bluuebunny/crossref_metadata_2025 huggingface dataset:
Fear of anesthesia for cesarean section among pregnant women: a multicenter cross-sectional study
Authors: Shawahna Ramzi , Jaber Mohammad , Maqboul Iyad , Hijaz Hatim , Arjan Eman , Karaki Maisa , Nasser Keen
Published: November 2023

Background

Fear of anesthesia for cesarean section delivery is an important health issue that should be addressed by anesthesiologists, obstetricians, and other providers of antenatal and perioperative healthcare. This multicenter study was conducted to assess the fear of anesthesia for cesarean section among Palestinian pregnant women and to identify the predictors of high fear.

Methods

The study was conducted in a cross-sectional design among Palestinian pregnant women in different antenatal healthcare clinics. The study participants were recruited using a convenience sampling procedure. The pregnant women were asked to respond to items in a questionnaire.

Results

In this study, a total of 394 pregnant women completed the questionnaires. Of the pregnant women, 280 (71.1%) have had cesarean delivery under anesthesia, and 104 (26.4%) elected cesarean delivery. Multiple linear regression showed that higher fear scores were predicted by having a university degree (p-value < 0.001), living in rural areas (p-value = 0.007), dissatisfaction with social life (p-value = 0.004), satisfaction with religious commitment (p-value = 0.001), having had cesarean delivery under anesthesia (p-value = 0.005), and preference of cesarean delivery (p-value < 0.001).

Conclusion

Fear of anesthesia was prevalent among pregnant women in Palestine. Higher fear could be predicted by education level, place of residence, satisfaction with social life, satisfaction with religious commitment, having had cesarean delivery under anesthesia, and preference for normal delivery. Anesthesiologists, gynecologists and obstetricians, nurses, midwives, and other providers of antenatal and perioperative healthcare services should consider these factors while counseling pregnant women and addressing their fear of anesthesia.
Metabolomics reveals that Curcuma longa and demethoxycurcumin inhibit HCT116 human colon cancer cell growth
Authors: Yoon Dahye , Choi Bo-Ram , Shin Woo Cheol , Kim Kwan-Woo , Lee Young-Seob , Lee Dae Young
Published: November 2023

Studies on the use of natural products to treat cancer are ongoing, and turmeric (Curcuma longa L.), a medicinal crop, is known for various effects including anticancer activity. In this study, the inhibitory effect of C. longa and demethoxycurcumin on cancer cell growth in a colorectal cancer cell line (HCT116) was investigated by using nuclear magnetic resonance (NMR) spectroscopy-based metabolomics. For this analysis, HCT116 cells were treated with doxorubicin (positive control), C. longa extract, or demethoxycurcumin (20, 40, and 60 μM). In the NMR spectra of the HCT116 cell extract, 45 metabolites were identified and quantified. The quantified metabolites were analyzed by biomarker analysis, and significantly changed metabolites were filtered by the area under the curve (AUC) of the receiver operator characteristic (ROC) curve. Multivariate statistical analysis of NMR spectra was conducted to confirm the distribution among groups. Through an S-line plot, it was possible to identify metabolites that contributed to the differences seen in the OPLS-DA score plot. Taken together, the results reveal that C. longa extract induces oxidative stress and changes the energy metabolism in HCT116 cells, and that demethoxycurcumin inhibits the energy metabolism strategy for the survival of cancer cells, escape from immune cells, and cancer cell proliferation, thereby enabling the survival of HCT116 cells.
Development and validation of a nomogram for predicting in-hospital mortality in patients with nonhip femoral fractures
Authors: Xing Zhibin , Xu Yiwen , Wu Yuxuan , Fu Xiaochen , Shen Pengfei , Che Wenqiang , Wang Jing
Published: November 2023

Background

The incidence of nonhip femoral fractures is gradually increasing, but few studies have explored the risk factors for in-hospital death in patients with nonhip femoral fractures in the ICU or developed mortality prediction models. Therefore, we chose to study this specific patient group, hoping to help clinicians improve the prognosis of patients.

Methods

This is a retrospective study based on the data from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Least absolute shrinkage and selection operator (LASSO) regression was used to screen risk factors. The receiver operating characteristic (ROC) curve was drawn, and the areas under the curve (AUC), net reclassification index (NRI) and integrated discrimination improvement (IDI) were calculated to evaluate the discrimination of the model. The consistency between the actual probability and the predicted probability was assessed by the calibration curve and Hosmer–Lemeshow goodness of fit test (HL test). Decision curve analysis (DCA) was performed, and the nomogram was compared with the scoring system commonly used in clinical practice to evaluate the clinical net benefit.

Results

The LASSO regression analysis showed that heart rate, temperature, red blood cell distribution width, blood urea nitrogen, Glasgow Coma Scale (GCS), Simplified Acute Physiology Score II (SAPSII), Charlson comorbidity index and cerebrovascular disease were independent risk factors for in-hospital death in patients with nonhip femoral fractures. The AUC, IDI and NRI of our model in the training set and validation set were better than those of the GCS and SAPSII scoring systems. The calibration curve and HL test results showed that our model prediction results were in good agreement with the actual results (P = 0.833 for the HL test of the training set and P = 0.767 for the HL test of the validation set). DCA showed that our model had a better clinical net benefit than the GCS and SAPSII scoring systems.

