mechanisms underlying these divergent results to allow appropriate risk stratification and counseling is important.
Telehealth use during the early COVID-19 public health emergency and subsequent health care costs and utilization
Authors: Lee Jun Soo , Bhatt Ami , Pollack Lisa M , Jackson Sandra L , Chang Ji Eun , Tong Xin , Luo Feijun
Published: January 2024

Telehealth utilization increased during the COVID-19 pandemic, yet few studies have documented associations of telehealth use with subsequent medical costs and health care utilization. We examined associations of telehealth use during the early COVID-19 public health emergency (March–June 2020) with subsequent total medical costs and health care utilization among people with heart disease (HD). We created a longitudinal cohort of individuals with HD using MarketScan Commercial Claims data (2018–2022). We used difference-in-differences methodology adjusting for patients’ characteristics, comorbidities, COVID-19 infection status, and number of in-person visits. We found that using telehealth during the stay-at-home order period was associated with a reduction in total medical costs (by −$1814 per person), number of emergency department visits (by −88.6 per 1000 persons), and number of inpatient admissions (by −32.4 per 1000 persons). Telehealth use increased per-person per-year pharmacy prescription claims (by 0.514) and average number of days’ drug supply (by 0.773 days). These associated benefits of telehealth use can inform decision makers, insurance companies, and health care professionals, especially in the context of disrupted health care access.
On Some Birational Invariants of Hyper-Kähler Manifolds
Authors: Bai Chenyu
Published: January 2024

We study in this article three birational invariants of projective hyper-Kähler manifolds: the degree of irrationality, the fibering gonality, and the fibering genus. We first improve the lower bound in a recent result of Voisin saying that the fibering genus of a Mumford–Tate very general projective hyper-Kähler manifold is bounded from below by a constant depending on its dimension and the second Betti number. We also study the relations between these birational invariants for projective $K3$ surfaces of Picard number $1$ and study the asymptotic behaviors of their degree of irrationality and fibering genus.
Androgen Receptors in the Dermal Glands of Male and Female Ouachita Dusky Salamanders
Authors: Gunelson A M , Tuong M A , Staub N L
Published: January 2024

Synopsis

The presence of androgens in female development is an important, yet often overlooked, topic. We tested for the presence of androgen receptors (ARs) in the dermal glands of male and female Desmognathus brimleyorum, a plethodontid salamander. This species engages in a courtship behavior called the tail-straddling walk. During this process, communication between males and females is hypothesized to be facilitated by pheromones secreted from modified granular glands (MGGs) on the dorsal tail base, where the female's chin is positioned. These glands are present not only dorsally but also laterally and ventrally on the tail of both males and females. Using immunohistochemistry with a polyclonal antibody, ARs were located in the MGGs of both sexes. Males had a higher percentage of immunopositive cells per MGG than females. The presence of ARs in both sexes highlights the similarity between MGGs in males and females and suggests androgens play a role in female gland function. Furthermore, our results suggest courtship communication is bidirectional, and females have a more active role, signaling the male, than previously described.
Agentive Names and Posthuman Ontologies: Onomastic Invocations of the “More-than-Human” in Early Christian and Medieval Tibetan Artifacts
Authors: Kimmel Joseph
Published: January 2024

In recent years, posthumanist arguments regarding ontology and agency have played a significant role in reshaping the contours of the so-called humanities. Whereas this reshaping has focused heavily on the impact of technology (e.g., artificial intelligence) on the meaning of “being human,” as well as on the agency of nonhuman others (e.g., nonhuman animals), typically invisible beings (e.g., gods, spirits) have received significantly less attention. This article addresses this lacuna through a close and comparative study of the role of the invocation of particular divine names in the canonical Acts of the Apostles and a tenth-century Tibetan spellbook. After examining how each text presents the onomastic invocation of divinities as an efficacious method, under certain conditions, for accomplishing particular goals, this article elucidates how such texts both challenge posthumanist thinkers to articulate much more robust accounts of agency and ontology while also providing a means of doing so.
Efficient slope reliability analysis using a surrogate-assisted normal search particle swarm optimization algorithm
Authors: Yuan Yi-li , Hu Chang-ming , Li Liang , Xu Jian , Hou Xu-hui
Published: January 2024

