bluuebunny/crossref_metadata_2025 huggingface dataset:
P053 A Chrononutrition Questionnaire to capture sleep, temporal patterns of eating, and chronotype: Reliability and Validity
Authors: Phoi Y , Rogers M , Dorrian J , Bonham M , Coates A
Published: October 2023

Chrononutrition investigates temporal patterns of eating. Irregular patterns in shift workers and evening chronotypes adversely affect cardiometabolic health. We investigated the test-retest reliability and convergent validity of a Chrononutrition Questionnaire that aims to capture temporal patterns of eating and chronotype in shift and non-shift workers. 58 non-shift and 47 shift workers completed the study. Outcomes include: 1) chronotype, 2) sleep: wake/sleep/mid-sleep time and sleep duration, 3) temporal eating patterns: meal/snack regularity and frequency, times of first/last/largest eating occasions (EO), main meal (MM) 1/2/3, and duration of eating window (DEW) on work and work-free days (non-shift) and morning/afternoon/night/work-free days (shift workers). Test-retest reliability (intraclass correlation coefficients and weighted kappa), and convergent validity was determined against food and sleep diaries (Spearman Rank Coefficients). Reliability was acceptable for chronotype, sleep, and all temporal eating patterns except morning (last EO) and night shifts (last EO, DEW). Convergent validity was good for chronotype and sleep except for wake times and/or sleep duration on work-free days after morning and afternoon shifts. Meal/snack regularity and frequency showed good validity for non-shift but not shift workers. Times of first/last EO, MM1/2/3 and DEW generally showed good validity except for on work-free days, morning shifts, and night shifts. Time of largest EO was poorly correlated except for night shifts. The Chrononutrition Questionnaire has good test-retest reliability and acceptable convergent validity.
P063 Long-term Non-invasive Ventilation in Patients with COPD: A Retrospective Cohort Study.
Authors: Broadhead R , Mukherjee S , Aiyappan V , Chai-Coetzer C , Ullah S , Walker A
Published: October 2023

Introduction

Domiciliary long-term non-invasive ventilation (LT-NIV) is an accepted therapy for patients with severe chronic obstructive pulmonary disease (COPD) and chronic hypercapnia. This study aimed to characterise patients with COPD who were commenced on LT-NIV.

Methods

A retrospective analysis was performed of all patients prescribed LT-NIV with a primary physician-diagnosis of COPD, between June 2016 and March 2022 at an Australian tertiary hospital.

Results

333 patients were commenced on LT-NIV, of whom 67 (20%) had COPD.

Inpatient LT-NIV Initiation: 53/67 (79%) were commenced on LT-NIV during an inpatient admission with acute exacerbation of COPD. Patients were elderly (age, mean 69± SD 9.5 years), predominantly female (60%) with moderate-severe COPD (FEV1 37±18%) and mild-moderate comorbidity burden (Charlson Comorbidity Index Score 2.1±1.4).

Prior to LT-NIV, 64% patients had a sleep study with 15% having severe OSA (AHI≥30 or ODI≥30). 30% previously required acute NIV. Pre-admission non-exacerbated PaCO2 was 58±7.3mmHg

During admission, all inpatients demonstrated hypercapnia (PaCO2≥45mmHg). Peak inpatient PaCO2 was 87±20mmHg, with persistent hypercapnia on discharge 58±9.0mmHg. On discharge, IPAP and EPAP settings were 17±3.8 and 7.7cm±2.7cmH2O respectively.

There was a non-significant reduction in respiratory-related and all-cause hospitalizations in the 12-months following LT-NIV initiation (p=0.66 and 0.53 respectively).

Outpatient LT-NIV Initiation: [Further data collection in progress]

Discussion

This study illustrates the real-world prescription of LT-NIV for COPD at our centre, with the majority being initiated in the inpatient setting, rather than early outpatient reassessment. A prospective multi-centre analysis is required to better understand the nuances of LT-NIV prescription in patients with COPD.
P064 Predictive Value of Awake Supine Pulse Oxygen Saturation in Detecting Resting Hypercapnoea Prior to Polysomnography
Authors: Metti F , Cho J , Lambert S , Wheatley J
Published: October 2023

Introduction

Arterial blood gases (ABG) are used during polysomnography (PSG) to assess gas exchange abnormalities in patients at risk of hypercapnoea. ABG sampling may cause discomfort and can be difficult to obtain. Normal, awake, supine finger pulse oxygen saturation (SpO2) immediately prior to PSG may reduce the need for ABG sampling.