Conclusion

In this study, the independent risk factors for in-hospital death in patients with nonhip femoral fractures were determined, and a prediction model was constructed. The results of this study may help to improve the clinical prognosis of patients with nonhip femoral fractures.
Insights into genetic diversity and phenotypic variations in domestic geese through comprehensive population and pan-genome analysis
Authors: Gao Guangliang , Zhang Hongmei , Ni Jiangping , Zhao Xianzhi , Zhang Keshan , Wang Jian , Kong Xiangdong , Wang Qigui
Published: November 2023

Background

Domestic goose breeds are descended from either the Swan goose (Anser cygnoides) or the Greylag goose (Anser anser), exhibiting variations in body size, reproductive performance, egg production, feather color, and other phenotypic traits. Constructing a pan-genome facilitates a thorough identification of genetic variations, thereby deepening our comprehension of the molecular mechanisms underlying genetic diversity and phenotypic variability.

Results

To comprehensively facilitate population genomic and pan-genomic analyses in geese, we embarked on the task of 659 geese whole genome resequencing data and compiling a database of 155 RNA-seq samples. By constructing the pan-genome for geese, we generated non-reference contigs totaling 612 Mb, unveiling a collection of 2,813 novel genes and pinpointing 15,567 core genes, 1,324 softcore genes, 2,734 shell genes, and 878 cloud genes in goose genomes. Furthermore, we detected an 81.97 Mb genomic region showing signs of genome selection, encompassing the TGFBR2 gene correlated with variations in body weight among geese. Genome-wide association studies utilizing single nucleotide polymorphisms (SNPs) and presence-absence variation revealed significant genomic associations with various goose meat quality, reproductive, and body composition traits. For instance, a gene encoding the SVEP1 protein was linked to carcass oblique length, and a distinct gene-CDS haplotype of the SVEP1 gene exhibited an association with carcass oblique length. Notably, the pan-genome analysis revealed enrichment of variable genes in the “hair follicle maturation” Gene Ontology term, potentially linked to the selection of feather-related traits in geese. A gene presence-absence variation analysis suggested a reduced frequency of genes associated with “regulation of heart contraction” in domesticated geese compared to their wild counterparts. Our study provided novel insights into gene expression features and functions by integrating gene expression patterns across multiple organs and tissues in geese and analyzing population variation.

Conclusion

This accomplishment originates from the discernment of a multitude of selection signals and candidate genes associated with a wide array of traits, thereby markedly enhancing our understanding of the processes underlying domestication and breeding in geese. Moreover, assembling the pan-genome for geese has yielded a comprehensive apprehension of the goose genome, establishing it as an indispensable asset poised to offer innovative viewpoints and make substantial contributions to future geese breeding initiatives.
Iterative gene integration mediated by 26S rDNA and non-homologous end joining for the efficient production of lycopene in Yarrowia lipolytica
Authors: Luo Zhen , Shi Jiang-Ting , Chen Xin-Liang , Chen Jun , Liu Feng , Wei Liu-Jing , Hua Qiang
Published: November 2023

Because of its potent antioxidant effects, lycopene has been used in various industries including, but not limited to, food, medical, and cosmetic industries. Yarrowia lipolytica, a non-conventional yeast species, is a promising chassis due to its natural mevalonate (MVA) pathway, abundant precursor acetyl coenzyme A content, and oleaginous properties. Several gene editing tools have been developed for Y. lipolytica along with engineering strategies for tetraterpenoid production. In this study, we engineered Y. lipolytica following multi-level strategies for efficient lycopene accumulation. We first evaluated the performance of the key lycopene biosynthetic genes crtE, crtB, and crtI, expressed via ribosomal DNA (rDNA) mediated multicopy random integration in the HMG1- and GGS1-overexpressing background strain. Further improvement in lycopene production was achieved by overexpressing the key genes for MVA synthesis via non-homologous end joining (NHEJ) mediated multi-round iterative transformation. Efficient strategies in the MVA and lipid synthesis pathways were combined to improve lycopene production with a yield of 430.5 mg/L. This strain produced 121 mg/g dry cell weight of lycopene in a 5-L fed-batch fermentation system. Our findings demonstrated iterative gene integration mediated by 26S rDNA and NHEJ for the efficient production of lycopene in Y. lipolytica. These strategies can be applied to induce Y. lipolytica to produce other tetraterpenoids.

Graphical Abstract
Embedding formal and experiential public and patient involvement training in a structured PhD programme: process and impact evaluation
Authors: Pierce Maria , Foley Louise , Kiely Bridget , Croke Aisling , Larkin James , Smith Susan M. , Clyne Barbara , Murphy Edel
Published: November 2023

Background

Incorporating Public and Patient Involvement (PPI) into doctoral research is valued by PhD funders and scholars. Providing early career researchers with appropriate training to develop skills to conduct meaningful PPI involvement is important. The Health Research Board (HRB) Collaborative Doctoral Award in MultiMorbidity programme (CDA-MM) embedded formal PPI training in its structured education. The four participating PhD scholars established a PPI panel comprising people living with two or more chronic conditions, presenting an opportunity for experiential PPI training. This study aimed to evaluate the process and impact of embedding PPI training in a structured PhD programme.

Methods

This study was a longitudinal mixed-methods evaluation, conducted over 24 months (June 2020 to June 2022). A process evaluation provided an understanding of how PPI was embedded and explored the experiences of key stakeholders involved. An impact evaluation assessed the impact of embedding PPI training in the programme. Participants included PhD scholars, PPI contributors and PhD supervisors. The data collection and analysis was led by an independent researcher not aligned with the CDA-MM. Data collection methods included five focus groups, individual interviews (n = 6), an impact log, activity logs and group reflections. Qualitative data were analysed using thematic and content analysis and quantitative data analysed using descriptive statistics.