Sampling of training data is the most important step in active learning slope reliability analysis, which controls the analysis accuracy. In this study, a novel surrogate-assisted normal search particle swarm optimization (SANSPSO) was proposed to enhance the accuracy and robustness of existing methodologies. In SANSPSO, the sampling process was considered a minimum problem with an objective function defined as the absolute value of the performance function. Initiated with a normal search paradigm and supplemented by three algorithm strategies, this approach seeks to preserve the continuity of the solution while refining the algorithm’s efficacy and efficiency. To reduce computation cost, surrogate-assistance was used, in which a surrogate model substitutes the objective function in most iterations. This surrogate model evolves during the iteration process and ultimately replaces the actual performance function within Monte Carlo simulation. Finally, this study presents a comparative study with five state-of-the-art methods across four explicit problems and three engineering cases, where test data suggest that the SANSPSO methodology yields a 20% improvement in accuracy and a 30% rise in stability under different dimensional problems relative to the most efficacious of the alternate methods assessed because of the improved and more consistent prediction of limit state function. These findings substantiate the validity and robustness of the SANSPSO approach.
Three-dimensional nanostructure analysis of non-stained Nafion in fuel-cell electrode by combined ADF-STEM tomography
Authors: Ube Takuji
Published: January 2024

The polymer electrolyte fuel cell (PEFC) is one of the strongest candidates for a next-generation power source for vehicles which do not emit CO2 gas as exhaust gas. The key factor in PEFCs is the nano-scaled electrochemical reactions that take place on the catalyst material and an ionomer supported by a carbon support. However, because the nano-scaled morphological features of the key materials in the catalyst compound cannot be observed clearly by transmission electron microscopy, improvement of PEFC performance had been approached by an imaginal schematic diagram based on an electrochemical analysis. In this study, we revealed the nano-scaled morphological features of the PEFC electrode in three dimensions and performed a quantitative analysis of the nanostructure by the newly developed ‘Combined ADF-STEM tomography technique’. This method combines information from plural annular darkfield detectors with different electron collection angles and can emphasize the difference of the electron scattering intensity between the ionomer and carbon in the cross-sectional image of the reconstructed three-dimensional (3D) data. Therefore, this segmentation method utilizing image contrast does not require a high electron beam current like that used in energy dispersive X-ray analysis, and thus is suitable for electron beam damage-sensitive materials. By eliminating the process of manually determining the thresholds for obtaining classified component data from grayscale data, the obtained 3D structures have sufficient accuracy to allow quantitative analysis and specify the nano-scaled structural parameters directly related to power generation characteristics.
Identification of major QTLs for drought tolerance in soybean, together with a novel candidate gene, GmUAA6
Authors: Jiang Wei , Liu Yandang , Zhang Chi , Pan Lang , Wang Wei , Zhao Chunzhao , Zhao Tuanjie , Li Yan
Published: January 2024

Drought tolerance is a complex trait in soybean that is controlled by polygenetic quantitative trait loci (QTLs). In this study, wilting score, days-to-wilting, leaf relative water content, and leaf relative conductivity were used to identify QTLs associated with drought tolerance in recombinant inbred lines derived from a cross between a drought-sensitive variety, Lin, and a drought-tolerant variety, Meng. A total of 33 drought-tolerance QTLs were detected. Of these 17 were major QTLs. In addition, 15 were novel drought-tolerance QTLs. The most predominant QTL was on chromosome 11. This was detected in at least three environments. The overlapped mapping interval of the four measured traits was 0.2 cM in genetic distance (about 220 kb in physical length). Glyma.11g143500 (designated as GmUAA6), which encodes a UDP-N-acetylglucosamine transporter, was identified as the most likely candidate gene. The allele of GmUAA6 from Lin (GmUAA6Lin) was associated with improved soybean drought tolerance. Overexpression of GmUAA6Lin in Arabidopsis and soybean hairy roots enhanced drought tolerance. Furthermore, a 3-bp insertion/deletion (InDel) in the coding sequence of GmUAA6 explained up to 49.9% of the phenotypic variation in drought tolerance-related traits, suggesting that this InDel might be used in future marker-assisted selection of drought-tolerant lines in soybean breeding programs.
Improvement of active salivary gland ultrasonography findings in Sjögren’s syndrome in response to short-term glucocorticoid treatment: A case report and review of the literature
Authors: Kida Takashi , Kawahito Yutaka , Suzuki Yusuke , Tamaki Shigenori , Tanaka Ikuko
Published: January 2024

Salivary gland ultrasonography is a non-invasive imaging technique that helps in the diagnosis and assessment of disease activity in Sjögren’s syndrome. However, it remains unclear whether the salivary gland ultrasonography findings are reversible in response to treatment. We present a case of a woman in her 20s who presented with parotid swelling and pain lasting for 3 months. The patient was diagnosed with anti-SS-A antibody-positive Sjögren’s syndrome with active sialadenitis, and short-term glucocorticoid treatment resulted in resolution of clinical symptoms and improvement of salivary gland ultrasonography findings by the Outcome Measures in Rheumatology Clinical Trials scoring system. Notably, the anechoic/hypoechoic foci and vascular signals in the parotid and submandibular glands were reduced after treatment. Furthermore, peak systolic blood flow velocity of the facial artery entering the submandibular gland was decreased. Our case highlights that the findings of ‘inflammatory’ structural changes and vascularisation on salivary gland ultrasonography, including the Outcome Measures in Rheumatology Clinical Trials scoring system, reflect the disease active of Sjögren’s syndrome and are reversible with treatment. Salivary gland ultrasonography has the potential to be a useful tool for monitoring treatment response and stratifying patients by disease activity in Sjögren’s syndrome; therefore, further research is needed on the relationship of salivary gland ultrasonography findings with the pathophysiological mechanisms of sialadenitis and long-term clinical outcomes.
Impact of Potential Case Misclassification by Administrative Diagnostic Codes on Outcome Assessment of Observational Study for People Who Inject Drugs
Authors: Goodman-Meza David , Goto Michihiko , Salimian Anabel , Shoptaw Steven , Bui Alex A T , Gordon Adam J , Goetz Matthew B
Published: January 2024