Aim

To determine if an awake supine evening SpO2 cutoff value can exclude awake hypercapnoea measured with ABG testing.

Methods : Prospective observational study of all patients referred for diagnostic or treatment PSGs with ABG at Westmead Sleep Laboratory between January 2019 and December 2021. ABGs were requested to exclude hypercapnoea and were collected awake, supine and breathing room air prior to PSG with simultaneous SpO2 measurement. We defined resting hypercapnoea as PaCO2 > 45mmHg. We used 2x2 tables for SpO2 values of 93% to 98% to determine the negative predictive values (NPV) for SpO2 cutoffs and construct a receiver operating characteristic (ROC) curve.

Results

We analysed 146 patients (60±17 years; 68% male; Body-mass Index 32.7±12.0 kg/m2; mean±SD) and 36 patients (25%) had hypercapnoea. The NPVs for hypercapnoea on the ABG with cut off SpO2 values of 96%, 95%, 94% and 93% were 92%, 92%, 89% and 83%, respectively. The ROC area under curve was 0.75.

Conclusion

Resting supine oxygen saturation of ≥95% was able to exclude hypercapnoea in 92% of subjects within this sleep population at high risk of hypercapnoea. Thus, an accurate, awake, supine SpO2 ≥95% will fail to diagnose hypercapnoea in ~8% of high risk patients.
P066 The Relationship between Chronic Breathlessness and Perceived Sleep Quality in Adult Australian
Authors: Toson B , Loffler K , Reynolds A , Li J , Kochovska S , Currow D , Adams R , Eckert D
Published: October 2023

Introduction

This study aimed to explore the relationship between breathlessness (severity and chronicity) and poor sleep quality.

Methods

Analysis of an Australia-wide, online cross-sectional survey carried out between 12 July - 2 August 2021. Community-dwelling adults were recruited from a web-based survey panel, with recruitment based on age, gender, and state of residence quotas to match the Australian 2016 census population data. Participants self-reported breathlessness using the modified Medical Research Council (mMRC) scale, as well as their perceived sleep quality and other demographic and health measures.

Results

Sleep quality was available for 9,877 responders (52% females, mean age 46, SD=19 years, BMI 27 SD=7 kg/m2). Sleep quality in the previous month was reported as “very good”, “fairly good”, “fairly bad” and “very bad” by 16, 49, 25%, and 10% of participants respectively. Breathlessness (mMRC 1–4), chronic breathlessness (mMRC 1–4 for longer than 3 months) and severe breathlessness (mMRC 2–4) were 42, 29 and 11% respectively. Respondents with perceived poor sleep quality were more likely to be breathless, younger, with a higher BMI, and higher likelihood of identifying as female. All measures of breathlessness were associated with increased odds of poor sleep quality [adjusted models with gender, age and BMI, OR (95% confidence interval): 2.6 (2.4 to 2.9), 3.1 (2.8 to 3.5) and 3.4 (2.9 to 3.9) for breathlessness, chronic and severe breathlessness respectively]. There were no significant interactions between any breathlessness measure and age.

Discussion

There is a strong association between breathlessness and perceived poor sleep quality.
P068 Factors affecting sleep quality in hospitalised respiratory medicine patients
Authors: Koshy K , Gibney M , O'Driscoll D , Ogeil R , Young A
Published: October 2023

Background & Aim

Hospitalised patients are at increased risk of poor sleep which can negatively impact on recovery and quality of life. This study aimed to assess sleep quality in hospitalised patients and explore the factors associated with poorer sleep.

Methods

A hospital-wide questionnaire completed at discharge as asked patients to rate their sleep quality during their admission. Results were compared between respiratory and non-respiratory inpatients. A more detailed questionnaire rating sleep quality and factors disrupting sleep was completed by respiratory ward inpatients at discharge and combined with medical record review of co-morbidities that may impact on sleep.

Results

The hospital-wide questionnaire was completed by 619 patients.28% of respiratory ward inpatients reported poor or very poor quality sleep compared to 20% of patients in a general medicine or other subspecialty ward. 83 respiratory inpatients have completed the more detailed questionnaire to date with recruitment ongoing. Sixteen patients (19.3%) reported poor or very poor sleep. These patients were compared to those who reported fair, good, or very good sleep. Age, gender distribution and BMI were similar between both groups. Noise rating was a significantly different between the groups and may predict sleep quality.