Results

Embedding formal and experiential PPI training in a structured PhD programme is feasible. Both approaches to training are fundamental to building PPI capacity. Involvement of an experienced and knowledgeable PPI lead throughout is perceived as critical. The PPI panel approach offered a good example of embedded consultation and worked well in a structured PhD programme, providing PhD scholars with ample opportunities for learning about PPI and its implementation. For PPI contributors, culture was the most important indicator of quality and was positively evaluated. Key roles for PhD supervisors were identified. Embedding formal and experiential PPI training impacted positively on many different aspects of individual PhD research projects and on PhD scholars as researchers. There were positive impacts for PPI contributors and PhD supervisors.

Conclusions

Embedding formal and experiential PPI training in a structured PhD programme is a novel approach. The evaluation has identified a number of lessons that can inform future doctoral programmes seeking to embed formal and experiential PPI training.
[18F]PSMA-1007 PET is comparable to [99mTc]Tc-DMSA SPECT for renal cortical imaging
Authors: Valind Kristian , Minarik David , Garpered Sabine , Persson Eva , Jögi Jonas , Trägårdh Elin
Published: November 2023

Background

Scintigraphy using technetium-99m labelled dimercaptosuccinic acid ([99mTc]Tc-DMSA), taken up in the proximal tubules, is the standard in functional imaging of the renal cortex. Recent guidelines recommend performing [99mTc]Tc-DMSA scintigraphy with single photon emission computed tomography (SPECT). Prostate-specific membrane antigen (PSMA) targeted positron emission tomography (PET) is used for staging and localization of recurrence in prostate cancer. A high renal uptake is often seen on PSMA PET, concordant with known PSMA expression in proximal tubules. This suggests PSMA PET could be used analogous to [99mTc]Tc-DMSA scintigraphy for renal cortical imaging. [18F]PSMA-1007 is a promising radiopharmaceutical for this purpose due to low urinary clearance. In this study, we aimed to compare [18F]PSMA-1007 PET to [99mTc]Tc-DMSA SPECT regarding split renal uptake and presence of renal uptake defects, in patients with prostate cancer. Three readers interpreted PET and SPECT images regarding presence of renal uptake defects, with each kidney split into cranial, mid and caudal segments. Kidneys were segmented in PET and SPECT images, and left renal uptake as a percentage of total renal uptake was measured.

Results

Twenty patients with prostate cancer were included. 2 participants had single kidneys; thus 38 kidneys were evaluated. A total of 29 defects were found on both [99mTc]Tc-DMSA SPECT and [18F]PSMA-1007 PET. Cohen’s kappa for concordance regarding presence of any defect was 0.76 on a per-segment basis and 0.67 on a per-kidney basis. Spearman’s r for left renal uptake percentage between [99mTc]Tc-DMSA SPECT and [18F]PSMA-1007 PET was 0.95.

Conclusions

[18F]PSMA-1007 PET is comparable to [99mTc]Tc-DMSA SPECT for detection of uptake defects in this setting. Measurements of split renal function made using [18F]PSMA-1007 PET are valid and strongly correlated to measurements made with [99mTc]Tc-DMSA SPECT.
A case of tongue swelling after S-1, oxaliplatin, and trastuzumab for HER2-positive gastric cancer
Authors: Abe Taichi , Sumiya Tatsuya , Tsuji Ayaka , Hanai Izumi , Otomo Yukiko , Yamamoto Takae , Iguchi Emiko
Published: November 2023

Background

We report a case of a patient with HER2-positive gastric cancer with marked tongue swelling during the second cycle of S-1, oxaliplatin, and trastuzumab.

Case presentation

The patient was a 74-year-old male, who was taking an angiotensin II receptor blocker (ARB) for pre-existing hypertension, with no history of allergies, diagnosed with HER2-positive gastric cancer, treated with tegafur, gimeracil, and oteracil potassium (S-1) and oxaliplatin for the first cycle, and trastuzumab was added from the second cycle. Three weeks after initiation, during an outpatient visit, grade 2 oral mucositis and significant enlargement of the patient's tongue were observed. Due to the risk of airway obstruction, the patient was referred to an otolaryngologist. After examination, hereditary angioedema was ruled out, and treatment was discontinued in view of ARB-induced angioedema. However, the tongue swelling did not improve markedly. Considering disease progression due to the discontinuation of chemotherapy, it was decided to change S-1 to capecitabine and continue treatment, and chemotherapy was resumed.

Conclusions

Angioedema has been reported to be hereditary and drug-related, and angiotensin-converting enzyme (ACE) inhibitors and ARBs have also been reported to lead to drug-related adverse events. Since the patient had oral mucositis at the time of onset and was taking an ARB, it is thought that oxaliplatin and S-1(SOX), and trastuzumab during ARB therapy induced oral mucositis, leading to the development of angioedema.
Determinants of success of mobile payments as innovations: An exploratory study based on the extant literature, the M-Pesa, Alipay, and Nubank cases, and the opinion of experts
Authors: Kawamoto Carlos Tadao , Spers Renata Giovinazzo , Fleury André Leme , Feldmann Paulo Roberto , Yoshida Nelson Daishiro
Published: November 2023

An important fact related to mobile payments is that adopters have already reached the majority group in more than 40 countries. Despite the growth of mobile payments, only a small portion of the related literature has focused on the topic from an organizational point of view. To fill this gap, this paper seeks to identify the main success determinants of firms operating in the segment, looking for relevant characteristics of organizations that are successful in this competitive arena. The investigation carried out a triangulation with the results of a literature review, a case study, and the answers given by a questionnaire applied to a group of specialists from private organizations and the public sector. The results suggest that companies with organic and flexible structures, open communication qualities, and decentralized decision processes increase their chances of success. Furthermore, the results also show that, given non-impeditive regulations, critical mass and the provision of different services other than the payment choice should be considered by firms operating in the mobile payment segment.