Introduction

Initiation of medications for opioid use disorder (MOUD) within the hospital setting may improve outcomes for people who inject drugs (PWID) hospitalized because of an infection. Many studies used International Classification of Diseases (ICD) codes to identify PWID, although these may be misclassified and thus, inaccurate. We hypothesized that bias from misclassification of PWID using ICD codes may impact analyses of MOUD outcomes.

Methods

We analyzed a cohort of 36 868 cases of patients diagnosed with Staphylococcus aureus bacteremia at 124 US Veterans Health Administration hospitals between 2003 and 2014. To identify PWID, we implemented an ICD code–based algorithm and a natural language processing (NLP) algorithm for classification of admission notes. We analyzed outcomes of prescribing MOUD as an inpatient using both approaches. Our primary outcome was 365-day all-cause mortality. We fit mixed-effects Cox regression models with receipt or not of MOUD during the index hospitalization as the primary predictor and 365-day mortality as the outcome.

Results

NLP identified 2389 cases as PWID, whereas ICD codes identified 6804 cases as PWID. In the cohort identified by NLP, receipt of inpatient MOUD was associated with a protective effect on 365-day survival (adjusted hazard ratio, 0.48; 95% confidence interval, .29–.81; P < .01) compared with those not receiving MOUD. There was no significant effect of MOUD receipt in the cohort identified by ICD codes (adjusted hazard ratio, 1.00; 95% confidence interval, .77–1.30; P = .99).

Conclusions

MOUD was protective of all-cause mortality when NLP was used to identify PWID, but not significant when ICD codes were used to identify the analytic subjects.
Viewpoint on Human Immunodeficiency Virus Medical Care Retention Guidelines in the Coronavirus 2019 Pandemic Era and Beyond: Lessons Learned From Electronic Health Record Screening and Outreach
Authors: Moitra Ethan , Jiménez Muñoz Paola C , Sanchez Martha C , Pinkston Megan M
Published: January 2024

In this viewpoint, we discuss retention in care for people with human immunodeficiency virus (HIV) and call into question the methodology used to characterize retention, as well as the definitions themselves. Optimal retention for people with HIV (PWH) is defined in multiple ways by major healthcare leaders in the United States, typically focusing on appointment attendance or laboratory work. Yet, these definitions rely on in-person encounters, an approach to care that is becoming less common due to the rise of telehealth visits, particularly in light of the coronavirus disease 2019 pandemic. Our recent work showed that relying on electronic health records to identify PWH who were not retained in care not only failed to capture the nuances of modern HIV medical treatment engagement, but also led to misidentification of patients’ retention status due to limitations in the record system. As such, we recommend a reevaluation of how HIV medical care retention is defined and reported.
Pseudoneurotic Symptoms in the Schizophrenia Spectrum: A Longitudinal Study of Their Relation to Psychopathology and Clinical Outcomes
Authors: Rosén Rasmussen Andreas , Handest Peter , Vollmer-Larsen Anne , Parnas Josef
Published: January 2024

Background and Hypothesis

Nonpsychotic symptoms (depression, anxiety, obsessions, etc.) are frequent in schizophrenia-spectrum disorders and are usually conceptualized as comorbidity or transdiagnostic symptoms. However, in twentieth century foundational psychopathological literature, many nonpsychotic symptoms with specific phenomenology (here termed pseudoneurotic symptoms) were considered relatively typical of schizophrenia. In this prospective study, we investigated potential associations of pseudoneurotic symptoms with diagnostic status, functional outcome as well as psychopathological dimensions of schizophrenia.

Study Design

First-admitted patients (N = 121) diagnosed with non-affective psychosis, schizotypal disorder, or other mental illness were examined at initial hospitalization and 5 years later with a comprehensive assessment of psychopathology. Informed by the literature, we constructed scales targeting pseudoneurotic symptoms and other, more general, nonpsychotic symptoms.