Conclusion

A high proportion of hospitalised patients reported poor sleep quality at our tertiary centre particularly on the respiratory inpatient ward where noise was a significant factor. Further research is needed to determine whether strategies to reduce noise will improved sleep quality and clinical outcomes.
P071 Simple Vestibular-Occular Motor Assessment as a Predictor of Driving Performance Vulnerability following extended Wakefulness
Authors: Dunbar C , Nguyen P , Guyett A , Nguyen K , Bickley K , Reynolds A , Hughes M , Scott H , Adams R , Lack L , Catcheside P , Cori J , Howard M , Anderson C , Lovato N , Vakulin A
Published: October 2023

Introduction

Driver fatigue is a significant contributor to road crashes, but identifying individuals at driving risk is challenging. We examined the potential of simple baseline vestibular ocular motor system (VOMS) assessment via virtual reality goggles to predict subsequent vulnerability to driving simulator impairment following extended wakefulness.

Methods

49 individuals (Mean±SD Age 32.6±12.9, 45% Males) underwent 9hr baseline sleep opportunity followed by approximately ~29hrs extended wakefulness with five 60min driving assessments. Cluster analysis classified drivers into vulnerable (n=17) or resistant (n=32) groups based on their worst steering deviation and number of crashes from driving tests. Baseline VOMS were performed ~10mins prior to the first three drives (1, 7 and 13hrs of wakefulness). XGBoost machine learning model was trained using baseline VOMs features to predict vulnerable vs resistant groups from driving tests 4 and 5 (19 and 25hrs of wakefulness) Model performance was evaluated using 5-fold cross-validation approach using ROC analysis.

Results

XGBoost machine learning ranked all 70 VOMS metrics on their importance in predicting vulnerable vs resistant groups. Top 10 VOMs metrics assessed during baseline non-sleep deprived tests demonstrated a strong ability to predict the driver's performance following extended wakefulness, differentiating between the vulnerable vs resistant groups (AUC 0.73 [95%CI 0.61-0.83, p<0.001]).

Conclusion

VOMs tests conducted at baseline holds promise for predicting future driving impairment. This approach has the potential to be highly valuable in determining an individual's fitness to drive. Future validation in independent samples, sleep disordered population and in-field on-road testing are needed to confirm these promising findings.
P082 Neural aperiodic activity as a novel biomarker of sleepiness in patients with obstructive sleep apnoea
Authors: Butler J , Yeo A , Lushington K , Chatburn A , Bay M , Sarkar P , Kang T
Published: October 2023

Background

Obstructive sleep apnoea (OSA) is characterised by repetitive collapse of the upper airway causing intermittent episodes of hypoxia and apnoeas during sleep. Excessive daytime sleepiness (EDS) is the cardinal symptom of OSA and presents in between 40.5 to 58% of patients. Currently, the diagnosis of OSA requires demonstration of an elevated apnoea hypopnea index (AHI) on a polysomnogram (PSG). Higher AHI scores denote increased OSA disease severity. The correlation between objective AHI scores and subjective sleepiness reporting tools such as the Epworth Sleepiness Scale (ESS) is less clear.

Electroencephalogram (EEG) readings form an important component of PSG testing. Traditionally, the periodic oscillatory waves captured on EEG are examined to accurately identify stages of sleep. EEG aperiodic activity is a measure of neural excitation/inhibition ratios and has emerged as a novel objective measure of sleepiness.

Methods

Intended data collection from 500 patients who have undergone ambulatory PSG testing at the Royal Adelaide Hospital between January 1st 2021 and December 31st 2022 as part of their routine care. Data collection will include patient demographics, cardiorespiratory comorbidities, medications, body mass index (BMI), Epworth Sleepiness Scale (ESS) and PSG EEG data including sleep parameters [Total sleep time (TST), stage of sleep, periodic limb movement limb index (PLMI), AHI scores].

Progress to date

Research proposal is currently under review by the CALHN HREC.

Intended outcome and impact

In this study we will assess the utility of aperiodic neural activity as a predictor of sleepiness in patients with elevated AHI and ESS scores.
P107 Optimizing Obstructive Sleep Apnea Therapy in Patients with Acute Coronary Syndrome: A Pilot Randomised Controlled Trial
Authors: Tong B , Dissanayake H , Patel S , Ucak S , McClintock S , Skilton M , Sutherland K , Yee B , Sarkissian N , Cistulli P
Published: October 2023

Continuous positive airway pressure (CPAP) therapy and oral appliance therapy (OAT) are recommended therapies for obstructive sleep apnoea (OSA). Recent clinical trials, limited by suboptimal implementation of OSA therapy, have demonstrated neutral cardiovascular benefit. It remains unclear if optimised OSA therapy will improve cardiovascular health. Thus, we have designed a pilot interventional study to inform a future RCT with the aim to evaluate the effectiveness of optimised and personalised OSA therapy in patients with acute coronary syndrome(ACS).