Graphical Abstract
An unusual case of excessive angulation of styloid process and ossified stylohyoid complex causing Eagle’s syndrome: a case report
Authors: Maradi Nagaraj , Beesanahalli Yogeesha Sadashivappa , Pawar Akshay , Jadhav Tanvi , Deshpande Shreya
Published: November 2023

Background

Eagle’s syndrome or stylalgia is a relatively rare condition that usually presents with throat pain and dysphagia. Most cases are asymptomatic, and diagnosis is difficult owing to the vague nature of the symptoms. There is a female preponderance. In most cases, the bony tip of the styloid process (SP) is palpable upon careful palpation of the ipsilateral tonsillar fossa. X-ray (Towne’s view) or an orthopantomogram indicates the length of the styloid process or the ossified stylohyoid complex (OSHC). Computerized tomography (CT) of the skull base, apart from measuring length, provides additional details such as medial or ventral angulation and relation to the surrounding neurovascular structures.

Case presentation

A 40-year-old female patient who presented to our hospital with left-sided throat pain and pricking sensation. After workup, she was diagnosed with left-sided stylalgia. X-ray (Towne’s view) showed that the left styloid process was 27 mm long, and the right styloid process was 24 mm long. CT of the skull base measured the length and angulation of the styloid process on both sides (sagittal and transverse angles), which were found to be 60° and 61° on the left and 64° and 60° on the right side, respectively. The patient underwent left styloidectomy under general anesthesia. Postoperatively, the symptoms were completely relieved by day 7.

Conclusion

Stylalgia is usually diagnosed on the basis of the elongated styloid process. Solely using the length of the styloid process as a parameter for diagnosis leads to misdiagnosis of cases that present with normal length of the styloid process. This article highlights the importance of CT scans in measuring the angulation of the ossified stylohyoid complex in such cases for accurate diagnosis.
Experimental investigation and optimization of cutting parameters during dry turning process of copper alloy
Authors: Tefera Aklilu Getachew , Sinha Devendra Kumar , Gupta Gaurav
Published: November 2023

Increasing the quality and productivity of machined components are the main issues of machining operations in metalworking industries. The copper alloys CuZr and CuCrZr generally find applications for current-carrying structural components, seam welder wheels, shafts, and bearings flash. The manufacturing of these components is still facing challenges in the form of machining process characteristics. One of the most common machining operations for removing material is turning that produces reasonably good surface finish quality, which is influenced by different factors (speed of cut, rate of feed, tool geometry, cutting fluid, cutting tool, etc.). This research has focused on experimental study and optimization of the cutting parameters viz. cutting speed, depth of cut, and feed, for best surface finish, material removal rate, tool tip temperature as well as surface morphology during dry turning of C15000 and C18150 copper alloy using High-Speed Steel (HSS) tool The plan and design of experiment has been performed through orthogonal Taguchi L9. array. The optimum cutting settings were discovered by using the Taguchi technique and using the performance index by applying a Grey Relational Grade (GRG). The best cutting parameters for both materials were a cutting speed 1200 rpm, feed rate 0.06 mm/rev, and depth of cut 1.25 mm. The optimum factors obtained from GRA for all responses (surface roughness, MRR, and tool temperature) at the best level of cutting parameters are the same for both materials. These cutting parameters values yielded the experimental result for each response like surface roughness, MRR, and tool tip temperature (2.5 µm,12,475 mm3/min, and 74 °C) for grade C15000 whereas (2.39 µm, 2590mm3/min and 68 °C) for grade C18150. The optimization of cutting parameters plays a vital role in the improvement of surface finish which minimizes mechanical failures caused by wear, corrosion, and thereby increasing the productivity of the products. This investigation is expected to help all researchers working in this area of applications.
Znaczenie rekonstrukcji granic reliktowych na przykładzie granicy pomiędzy monarchią austro-węgierską a Imperium Rosyjskim
Authors: Więckowski Marek
Published: November 2023

In recent times, a process of the deliberate “re-creation” of relict borders has developed, with a view to serving tourist, heritage-related and remembrance functions. These processes have been observed in many European areas. This article pays attention to the “re-creation” of borders and the way this activity supports tourism- and heritage-related objectives now seen to represent a novel function performed by the former borders. The author illustrates the processes by referring to the border once separating the Austro-Hungarian and Russian Empires as one of those associated with Poland’s erasure from the map of Europe for more than a century. Empirical research on the section of that old border drawn from the Vistula River to the present Polish-Ukrainian border shows at least 15 different places related to it, now playing the role of heritage and tourist attractions. The study of 20 information boards associated with these places is able to point to the significance and content of the information being presented, with the three leading themes being: loss of independence as a result of the Partitions; the regaining of Poland’s independence (in 1918) as well as commemoration of the heroes who contributed to it; and information about local determinants regarding border operations and controls, also in the wider context of its significance for everyday life, and consequently the possibilities of crossing the border.
Przebieg granicy kulturowej między chrześcijaństwem zachodnim (łacińskim) i wschodnim (prawosławnym) w Europie i sposoby jej wyznaczania
Authors: Awramiuk-Godun Alina
Published: November 2023