Study Results

Pseudoneurotic symptoms aggregated in schizophrenia-spectrum groups compared to other mental illnesses and occurred at similar levels at baseline and follow-up. They longitudinally predicted poorer social and occupational functioning in schizophrenia-spectrum patients over a 5-year-period but not transition to schizophrenia-spectrum disorders from other mental illnesses. Finally, the level of pseudoneurotic symptoms correlated with disorder of basic self at both assessments and with positive and negative symptoms at follow-up. The scale targeting general nonpsychotic symptoms did not show this pattern of associations.

Conclusions

The study supports that a group of nonpsychotic symptoms, ie, pseudoneurotic symptoms, are associated with schizophrenia-spectrum disorders and linked with temporally stable psychopathology, particularly disorder of the basic self. Their prospective association with social and occupational functioning needs replication.
Downregulation of hypocretin/orexin after H1N1 Pandemrix vaccination of adolescent mice
Authors: Pagh-Berendtsen Nicolai , Pavlovskyi Artem , Flores Téllez Daniel , Egebjerg Christine , Kolmos Mie Gunni , Justinussen Jessica , Kornum Birgitte Rahbek
Published: January 2024

Narcolepsy type 1 (NT1), characterized by the loss of hypocretin/orexin (HCRT) production in the lateral hypothalamus, has been linked to Pandemrix vaccination during the 2009 H1N1 pandemic, especially in children and adolescents. It is still unknown why this vaccination increased the risk of developing NT1. This study investigated the effects of Pandemrix vaccination during adolescence on Hcrt mRNA expression in mice. Mice received a primary vaccination (50 µL i.m.) during prepubescence and a booster vaccination during peri-adolescence. Hcrt expression was measured at three-time points after the vaccinations. Control groups included both a saline group and an undisturbed group of mice. Hcrt expression was decreased after both Pandemrix and saline injections, but 21 days after the second injection, the saline group no longer showed decreased Hcrt expression, while the Pandemrix group still exhibited a significant reduction of about 60% compared to the undisturbed control group. This finding suggests that Pandemrix vaccination during adolescence influences Hcrt expression in mice into early adulthood. The Hcrt mRNA level did not reach the low levels known to induce NT1 symptoms, instead, our finding supports the multiple-hit hypothesis of NT1 that states that several insults to the HCRT system may be needed to induce NT1 and that Pandemrix could be one such insult.
The naringenin-dependent regulator FdeR can be applied as a NIMPLY gate controlled by naringenin and arabinose
Authors: Kashiwagi Fernanda Miyuki , Wendler Miranda Brenno , Maltempi de Souza Emanuel , Müller-Santos Marcelo
Published: January 2024

The FdeR regulator has been reported as a transcriptional activator dependent on the interaction with naringenin. Previously, FdeR and its cognate promoter were used to construct naringenin-sensitive sensors, though no correlation was associated between the FdeR level of expression and outputs. Therefore, to understand this correlation, we constructed a circuit with FdeR expression adjusted by the arabinose concentration through an AraC-PBAD system and the FdeR-regulated promoter controlling the expression of GFP. We observed a significant reduction in the activity of the target promoter by increasing FdeR expression, indicating that although FdeR has been primarily classified as a transcriptional activator, it also represses transcription. Leveraging the bifunctional feature of FdeR, acting as both transcriptional activator and repressor, we demonstrated that this genetic circuit, when previously switched on by naringenin, can be switched off by inducing an increased FdeR expression level. This engineered system functioned as a NIMPLY gate, effectively decreasing GFP expression by 50% when arabinose was added without removing naringenin from the medium. Exploiting FdeR versatility, this study demonstrates an innovative application of this transcriptional factor for developing novel NIMPLY gates activated by a molecule with low toxicity and nutraceutical properties that may be important for several applications.

Graphical Abstract
The impact of insect egg deposition on Pinus sylvestris transcriptomic and phytohormonal responses to larval herbivory
Authors: Hundacker Janik , Linda Tom , Hilker Monika , Lortzing Vivien , Bittner Norbert
Published: January 2024

Plants can improve their resistance to feeding damage by insects if they have perceived insect egg deposition prior to larval feeding. Molecular analyses of these egg-mediated defence mechanisms have until now focused on angiosperm species. It is unknown how the transcriptome of a gymnosperm species responds to insect eggs and subsequent larval feeding. Scots pine (Pinus sylvestris L.) is known to improve its defences against larvae of the herbivorous sawfly Diprion pini L. if it has previously received sawfly eggs. Here, we analysed the transcriptomic and phytohormonal responses of Scots pine needles to D. pini eggs (E-pine), larval feeding (F-pine) and to both eggs and larval feeding (EF-pine). Pine showed strong transcriptomic responses to sawfly eggs and—as expected—to larval feeding. Many egg-responsive genes were also differentially expressed in response to feeding damage, and these genes play an important role in biological processes related to cell wall modification, cell death and jasmonic acid signalling. EF-pine showed fewer transcriptomic changes than F-pine, whereas EF-treated angiosperm species studied so far showed more transcriptional changes to the initial phase of larval feeding than only feeding-damaged F-angiosperms. However, as with responses of EF-angiosperms, EF-pine showed higher salicylic acid concentrations than F-pine. Based on the considerable overlap of the transcriptomes of E- and F-pine, we suggest that the weaker transcriptomic response of EF-pine than F-pine to larval feeding damage is compensated by the strong, egg-induced response, which might result in maintained pine defences against larval feeding.
Nursing Student Perceptions of Incivility in Academia
Authors: Lopez Michele Lucille
Published: January 2024