Patients diagnosed with ACS and OSA (ODI4≥10 events/h) were randomised to personalised OSA treatment (CPAP and/or OAT) versus usual medical care (UC). Patients receiving OSA therapy were allowed to acclimatise to therapy for 1-2 months, with the aim of optimising therapy. Patients were followed up monthly for 6 months to assess treatment effectiveness. Polysomnography and cardiovascular measures were conducted at baseline and 6 months post-therapy or usual care.

To date, 9 patients (CPAP=4, OAT=1, UC=4) have completed the study. OSA severity reduced in both treatment groups (CPAP: 53±14 vs. 17±18events/h, OAT: 22.4 vs. 14.7events/h). CPAP compliance was 6.8±0.9hours/day, 90±6%days >4h. OAT subjective compliance was 7 hours/day daily. At completion, 3 patients on CPAP therapy reported they were ‘extremely-comfortable’ using CPAP for OSA treatment. The patient on OAT reported OAT was ‘very effective in reducing OSA symptoms’ and will continue therapy.

This preliminary data suggests that it is feasible to personalise and optimise OSA therapy in patients with ACS. Whether this positively impacts on cardiovascular risk remains to be determined.
RSSC-Lineage Multiplex PCR Assay Detects and Differentiates Ralstonia solanacearum, R. pseudosolanacearum, R. syzygii, and the R3bv2 Subgroup
Authors: Paudel Sujan , Dobhal Shefali , Lowe-Power Tiffany , Schlub Robert L. , Hu John , Allen Caitilyn , Alvarez Anne M. , Arif Mohammad
Published: October 2023

Bacterial wilt strains in the Ralstonia solanacearum species complex (RSSC) pose serious threats to economically important crops worldwide. In 2014, Safni et al. proposed the reclassification of the RSSC into three genomospecies: R. solanacearum (Rsol), R. pseudosolanacearum (Rpseu), and R. syzygii (Rsyz). The revision requires the proper identification of strains for diagnostic and epidemiological studies. In response, we developed the inexpensive and user-friendly RSSC-Lineage Multiplex PCR, which effectively detects plant-pathogenic Ralstonia strains in general and also distinguishes between Rpseu, Rsol, Rsyz, and the high-security Select Agent “race 3 biovar 2” subgroup of Rsol, also known as the phylotype IIB-1 potato brown rot pandemic lineage. Genomes were retrieved from the NCBI GenBank database and screened for unique gene regions using OrthoMCL and other comparative genomic approaches. Specific primers were designed for each genomospecies, Ralstonia in general, and “race 3 biovar 2.” AT-rich flaps were added at the 5ʹ position of each primer to optimize the reaction thermodynamics. The specificity was tested in silico using the NCBI GenBank genome database and an in-house database. The in vitro specificity and accuracy of the tool was validated with 113 representative Ralstonia strains and 24 strains from other genera. The assay is highly specific, generating neither false positives nor false negatives. Primer set detection limits ranged from 10 to 100 pg. The assay also detected and differentiated strains from naturally and artificially inoculated plant hosts. This tool is highly specific, reliable, and economical for culture characterization, diagnostics, surveys, quarantine decisions, and epidemiological studies.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Environmental Influences on the Evaporation Rate of Horticultural Disinfestants
Authors: Copes Warren E. , Smith Barbara J.
Published: October 2023

The evaporation rate of disinfestants when sprayed on production surfaces is expected to vary under different weather conditions, but it is unknown how that affects efficacy. This study was an initial investigation into how the evaporation rates of water and six commercial disinfestants vary under eight weather condition categories. Additionally, an empirical model was developed on the evaporation rate of water in response to air temperature, relative humidity, solar radiation, vapor pressure deficit, and wind speed under the same eight weather condition categories. Isopropyl alcohol lost more weight due to evaporation over 4 h ( P < 0.0001) than all other disinfestant solutions, and no differences ( P = 0.05) existed between the other five disinfestant solutions and water. Isopropyl alcohol had a mean percentage weight loss of 71% under hot and sunny conditions, 43% under cool and cloudy conditions, and 6% under indoor laboratory conditions. Water, hypochlorite, quaternary ammonium, and peroxy disinfestant solutions evaporated at a similar rate over 4 h, with an approximate mean percentage weight loss of 17% under hot and sunny conditions, 6% under cool and cloudy conditions, and 1% under indoor laboratory conditions. The regression model that best explained the influence of weather on evaporation included the variables solar radiation, temperature, and wind speed ( P < 0.0001, R2 = 0.5603). This information will be used further to model the evaporative rate of disinfestants under the same range of weather conditions when applied to multiple types of substrate materials that represent common horticultural plant production surfaces.