The cultural boundary between Western (Latin) and Eastern (Orthodox) Christianity is widely regarded as the main line (zone) of civilizational division in Europe. The aim of the article is to present a theoretical approach to the issue of cultural boundaries in spatial terms and to discuss a research procedure for delineating the boundary between Western and Eastern traditions based on the occurrence rate of sacred sites. The article draws attention to the problems associated with the delineation of cultural boundaries and their graphical representation on maps. It discusses the importance of a religious factor in the formation of cultural areas and presents selected views on the course of cultural boundaries in Europe, providing examples of their visualisation. Furthermore, the article discusses potential applications of cartographic methods and GIS tools in the study of cultural phenomena, using the example of the location of Roman Catholic and Orthodox temples in the border area of Poland, Lithuania and Belarus. Contemporary geo-information technologies provide a broad range of possibilities for conducting comprehensive spatial analyses that consider the distribution intensity of places associated with different traditions, e.g. sacred sites. These tools can support studies aimed at delineating the range of cultures while also facilitating the identification of the zonal nature of cultural boundaries.
Analysis of dry bulk freight markets using the Cobweb Theorem
Authors: Καραουλάνης Ιωάννης
Published: November 2023

Η ναυλαγορά των χύδην ξηρών φορτίων είναι μία ευμετάβλητη αγορά, παρουσιάζοντας πολλές διακυμάνσεις βραχυπρόθεσμα και μακροπρόθεσμα. Η ναυλαγορά των χύδην ξηρών φορτίων παρακολουθείται από την πορεία του γενικού δείκτη ξηρού φορτίου (Baltic Dry Index), αλλά και των επιμέρους δεικτών των διαφόρων ναυλαγορών ξηρού φορτίου. Στην παρούσα διατριβή εξετάζονται οι περιπτώσεις όλων των κατηγοριών των πλοίων μεταφοράς χύδην ξηρών φορτίων, και πιο συγκεκριμένα Capesize, Panamax, Supramax, Handymax και Handysize. Εξετάζεται η πορεία της κάθε κατηγορίας στην ελεύθερη αγορά (spot market) και στην αγορά χρονοναυλοσυμφώνων, βραχυπρόθεσμα και μακροπρόθεσμα, χρησιμοποιώντας το θεώρημα του ιστού της αράχνης και τις βασικές παραδοχές του: τις προσδοκίες (expectations) και την χρονική υστέρηση (time lags). Η επιλογή των βέλτιστων χρονικών υστερήσεων γίνεται με βάση το κριτήριο Hannan – Quinn criterion και κατασκευάζεται ένα αυτοπαλινδρομικό μοντέλο (autoregressive model) για την στατιστική ανάλυση. Τα αποτελέσματα αναδεικνύουν μια ισχυρή συσχέτιση μεταξύ των χρονικών υστερήσεων και των ναύλων σε όλες τις ναυλαγορές χύδην ξηρού φορτίου και μια πρόβλεψη της πορείας των επιμέρους ναυλαγορών είναι εφικτή ακολουθώντας την μεθοδολογία της παρούσας διατριβής. Η διατριβή έχει και πρακτική εφαρμογή, καθώς οι πλοιοκτήτες και οι ναυλωτές μπορούν να βελτιστοποιήσουν τις αποφάσεις που λαμβάνουν σχετικά με τις ναυλώσεις πλοίων, έχοντας κατανοήσει την συμπεριφορά της αγοράς και προβλέποντας την πορεία της.
Comparative study of Nishaamalaki and metformin in obese patients of type 2 diabetes mellitus (Madhumeha): A study protocol
Authors: Chhabra Dr. Aman , Kuchewar Vaishali , Joshi Twinkle
Published: November 2023

Background Poor synthesis of insulin by beta cells present in the pancreas combined with resistance of insulin in peripheral organs is referred to as type 2 diabetes mellitus. Insulin resistance leads to an increase in plasma fatty acids, which reduces transfer of glucose within the cells of muscles and increases breakage of lipids, resulting in an increase in hepatic glucose production. Nishamalaki (a formulation of turmeric and Indian gooseberry) is suggested in the therapy of all kinds of Madhumeha (diabetes mellitus) in Ayurveda classics. Turmeric and Indian gooseberry are the two main ingredients. Both are considered as effective medicines in the management of Madhumeha individually as well as in combined form. Aim To compare the efficacy of Nishaamalaki and metformin in obese patients of type2 diabetes mellitus. Methods The study will include 60 obese type 2 diabetes mellitus patients who were distributed into two distinct categories, each with 30 patients. Nishamalaki Churna 3gm two times a day before food with warm water for 60 days in Group N (Experimental Group) and 500 mg metformin tablets twice daily before meals for 60 days in Group M (Control Group). Every 15th day, an assessment was made (15th, 30th, 45th and 60th day). Results Objective outcomes will be assessed. Conclusion: From this study protocol, it can be depicted that the trial formulation of turmeric and Indian gooseberry (Nisha-amalaki) is as effective in obese patients suffering from type- 2 diabetes mellitus as compared to metformin tablets.
Assessment of neonatal referral infrastructure and clinical characteristics of referred neonates in three first referral hospitals in Nairobi County, Kenya
Authors: Wainaina John , Irimu Grace , English Mike , Mbaire Emily , Waiyego Mary , Manyasi Christine , Kimutai David , Emadau Caren , Muturi Celia , Aluvaala Jalemba
Published: November 2023