Compassion is an essential value held by the nursing profession, but many nurses demonstrate incivility that may originate from their experiences in nursing academia. The Incivility in Nursing Education-Revised tool was used at a community college nursing program to gain student perspectives on incivility. Watson’s theory of human caring influenced this study. Participants were surveyed about types and frequencies of perceived faculty incivility. At least 77.8 percent of participants observed some degree of incivility in the program. No correlations between incivility and age or health care experience were identified.
Impact of Team-Based Learning on the Development of Critical Thinking Disposition in Entry-Level Master’s Nursing Students
Authors: George Ragi
Published: January 2024

Team-based learning (TBL) is an evidence-based teaching-learning strategy increasingly used in nursing education to improve student learning outcomes. Few studies have focused on its effects on the critical thinking disposition of second-degree nursing students enrolled in accelerated, entry-level master’s programs. The purpose of this study was to evaluate the impact of TBL on the critical thinking disposition of entry-level master’s nursing students. Critical thinking disposition scores did not significantly improve, but students’ confidence in reasoning skills and intellectual curiosity were strengthened, suggesting that TBL is an instructional strategy worth pursuing in entry-level master’s nursing programs.
Efficacy and Safety of Fezolinetant for the Treatment of Menopause-Associated Vasomotor Symptoms
Authors: Bonga Krishna Nikhila , Mishra Archana , Maiti Rituparna , Padhy Biswa Mohan , Meher Bikash Ranjan , Srinivasan Anand
Published: January 2024

OBJECTIVE:

To evaluate the efficacy and adverse events of fezolinetant for treating vasomotor symptoms (VMS) of menopause.

DATA SOURCES:

PubMed/MEDLINE, ClinicalTrials.gov, EMBASE, Cochrane Database, Scopus, and WHO International Clinical Trials Registry Platform were searched through June 2023 for publications and randomized controlled trials on fezolinetant compared with placebo in menopausal women who experienced moderate-to-severe VMS.

METHODS OF STUDY SELECTION:

Our literature search identified 330 articles, of which five studies with six reports were included in our meta-analysis per our eligibility criteria.

TABULATION, INTEGRATION, AND RESULTS:

The risk of bias was evaluated using Cochrane's RoB 2 (Risk of Bias version 2) tool, quality of evidence was graded using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach, and outcome measures data for effect size were pooled in random-effects model and rated. A total of 2,168 participants from five randomized clinical trials (six reports) were included. Fezolinetant significantly lowered VMS frequency, with pooled mean difference of 2.62 (95% CI, 1.84–3.41). The pooled mean difference for fezolinetant compared with placebo for the MENQOL (Menopause-Specific Quality of Life) measure was −0.60 (95% CI, −0.92 to −0.28), and the mean percentage improvement in VMS frequency was 22.51% (95% CI, 15.35–29.67). Fezolinetant was associated with improvement in sleep quality when compared with placebo.

CONCLUSION:

Fezolinetant is effective in lowering moderate-to-severe VMS frequency and sleep disturbances in postmenopausal women.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42023427616.
Venous Thromboembolic Risk of Estradiol Valerate–Dienogest Compared with Ethinyl Estradiol–Levonorgestrel Combined Oral Contraceptives
Authors: Bauerfeind Anja , von Stockum Sophia , Boehnke Tanja , Heinemann Klaas
Published: January 2024

This pooled analysis compared the risk of venous thromboembolism (VTE) associated with combined oral contraceptives (COCs) containing estradiol (E2) valerate–dienogest with those containing ethinyl E2–levonorgestrel. Data were retrieved from two large, prospective, observational cohort studies. Propensity score subclassification was applied to balance baseline parameters between the COC user cohorts. Crude and adjusted hazard ratios (HRs) were calculated based on the extended Cox model. The pooled data set included 11,616 E2 valerate–dienogest users and 18,681 ethinyl E2–levonorgestrel users, contributing 17,932 and 29,140 women-years of observation, respectively. A significantly decreased VTE risk in E2 valerate–dienogest COCs compared with ethinyl E2–levonorgestrel COCs was observed (propensity score–stratified HR 0.46, 95% CI, 0.22–0.98). This pooled analysis expands data from a previous postauthorization safety study and provides valuable real-world safety information on the relative safety of current COCs.
Longitudinal Reoperation Risk After Apical Prolapse Procedures in Women Aged 65 Years and Older
Authors: Berger Alexander A. , Bretschneider Carol E. , Gregory W. Thomas , Sung Vivian
Published: January 2024

OBJECTIVE:

To describe longitudinal reoperation risk among older women undergoing surgery for apical pelvic organ prolapse (POP) and to compare risk of reoperation for prolapse and complications among different surgical approaches.