[Formula: see text] The author(s) have dedicated the work to the public domain under the Creative Commons CC0 “No Rights Reserved” license by waiving all of his or her rights to the work worldwide under copyright law, including all related and neighboring rights, to the extent allowed by law, 2024.
Fear of Movement in People with CRPS
Authors: Farzad Maryam , MacDermid Joy , Packham Tara
Published: October 2023

Background:

People with complex regional pain syndrome (CRPS) commonly report a fear of movement that can worsen symptoms and increase disability. The Tampa Scale of Kinesiophobia (TSK) is used to evaluate fear of movement and (re)injury, but findings have been inconsistent in different populations.

Objective:

To evaluate the psychometric properties of the Persian version of TSK-11 in individuals with upper limb CRPS. Specifically, to determine if the factor structure aligns with the original two-factor model, consisting of “activity avoidance” and “somatic focus.”

Methods:

People with CRPS (n=142, mean age=42, 54% female) completed the TSK. The psychometric testing included internal consistency and test-retest reliability (intra-class correlation coefficient), and convergent construct validity. Confirmatory and Exploratory factor analyses (CFA, EFA) were performed to evaluate the structural validity.

Results:

The TSK-11 showed acceptable internal consistency (Cronbach alpha 0.93) and excellent test-retest reliability (ICC=0.93, 95% CI: 0.92 to 0.94). The Standard Error of Measurement and Minimal Detectable Change were 4.3 and 11.7, respectively. The results also demonstrated excellent criterion validity (r=0.81). CFA demonstrated that the original two-factor model did not fit. EFA derived a two-factor solution with different items. The factor structure accounted for 64.91% of the variance, and the internal consistency of the factors was acceptable (>0.90). Expert consensus suggested naming these two factors as Fear-avoidance, Magnification & Helplessness.

Discussion:

The TSK-11 demonstrates excellent retest reliability in people with CRPS. The original two-factor structure was not confirmed, and a new 2-factor structure of the TSK-11 proposed consisting of subscales for Fear Avoidance beliefs and Magnification/Helplessness. Given the overlap between these constructs and the construct of pain catastrophizing, further study is needed to clarify both measures’ content validity and relative uniqueness.
Socioeconomic, Racial, and Insurance Disparities in Clinical Outcomes After Surgery Among Patients With Idiopathic Scoliosis
Authors: Thornley Patrick , Garner Sarah , Rogers Kenneth J. , Yorgova Petya , Gabos Peter G. , Shah Suken A.
Published: October 2023

Background:

Socioeconomic status (SES), race, and insurance type correlate with initial curve severity for patients with idiopathic scoliosis, but less is known regarding how these variables impact surgical outcomes. The objectives of this study were to determine the influence of SES, race, and insurance on preoperative appointment attendance, likelihood of obtaining a preoperative second opinion, brace prescription, missed 6 or 12-month postsurgical appointments, incidence of emergency department visits 0 to 90 days after surgery, and major complications within a year of surgery.

Methods:

A review of 421 patients diagnosed with idiopathic scoliosis who underwent surgery at a single high-volume pediatric spinal deformity institution between May 2015 and October 2021 was conducted. Area Deprivation Index, a quantitative measure of SES, was collected. Scores were stratified by quartile; higher scores indicated a lower SES. χ2 tests for correlation were performed to determine whether clinical outcomes were dependent upon Area Deprivation Index, race, or insurance type; P ≤0.05 was significant.

Results:

The sample was 313 Caucasian (74%), 69 (16%) black, and 39 (9.3%) other patients. More patients had private versus public insurance (80% vs 20%) and were of higher SES. The likelihood of missing preoperative appointments was higher for black patients (P = 0.037). Those with lower SES missed more postoperative appointments and received less bracing and second opinions (P = 0.038, P = 0.017, P = 0.008, respectively). Being black and publicly insured correlated with fewer brace prescriptions (P < 0.001, P = 0.050) and decreased rates of obtaining second opinions (P = 0.004, P = 0.001).