Background One in five newborns in Nairobi County, Kenya, may require inpatient neonatal care. We sought to examine referrals to and from three busy first-level referral public hospitals in Nairobi and what infrastructure and systems are available to support neonatal transport from these first-referral level hospitals to the main tertiary care center. Methods Patient-level data of newborns over 12 months were retrospectively extracted from routinely collected patient data and examined to characterize those referred into and out of three newborn units in the study hospitals. Structural assessments using a checklist completed during hospital visits were used to describe hospitals’ readiness to support newborn referral and transport. Results Five percent (398/7720) of the cohort studied were either referrals into study hospitals (68%, 272/398) or referrals out (32%, 126/398). Among 397 (99%) and 268 (67%) with sex and gestation documented respectively, 63% (251) were male and 44% (118) were preterm infants (<37 weeks). Among those referred in, 26% (69/272) died and 2.6% (7/272) were further referred to a tertiary-care newborn unit. Prematurity (39%) and birth asphyxia (29%) were the main in-referral reasons from 38 different health facilities, with specialist reviews (34%) predominant for out-referrals to a tertiary center. Diverse transport methods were used for referrals to study hospitals including private and public ambulances, vehicles, and guardian’s arms while onward referrals to the tertiary center were done by hospital ambulances. Drugs and medical supplies required for stabilization were well available at the study sites, however, only oxygen nasal cannula, nasal prongs, and face masks were available in ambulance of hospital 3. Conclusion There is a need to develop, equip and maintain a high-quality referral and newborn transport system that can support the continuum of newborn care across referral care pathways into and from first-referral level hospitals.
Hábitat colaborativo: Vivienda liderada por la comunidad.
Authors: Jerez Esteban de Manuel
Published: November 2023

La crisis de la vivienda provocada por la aplicación de políticas neoliberales, causantes de la crisis inmobiliario-financiera que estalló en 2008, ha puesto de actualidad formas de producción social del hábitat como las viviendas colaborativas de iniciativa social que tuvieron su origen a principios del siglo pasado en el norte de Europa y que arraigaron con fuerza en Centro Europa y en Uruguay a partir de los años sesenta. El confinamiento impuesto para frenar la pandemia ha puesto de manifiesto la importancia de contar con redes sociales de apoyo mutuo y espacios comunitarios de calidad al aire libre. Todo ello nos llevó a hacer una llamada a la publicación de investigaciones que abordaran estas cuestiones. Las respuestas recibidas ponen de relieve la importancia de aplicar metodologías de diseño participativo al hábitat colaborativo, de crear condiciones políticas, jurídicas y financieras favorables para desarrollar este modelo, y la mayor resiliencia que el hábitat producido por la comunidad tiene en situaciones de crisis global como las vividas en la pandemia.
The Voice of the Apocalypse
Authors: St John Graham
Published: November 2023

The acid house rave scene of the early nineties sought its champions and there was no spruiker more willing, vocal and weird than Terence McKenna, a figure for whom rave was a novelty signal in a forecasted apocalypse. A slate of music collaborations with McKenna in the early nineties had one feature in common. They recorded McKenna speaking in an alien tongue. Releases with The Shamen, Space Time Continuum and Zuvuya featured McKenna emulating the “elf chatter” that had poured from him in entranced states under the influence of powerful psychoactive tryptamines. Subsequently, producers of psychedelic electronica mined the “unEnglishable” sprechen of this surreal psychopomp as if it was precious aural ore. Drawing upon in-depth biographical research, I demonstrate that this strange prediscursive realm has proven appealing into the present era in which McKenna has become a medium—not of language, meaning or ideology, but of the unspeakable. Over three decades, McKenna’s voice has been adopted by audio alchemists sampling from a vast archive of spoken word material to evoke, affect and burlesque states transcending language and history. While McKenna died in 2000, he remains likely the most sampled individual in the history of electronic music. And as illustrated in this article, electronic artists have adopted his voice as a sonic template for the unknown. What I call mckennasploitation intrigues since, as is further demonstrated, it transpires in an era of growing uncertainty. The article suggests that McKenna is the voice of the apocalypse in two interrelated senses. First, the sampling evokes the “apocalypse” of the self, mind and culture that is the perennial desire of ecstatic dance movements. Second, McKenna is posthumously prolific in an era of accelerating crisis and novelty, a circumstance with uncanny echoes of his prophesied “Eschaton”. In psytrance and other psychedelic electronic styles, these strands are woven into a McKennaesque aesthetic.
Investing in improving kidney care for patients across the UK
Authors: Yianni Suzan
Published: November 2023

This article highlights the improvements and innovations in care that have been funded by Kidney Care UK
Label-Free Detection of Doxorubicin in Lake Water by an Electrochemical Aptamer Biosensor
Authors: Luo Songjia , Wang Lu , Qu Hao , Zheng Lei
Published: November 2023

The application of electrochemical sensors to the detection of real samples is hampered by the fact that the electrode surface is often prone to adsorption of other substances that cause a non-specific current response. In addition, electroactive substances in the actual sample are prone to redox reactions on the electrode surface and affect the detection of target molecules. In this paper, we constructed a novel DOX sensor with excellent selectivity using an aptamer-modified gold electrode and used it for the label-free rapid detection of DOX in lake water. DOX molecules in solution can be captured by the aptamers immobilised on the surface of the gold electrode, followed by the DOX molecules getting electrons on the surface of the electrode and undergoing a reduction reaction. Aptamers give electrochemical sensors excellent sensitivity and selectivity. Finally, the electrochemical aptamer biosensor was successfully applied to detect DOX in lake water with a detection limit of 30 nmol/L and a detection range of 30 nmol/L–10 μmol/L.
THE EFFECT OF DURATION OF INFECTION ON THE SUCCESS RATE OF DEBRIDEMENT, ANTIBIOTICS, AND IMPLANT RETENTION IN PATIENTS WITH A FRACTURE-RELATED INFECTION OF THE LOWER LEG
Authors: Sliepen J. , Buijs M.A.S. , Wouthuyzen-Bakker M. , Depypere M. , Rentenaar R.J. , De Vries J.P.P.M. , Onsea J. , Metsemakers W.J. , Govaert G.A.M. , IJpma F.F.A.
Published: November 2023