METHODS:

This nationwide, retrospective cohort study evaluated older adult women (aged 65 years and older) within the Centers for Medicare & Medicaid Services’ (CMS) 5% LDS (Limited Data Set) who underwent sacrocolpopexy, uterosacral ligament suspension (USLS), sacrospinous ligament fixation (SSLF), or colpocleisis, or their uterine-preserving equivalents, from January 1, 2011, to December 31, 2018, with follow-up through 2019. The primary outcome was overall reoperation, and secondary outcomes included reoperation for POP and for complications. Rates were compared using χ2 tests for categorical variables, Wilcoxon rank-sum for continuous variables and Kaplan Meier estimates of cumulative incidence. Death and exit from CMS insurance were considered as censoring events. We used cumulative incidence to calculate reoperation risk as a function of time at 1 year or more, 3 years or more, and 7 years or more.

RESULTS:

This cohort included 4,089 women who underwent surgery to treat apical POP from 2011 to 2018: 1,034 underwent sacrocolpopexy, 717 underwent USLS, 1,529 underwent SSLF, and 809 underwent colpocleisis. Demographics varied among patients for each POP surgery. Patients who underwent the different surgeries had differences in age (P<.01), Charlson Comorbidity Index score (P<.01), diabetes (P<.01), chronic obstructive pulmonary disease (P<.01), hypertension (P<.01), chronic pain (P=.01), congestive heart failure (P<.01), and concomitant hysterectomy (P<.01). Reoperation rates were low and increased over time. The overall reoperation risk through 7 years was 7.3% for colpocleisis, 10.4% for USLS, 12.5% for sacrocolpopexy, and 15.0% for SSLF (P<.01). Reoperation for recurrent POP through 7 years was 2.9% for colpocleisis, 7.3% for sacrocolpopexy, 7.7% for USLS, and 9.9% for SSLF (P<.01). Reoperation for complications through 7 years was 5.3% for colpocleisis, 8.2% for sacrocolpopexy, 6.4% for USLS, and 8.2% for SSLF (P<.01).

CONCLUSION:

The type of surgical repair is significantly associated with long-term risk of reoperation. Colpocleisis offers the least likelihood of reoperation for prolapse, followed by sacrocolpopexy; colpocleisis followed by USLS has the least risk of long-term reoperation for complication.
Feasibility of Setting the Tidal Volume Based on End-Expiratory Lung Volume: A Pilot Clinical Study
Authors: Grassi Alice , Teggia-Droghi Maddalena , Borgo Asia , Szudrinsky Konstanty , Bellani Giacomo
Published: January 2024

OBJECTIVES:

To assess the feasibility of setting the tidal volume (TV) as 25% of the actual aerated lung volume (rather than on ideal body weight) in patients with Acute Respiratory Distress Syndrome (ARDS).

DESIGN:

Physiologic prospective single-center pilot study.

SETTING:

Medical ICU specialized in the care of patients with ARDS.

PATIENTS:

Patients with moderate-severe ARDS deeply sedated or paralyzed, undergoing controlled mechanical ventilation with a ventilator able to measure the end-expiratory lung volume (EELV) with a washin, washout technique.

INTERVENTIONS:

Three-phase study (baseline, strain-selected TV setting, ventilation with strain-selected TV for 24 hr). The TV was calculated as 25% of the measured EELV minus the static strain due to the applied positive end-expiratory pressure.

MEASUREMENTS AND MAIN RESULTS:

Gas exchanges and respiratory mechanics were measured and compared in each phase. In addition, during the TV setting phase, driving pressure (DP) and lung strain (TV/EELV) were measured at different TVs to assess the correlation between the two measurements. The maintenance of the set strain-selected TV for 24 hours was safe and feasible in 76% of the patients enrolled. Three patients dropped out from the study because of the need to set a respiratory rate higher than 35 breaths per minute to avoid respiratory acidosis. The DP of the respiratory system was a satisfactory surrogate for strain in this population.