Conclusion:

Patients with idiopathic scoliosis surgery who were Caucasian, privately insured, and of higher SES were more likely to seek preoperative second opinions, be prescribed a brace, and attend postoperative appointments. Recognition of the inherent health care disparities prevalent within each pediatric spine surgery referral region is imperative to better inform local and national institutional level programs to educate and assist patients and families most at risk for disparate access to scoliosis care.

Level of Evidence:

Level III; retrospective case-control study.
A Web-based Prediction Model for Early Death in Patients With Metastatic Triple-negative Breast Cancer
Authors: Pan Wen-kai , Ren Si-yan , Zhu Liao-xiang , Lin Bao-chai
Published: October 2023

Background:

Triple-negative breast cancer (TNBC) is a subtype of breast cancer characterized by the absence of expression of estrogen receptor, progesterone receptor, or human epidermal growth factor receptor 2. This subtype of breast cancer is known for its high aggressiveness, high metastatic potential, tendency for recurrence, and poor prognosis. Patients with metastatic TNBC (mTNBC) have a poorer prognosis and a higher likelihood of early death (survival time ≤3 months). Therefore, the development of effective individualized survival prediction tools, such as prediction nomograms and web-based survival calculators, is of great importance for predicting the probability of early death in patients with metastatic TNBC.

Methods:

Patients diagnosed with mTNBC in the Surveillance, Epidemiology, and End Results database between 2010 and 2015 were included in the model construction. Univariate and multivariate logistic regression analysis was performed to identify risk factors associated with early death in patients with mTNBC and predictive prognostic nomograms were constructed. The accuracy of the nomograms was verified using receiver operating characteristic curves, and GiViTi Calibration belt plots were used to evaluate the model consistency. The clinical applicability of the nomograms was evaluated using decision curve analysis. On the basis of the predictive prognostic nomograms, a network survival rate calculator was developed for individualized survival prediction in patients with mTNBC.

Results:

A total of 2230 patients diagnosed with mTNBC were included in the Surveillance, Epidemiology, and End Results database for this study. After strict exclusion criteria, 1428 patients were found to be eligible for the study. All the patients were randomly divided into a training cohort and a validation cohort in a ratio of 7:3. Independent risk factors for mTNBC, including age, tumor size, brain metastasis, liver metastasis, surgery, and chemotherapy, were identified and integrated to construct the prediction nomogram and survival calculator. Results of receiver operating characteristic curves, calibration curves, and decision curve analysis curves from the training and validation cohort confirmed that the developed nomogram and web-based survival calculator in this study could accurately predict the probability of early death in patients with mTNBC.

Conclusions:

In this study, we developed a reliable prediction nomogram and web-based survival calculator for predicting the probability of early death in patients with mTNBC. These tools can assist clinical physicians in identifying high-risk patients and developing personalized treatment plans as early as possible.
Secondary Syphilis With Pulmonary Involvement
Authors: Öz Miraç , Absieha Nasser E. , Dilegelen Umut , Zengin Burak Alper , Gündüz Kaan , Evren Ebru , Saryal Sevgi
Published: October 2023

Syphilis is a multisystem infection caused by the spirochete Treponema pallidum. A 63-year-old man admitted to the hospital with chest pain and rashes on the chest wall and hands for 14 days. Thorax computed tomography revealed multiple nodular shadows in the bilateral lower lobes of the lung. Skin lesions were considered compatible with secondary syphilis.

The antibody test for syphilis was positive. Screening for other associated sexually transmitted diseases (serology for HIV, hepatitis C, and hepatitis B) was negative. A specific therapy with crystallized penicillin G 2.4 MIU was applied. The key features for secondary syphilis diagnosis were positive serologic tests for syphilis and complete recovery on thorax computed tomography after antisyphilitic treatment. Pulmonary involvement in secondary syphilis is considered a rare occurrence.
Misuse of Antibiotics in Dengue Fever—A Contributor to Antimicrobial Resistance?
Authors: Alosious Aaja , Luvis Mariya , Shaji Roshitha Ann , Tom Antriya Annie
Published: October 2023

Background

Dengue, a vector-borne viral infection, is a concern in the tropical and subtropical regions across the world. The rampant use of antibiotics in dengue patients in India reinforces the anticipated threat of emergence of antimicrobial resistance.

Aim

We aimed to retrospectively investigate the prescribing pattern of antibiotics and compare the clinical status of dengue patients treated with and without antibiotics.

Methods

Between January 2016 and December 2020 period, data of patients who tested positive for at least 1 of the 3 screening tests (nonstructural protein 1, immunoglobulin M, or immunoglobulin G) were collected from patient medical chart, and we assessed the clinical outcome of dengue patients treated with and without antibiotics.