Aims

Fracture-Related Infection (FRI) is a severe complication caused by microbial infection of bone. It is imperative to gain more insight into the potentials and limitations of Debridement, Antibiotics and Implant Retention (DAIR) to improve future FRI treatment. The aims of this study were to: 1) determine how time to surgery affects the success rate of DAIR procedures of the lower leg performed within 12 weeks after the initial fracture fixation operation and 2) evaluate whether appropriate systemic antimicrobial therapy affects the success rate of a DAIR procedure.

Methods

This multinational retrospective cohort study included patients of at least 18-years of age who developed an FRI of the lower leg within 12 weeks after the initial fracture fixation operation, between January 1st 2015 to July 1st 2020. DAIR success was defined by the absence of recurrence of infection, preservation of the affected limb and retention of implants during the initial treatment. The antimicrobial regimen was considered appropriate if the pathogen(s) was susceptible to the given treatment at the correct dose as per guideline. Logistic regression modelling was used to assess factors that could contribute to the DAIR success rate.

Results

A total of 120 patients were included, of whom 70 DAIR patients and 50 non-DAIR patients. Within a median follow-up of 35.5 months, 21.4% of DAIR patients developed a recurrent FRI compared to 12.0% of non-DAIR patients. The DAIR procedure was successful in 45 patients (64.3%). According to the Willenegger and Roth classification, DAIR success was achieved in 66.7% (n=16/24) of patients with an early infection (<2 weeks), 64.4% (n=29/45) of patients with a delayed infection (2–10 weeks) and 0.0% (0/1) of patients with a late infection (>10 weeks). Univariate analysis showed that the duration of infection was not associated with DAIR success in this cohort (p=0.136; OR: 0.977; 95%CI: [0.947–1.007]). However, an appropriate antimicrobial regimen was associated with success of DAIR (p=0.029; OR: 3.231; 95%CI: [1.138–9.506]).

Conclusions

Although the results should be interpreted with caution, an increased duration of infection was not associated with a decreased success rate of a DAIR procedure in patients with FRI of the lower leg. The results of this study highlight the multifactorial contribution to the success of a DAIR procedure and emphasize the importance of adequate antimicrobial treatment. Therefore, time to surgery should not be the only key-factor when considering a DAIR procedure to treat FRI.
MANAGEMENT AND OUTCOME FOLLOWING SEVERE OSTEOMYELITIS DUE TO PIN SITE INFECTIONS
Authors: Frank Florian , Pomeroy Eoghan , Hotchen Andrew , Stubbs David , Ferguson Jamie , McNally Martin
Published: November 2023

Aim

Pin site infection (PSI) is a common complication of external fixators. PSI usually presents as a superficial infection which is treated conservatively. This study investigated those rare cases of PSI requiring surgery due to persistent osteomyelitis (OM), after pin removal.

Method

In this retrospective cohort study we identified patients who required surgery for an OM after PSI (Checketts-Otterburn Classification Grade 6) between 2011 and 2021. We investigated patient demographics, aetiology of the OM, pathogen and histology, treatment strategies and complications. Infection was confirmed using the 2018 FRI Consensus Definition. Successful outcome was defined as an infection-free interval of at least 24 months following surgery, which was defined as minimum follow-up.

Results

Twenty-seven patients were treated due to a pin site infection with an osteomyelitis (22 tibias, 2 humeri, 2 calcanei, 1 radius). 85% identified as male and the median age was 53.9 years. Eighteen infections followed external fixation of fractures, with 4 cases after Ilizarov deformity correction, 2 cases followed ankle fusion and 3 after traction pin insertion. Fifteen patients were classified as BACH Uncomplicated and 12 were BACH Complex. The median follow-up was 3.99 years (2.00–8.05 years).

Staphylococci were the most common pathogens (16 MSSA, 2 MRSA, 2 CNS). Polymicrobial infections were present in 5 cases (19%).

All surgery was performed in a single stage following the same protocol at one institution. This included deep sampling, debridement, implantation of local antibiotics, culture-specific systemic antibiotics and soft tissue closure. Seven patients required flap coverage (6 local, 1 free flap), which was performed in the same operation.

25 (93%) patients had a successful outcome after one surgery. Two had recurrence of infection which was successfully treated by repeat of the protocol. One patient suffered a fracture through the operated site after a fall. This healed without infection recurrence. Wound leakage after local antibiotic treatment was seen in 3/27 (11%) of cases. All resolved without treatment.

After a minimum of 2 years follow up, all patients were infection free at the site of the former osteomyelitis.