CONCLUSIONS:

In our population of 17 patients with moderate to severe ARDS, setting TV based on the actual lung size was feasible. DP was a reliable surrogate of strain in these patients, and DP less than or equal to 8 cm H2O corresponded to a strain less than 0.25.
Primary Amebic Meningoencephalitis Caused by Naegleria fowleri in China: A Case Report
Authors: Wu Qihuan , Chen Chensong , Li Jie , Lian Xiang
Published: January 2024

Naegleria fowleri is a thermophilic, free-living ameba that is commonly known as the “brain-eating ameba.” This parasite invades the central nervous system and causes an acute fulminant infection, which results in a fatal form of primary amebic meningoencephalitis (PAM). Here, we report a case of PAM by an unexpected transmission route. Regrettably, the patient deteriorated swiftly and passed away subsequent to diagnosis, despite our exhaustive efforts. Here, we compiled a summary of 11 cases of PAM survivors who have all been treated with amphotericin, rifampicin and triazoles. Beside this regimen, miltefosine was also used successfully to treat PAM in an adolescent. More precise understanding of the survival rate and contributing factors can be established with further validation on additional cases.
Cold Endoscopic Mucosal Resection (c-EMR) of Nonpedunculated Colorectal Polyps ≥20 mm
Authors: Ramai Daryl , Clement Benjamin , Maida Marcello , Previtera Melissa , Brooks Olivia W. , Wang Yichen , Chandan Saurabh , Dhindsa Banreet , Deliwala Smit , Facciorusso Antonio , Khashab Mouen , Ofosu Andrew
Published: January 2024

Background:

There is increasing evidence that cold endoscopic mucosal resection (c-EMR) can effectively treat large colorectal polyps. We aim to appraise the current literature and evaluate outcomes following c-EMR for nonpedunculated colonic polyps ≥20 mm.

Methods:

Major databases were searched. Primary outcomes included recurrence rate and adverse events. Meta-analysis was performed using a random-effects model.

Results:

Nine articles were included in the final analysis, which included 817 patients and 1077 colorectal polyps. Average polyp size was 28.8 (±5.1) mm. The pooled recurrence rate of polyps of any histology at 4 to 6 months was 21.0% (95% CI: 9.0%-32.0%, P<0.001, I
2=97.3, P<0.001). Subgroup analysis showed that recurrence was 10% for proximal lesions (95% CI: 0.0%-20.0%, P=0.054, I
2=93.7%, P=0.054) and 9% for distal lesions (95% CI: 2.0%-21.0%, P=0.114, I
2=95.8%, P=0.114). Furthermore, subgroup analysis showed that recurrence was 12% for adenoma (95% CI: 4.0%-19.0%, P=0.003, I
2=98.0%, P=0.003), and 3% for sessile serrated polyps (95% CI: 1.0%-5.0%, P=0.002, I
2=34.4%, P=0.002). Post-polypectomy bleeding occurred in 1% (n=8/817) of patients, whereas abdominal pain occurred in 0.2% (n=2/817) of patients.

Conclusions:

C-EMR for nonpedunculated colorectal polyps ≥20 mm shows an excellent safety profile with a very low rate of delayed bleeding as well as significantly less recurrence for sessile serrated polyps than adenomas.
Utility of Intraprocedural Luminal Diameter and Distensibility Measurements During the Esophageal Peroral Endoscopic Myotomy Procedure
Authors: Eke Chiemeziem , Greenberg Ian , Bushe Bryce , Joelson Andrew , Acharya Priyanka , Lee David , Sethi Amrita , Kedia Prashant
Published: January 2024

Goals:

Through evaluation of the lower esophageal sphincter immediately before and after myotomy using an endoluminal functional lumen imaging probe (EFLIP), our study aimed to determine the clinical response to peroral endoscopic myotomy (POEM) and the incidence of postprocedure reflux.

Background:

Achalasia is a rare esophageal motility disorder characterized by impaired relaxation of the lower esophageal sphincter (LES) and diminished peristalsis. POEM is a therapeutic option for durable management of achalasia. However, symptomatic acid reflux and esophagitis are well-known adverse effects of the procedure.

Study:

Electronic medical records of 168 patients who underwent POEM for achalasia at 2 tertiary care referral centers from May 2014 to May 2021 were reviewed. EFLIP was used at a range of catheter fill volumes to assess LES dynamics. Preprocedure and postprocedure Eckardt Symptom Scores were recorded.

Results:

Significant clinical improvement from POEM was sustained in over 94% of patients after 1 year. EFLIP changed intraprocedural management 5% of the time by means of myotomy extension. In patients with reflux>1 year following POEM, there was no significant difference in post-POEM LES diameter or change in LES diameter compared with those without reflux. However, post-POEM LES distensibility index (DI) was significantly higher in patients with reflux after 1 year compared with those without reflux.