Results

Of 370 patients, 196 (52.97%) were managed with antibiotics and 174 (47.02%) were managed without antibiotics along with other supportive measures. A peak in the percentage of prescriptions with antibiotics was seen in 2019, 168 (85.71%) were prescribed with a single antibiotic with a majority of them, and 56.6% received third generation cephalosporins. Only 46 (23.46%) had bacterial co-infection while 150 (76.53%) had no co-infection. Thirty-five patients (70%) with dengue hemorrhagic fever were clinically managed with antibiotics compared with 50% patients in the “dengue fever” category. Only 8% of patients with mild dengue were given 2 antibiotics, whereas 13% with moderate dengue and 16% with severe dengue were prescribed with 2 antibiotics.

Conclusions

The increased number of prescriptions with antibiotics for a viral infection when not recommended by the guideline may lead to emergence of antibiotic resistance in hospitals as well as community.
Burnout and Disengagement at Work Among Health Professionals—Interrelations and Associations With Stress Indicators and Job Resources
Authors: Hämmig Oliver
Published: October 2023

Objective

The aim of the study is to explore common risk and protective factors of burnout and disengagement at work among healthcare workers.

Methods

Cross-sectional survey data of 1232 health professionals and employees of five public hospitals and rehabilitation clinics collected in 2015/16 in German-speaking Switzerland were used and analyzed. Different stress measures and job resources were studied as predictors of burnout and work engagement.

Results

Burnout was found to be largely explained by work stress (β = 0.22) and particularly by general stress (β = 0.54) whereas work engagement was only marginally determined by these stress indicators. Job autonomy or supervisor support on the other hand had no protective effect on burnout at all but a fairly strong predictive effect on work engagement (β = 0.27/0.23).

Conclusion

Burnout turned out to be mainly stress-induced whereas work engagement emerged largely as a result of job autonomy and supervisor support.
Orthosis vs. exercise for the treatment of adult idiopathic trigger fingers: A randomized clinical trial
Authors: Nadar Mohammed Sh.
Published: October 2023

Objective:

Trigger finger is a common clinical disorder that often results in pain and functional limitations. This study aimed to determine whether joint-blocking orthosis was effective in treating adult idiopathic trigger fingers.

Methods:

Fifty-five participants were randomly assigned to either a hand therapy group or an orthosis group that immobilized the proximal interphalangeal joint for 6 weeks. The Green classification of triggering; short-form version of the Disabilities of the Arm, Shoulder, and Hand; and numeric pain rating scale were used to assess participants’ data.

Results:

The orthosis was “successful” in completely resolving the symptoms of trigger finger in 53.6% of the participants at 6 weeks postintervention, whereas the hand therapy control group did not result in any “successful” outcomes. The Green classification score for the orthosis group decreased from 2.68 (standard deviation = 0.47) at baseline to 0.93 (standard deviation = 1.12) at 6 weeks. The short-form version of the Disabilities of the Arm, Shoulder, and Hand disability score was significantly reduced after wearing the orthosis, F (2, 52) = 74.16 p < 0.001, and improved from baseline (M = 37.6) to 6 weeks (M = 20.26). The pain intensity score was also significantly decreased after wearing the orthosis, F (2, 52) = 52.17 p < 0.001, partial η2 = 0.67.

Conclusion:

Using orthosis to immobilize the proximal interphalangeal joint, day and night, for 6 weeks, is an effective and reasonable option for treating idiopathic trigger fingers with Green grade 2 or 3. Hand therapy without orthosis did not result in significant improvements.
A phenomenological analysis of medical tourism: Investigating the lived experience of returning to Canada after osseointegration abroad
Authors: Bedore Christopher D. , Woodend A. Kirsten
Published: October 2023

Background:

Travel out of country for medical care is increasing for many reasons including costs, wait-lists, and availability of procedures. Until 2018, when the surgery was offered in only 1 province, Canadians with amputation wanting osseointegration (OI) had to travel out of country for the surgery. The purpose of this study was to understand the lived experience of accessing health care in Canada after having a procedure performed out of country.

Methods:

This is a phenomenological study of persons with amputation who had OI outside of Canada. The grand tour interview question was “What was it like travelling to another country for OI surgery and then returning to access follow-up care in Canada?”

Results:

There were 5 participants, and 5 themes emerged: (1) lack of support from Canadian physicians; (2) exceptional support from prosthetists and other members of the health care team; (3) continued reliance on the country where the procedure was initially performed; (4) self-advocacy for access to care; and (5) benefits of travelling outweighing the problems faced.