Conclusions

OM after PSI is uncommon but has major implications for the patient as 7 out of 27 patients needed flap coverage. This reinforces the need for careful pin placement and pin site care to prevent deep infection. These infections require appropriate surgery, not just curettage. All patients in our cohort were infection-free after a minimum follow-up of 2 years suggesting that this protocol is effective.
RETHINKING THE INOCULUM USED IN ANIMAL MODELS OF IMPLANT-ASSOCIATED OSTEOMYELITIS: THE FORMATION AND APPLICATION OF BACTERIAL AGGREGATES
Authors: Hartmann Katrine Top , Nielsen Regitze Lund , Mikkelsen Freja , Ingmer Hanne , Kvich Lasse Andersson , Aalbaek Bent , Odgaard Anders , Jensen Henrik Elvang , Lichtenberg Mads , Bjarnsholt Thomas , Jensen Louise Kruse
Published: November 2023

Aim

To make an inoculum for induction of Implant-Associated Osteomyelitis (IAO) in pigs based on bacterial aggregates resembling those found on the human skin, i.e. aggregates of 5–15 µm with low metabolic activity. The aggregates were evaluated and compared to a standard planktonic bacterial inoculum.

Method

The porcine Staphylococcus aureus strain S54F9 was cultured in Tryptone Soya Broth for seven days. Subsequently, the culture was filtered through cell strainers with pore sizes of 15 µm and 5 µm, respectively. The fraction of 5–15 µm aggregates in the top of the 5 µm filter was collected as the aggregate-inoculum. The separation of aggregates into different size fractions was evaluated by light microscopy. The metabolism of the aggregate-inoculum and a standard overnight planktonic inoculum was evaluated with isothermal microcalorimetry. In total, six female minipigs were allocated into three groups (n=2), receiving different inoculums. Group A: overnight planktonic inoculum; 104 CFU S. aureus (S54F9), Group B: seven days old 5–15 µm aggregate-inoculum; 104 CFU S. aureus (S54F9), Group C: saline. All inoculums were placed in a pre-drilled implant cavity in the right tibia of the pig and a sterile stainless-steel implant was inserted. The pigs were euthanized seven days after surgery. Postmortem macroscopic pathology, microbiology, computed tomography and histopathology were performed.

Results

The separation of aggregates into different size fractions was done successfully by the filtering method. Isothermal microcalorimetry showed, a delayed Time-to-peak metabolic activity of the aggregate-inoculum compared to the planktonic inoculum. S. aureus was isolated from subcutis, bone and implants from all animals in groups A and B. Both group A animals showed osteomyelitis at gross inspection with suppuration and sequestration, while groups B and C animals had no macroscopic lesions. From CT scans, both group A animals also showed positive signs of osteomyelitis, i.e., osteolysis, while only one animal in group B did, and none in group C. Histopathological examination of the bones showed more extensive inflammation in group A animals compared to those in group B, which showed more osteoid formation.

Conclusions

Formation and separation of low metabolism bacterial aggregates into different size fractions was possible. The aggregates can be used as inoculum in the porcine IAO model, with microbiological re-isolation from both implants and tissue. Furthermore, the aggregates caused a less aggressive IAO, than the planktonic counterparts. Using aggregated bacteria as inoculum appears to be more relevant to the clinical situation of infecting bacteria.
EMERGING ROLES OF THE LONG PENTRAXIN PTX3 IN STAPHYLOCOCCUS AUREUS-DEPENDENT OSTEOMYELITIS
Authors: Parente Raffaella , Possetti Valentina , Granata Valentina , Schiavone Maria Lucia , Strina Dario , Davi Francesca , Menale Ciro , Palagano Eleonora , Filipović Maša , Grčević Danka , Bottazzi Barbara , Mantovani Alberto , Sobacchi Cristina , Inforzato Antonio
Published: November 2023

Aim

Osteomyelitis (OM) is a debilitating infection of the bone that originates from hematogenous spreading of microbes or contamination after surgery/fracture. OM is mainly caused by the opportunistic bacterium Staphylococcus aureus (SA), which can evade the host immune response, acquire antibiotic resistance and chronically colonize the musculoskeletal tissue 1,2, yet the underlying molecular and cellular processes are largely unclear. This study aimed to characterize the pathogenetic mechanisms of SA-OM with a focus on the long pentraxin 3 (PTX3), a soluble pattern recognition molecule and bone tissue component that is emerging as a new player in osteoimmunology 3 and a diagnostic marker of periprosthetic joint infections, a common form of OM4.

Method

A murine model of OM based on intra-bone injection of SA was developed that closely mimicked surgery/trauma-related OM in humans and allowed addressing the role of PTX3 in gene-modified (Ptx3-/-) animals. Local and systemic infection and inflammation were assessed via microbiology, flow cytometry, histochemistry and microCT techniques.

Results

SA-injected mice developed chronic infection with measurable levels of viable bone-resident bacteria up until 30 days from microbial challenge. The infection was confined to the treated limbs only and accompanied by extensive tissue remodelling. The bacterial load was higher in WT than Ptx3-/- animals at 6 and 14 days from SA injection. Accordingly, WT mice had enhanced systemic inflammation with expanded innate immune compartment in the spleen and increased serum levels of inflammatory cytokines and chemokines. PTX3 levels were higher in SA- than vehicle (PBS)-injected WT animals both in the serum and bone tissue. Furthermore, administration of a PTX3-targeting antibody reduced the bacterial burden in the bones of SA-injected WT mice.

Conclusions

In a mouse model of SA-OM, genetic deficiency of PTX3 protected from infection and inflammation, pointing to this pentraxin as a crucial player in OM pathogenesis and a novel therapeutic target in bone infections.

The study was approved by the Italian Ministry of Health (approval n. 520/2019-PR issued on 19/07/2019) and supported by Fondazione Beppe and Nuccy Angiolini.