Conclusions:

POEM is a safe and increasingly effective therapy for patients with symptomatic achalasia. Intraprocedural EFLIP measurements suggest that post-POEM reflux may be correlated more with DI than LES diameter. Yet, more data is needed to substantiate these outcomes.
The Effect of Renin-Angiotensin System Inhibitors in Patients Undergoing Pancreatic Cancer Resection
Authors: Abe Satoru , Nakai Yousuke , Arita Junichi , Ichida Akihiko , Kawaguchi Yoshikuni , Akamatsu Nobuhisa , Kaneko Junichi , Ijichi Hideaki , Koike Kazuhiko , Fujishiro Mitsuhiro , Hasegawa Kiyoshi
Published: January 2024

Objectives

The local renin-angiotensin system promotes angiogenesis and proliferation via vascular endothelial growth factor or epidermal growth factor receptor expression. In this study, we aimed to evaluate the impact of angiotensin system inhibitors (ASIs) on long-term outcomes in patients undergoing surgical resection of pancreatic ductal adenocarcinoma (PDAC).

Methods

A single institutional retrospective analysis was performed using the medical records of patients who underwent pancreatic resection with curative intent for PDAC between January 2005 and December 2018. Patient characteristics and surgical outcomes were compared between patients taking ASIs and those who are not.

Results

A total of 272 patients were included in the study and classified into the ASI group (n = 121) and the non-ASI group (n = 151). The median overall survival times in the ASI group and non-ASI group were 38.0 and 34.0 months (P = 0.250), and the median recurrence-free survival times were 24.0 and 15.0 months (P = 0.025), respectively. Multivariate analysis for recurrence-free survival identified the use of ASIs (P = 0.020), CA19-9 level >500 IU/L (P = 0.010), positive lymph node metastasis (P < 0.001), and no adjuvant chemotherapy (P < 0.001) as independent prognostic factors.

Conclusions

The use of ASI may improve long-term outcomes after surgery for PDAC.
Anaesthetic managements of 16 days’ neonate with large occipital meningeoencephalocele in a resource-limited setting, Ethiopia: a clinical case report and review of literature
Authors: Ibrahim Amelmasin Faris , Ayen Biresaw , Belayneh Tadesse , Dereje Tesera
Published: January 2024

Introduction:

Meningoencephalocele is a rare congenital neural tube defect that results in herniation of brain tissue, necessitating surgical treatment. However, anaesthetic management of meningoencephalocele is challenging because of the giant occipital mass in airway management, particularly for anaesthetists working in resource-limited settings. Therefore, this case report aimed to share the challenges encountered during the perioperative anaesthesia management of a giant occipital meningoencephalocele in Ethiopia.

Case presentation:

A 16-day-old female neonate was referred from a health centre in Ethiopia for surgical excision and repair of a giant occipital meningoencephalocele (GOM). The main challenges were hemodynamic instability and airway management due to the giant mass on neck movement and inability to achieve the optimal position for intubation.

Methods:

A single clinical case report discussed challenges encountered during perioperative anaesthesia management of GOM in a resource-limited setting in Ethiopia, and this work has been reported in line with the SCARE 2023 criteria.

Conclusion:

Anaesthesia management in neonates with GOM is challenging for anaesthetists in resource-limited settings because of the scarcity of different airway equipment and large masses. Another concern was to avoid pressure on the GOM due to rupture, which may result in hemodynamic instability and hypothermia. Therefore, attention should be paid to proper handling of the airway, hypothermia, and fluid loss. Generally, managing an occipital meningoencephalocele poses challenges for anaesthetists, particularly in terms of securing the airway. Despite these challenges, the authors managed with locally available resources.
Impact of artificial intelligence on the diagnosis, treatment and prognosis of endometrial cancer
Authors: Butt Samia Rauf , Soulat Amna , Lal Priyanka Mohan , Fakhor Hajar , Patel Siddharth Kumar , Ali Mashal Binte , Arwani Suneel , Mohan Anmol , Majumder Koushik , Kumar Vikash , Tejwaney Usha , Kumar Sarwan
Published: January 2024

Endometrial cancer is one of the most prevalent tumours in females and holds an 83% survival rate within 5 years of diagnosis. Hypoestrogenism is a major risk factor for the development of endometrial carcinoma (EC) therefore two major types are derived, type 1 being oestrogen-dependent and type 2 being oestrogen independent. Surgery, chemotherapeutic drugs, and radiation therapy are only a few of the treatment options for EC. Treatment of gynaecologic malignancies greatly depends on diagnosis or prognostic prediction. Diagnostic imaging data and clinical course prediction are the two core pillars of artificial intelligence (AI) applications. One of the most popular imaging techniques for spotting preoperative endometrial cancer is MRI, although this technique can only produce qualitative data. When used to classify patients, AI improves the effectiveness of visual feature extraction. In general, AI has the potential to enhance the precision and effectiveness of endometrial cancer diagnosis and therapy. This review aims to highlight the current status of applications of AI in endometrial cancer and provide a comprehensive understanding of how recent advancements in AI have assisted clinicians in making better diagnosis and improving prognosis of endometrial cancer. Still, additional study is required to comprehend its strengths and limits fully.