Conclusions:

These themes are not unique to OI, but to medical tourism as a whole. The lack of support was countered partly by a strong sense of self-advocacy from the participants and support from other members of the health care team.
Ischemia-Induced Metabolic Patterns Associate With Kidney Function During Normothermic Kidney Perfusion, a Preclinical Study
Authors: De Beule Julie , De Craemer Sam , Verstraeten Laurence , Ghesquière Bart , Jochmans Ina
Published: October 2023

Objective:

To investigate if ischemia alters donor kidney metabolism and whether these changes associate with organ function.

Summary Background Data:

An unmet need in kidney transplantation is the ability to predict post-transplant organ function before transplantation. Key to such viability testing is a profound understanding of the organ’s complex biochemistry and how ischemia, inevitable during the transplantation process, influences this.

Methods:

First, metabolic changes in glucose, lactate and 20 amino acids induced by no, 1h of warm, or 22h of cold ischemia were investigated during 4h perfusion of pig kidneys with autologous whole blood (n=6/group), simulating the ischemia-reperfusion phase of transplantation. Next, we confirmed similar metabolic changes during normothermic preservation of pig (n=3/group; n=4 for cold ischemia) and discarded human kidneys (n=6) perfused with a red-blood cell based perfusate.

Results:

At 2h of perfusion with autologous whole blood, abundances of 17/20 amino acids were significantly different between groups, reflecting the type of ischemia. Amino acid changes at 15 min and 2h of perfusion correlated with future kidney function during perfusion. Similar metabolic patterns were observed during perfusion preservation of pig and discarded human donor kidneys, suggesting an opportunity to assess kidney viability before transplantation.

Conclusions:

Perfusate metabolite changes during normothermic kidney perfusion represent a unique non-invasive opportunity to assess graft viability. These findings now need validation in transplant studies.
Effect of Surgery on Postoperative Levels of the Gut Homeostasis-Regulating Enzyme Intestinal Alkaline Phosphatase
Authors: Duan Ruifeng , von Ehrlich-Treuenstätt Viktor H , Kakoschke Sara C , Schardey Josefine , Wirth Ulrich , Albertsmeier Markus , Renz Bernhard W , Andrassy Joachim , Bazhin Alexandr V , Hodin Richard A , Werner Jens , Ilmer Matthias , Kühn Florian
Published: October 2023

BACKGROUND:

Intestinal homeostasis is a crucial factor for complication-free short- and long-term postoperative recovery. The brush border enzyme intestinal alkaline phosphatase (IAP) is an important regulator of gut barrier function and intestinal homeostasis and prevents endotoxemia by detoxifying lipopolysaccharides (LPSs). As IAP is predominantly secreted by enterocytes in the duodenum, we hypothesized that pancreaticoduodenectomy (PD) leads to a significantly stronger decrease in IAP than other major abdominal surgery.

STUDY DESIGN:

Pre- and postoperative blood, stool, and intestinal samples were collected from patients undergoing PD, as well as other major surgical procedures without duodenectomy. The samples were analyzed using enzyme histochemistry, the para-nitrophenyl phosphate method for IAP, and the limulus amebocyte lysate assay for LPS.

RESULTS:

Overall, 88 patients were prospectively enrolled in the study. Fecal IAP activity negatively correlated with serum LPS (r = −0.3603, p = 0.0006). PD led to a significant decline in IAP compared to preoperative baseline levels (p < 0.0001). The decline in IAP correlated with the length of proximal small intestinal resection (r = 0.4271, p = 0.0034). Compared to controls, PD was associated with a much more pronounced reduction in IAP—also after adjusting for surgical trauma (operative time, blood loss; r = 0.4598, p = 0.0086). Simultaneously, PD triggered a clearly more prominent increase in serum LPS compared to controls (p = 0.0001). Increased postoperative LPS was associated with an elongated hospitalization (r = 0.7534, p = 0.0062) and more prominent in pancreatic cancer (p = 0.0009).

CONCLUSIONS:

Based upon the functional roles for IAP, supplementation with exogenous IAP might be a new treatment option to improve short- and long-term outcome after PD.
Effect of Oral Chondroitin Sulfate Supplementation on Acute Brain Injury in a Murine Necrotizing Enterocolitis Model
Authors: Manohar Krishna , Mesfin Fikir M , Liu Jianyun , Shelley W Christopher , Brokaw John P , Markel Troy A
Published: October 2023

BACKGROUND:

Necrotizing enterocolitis (NEC) is a devastating condition where inflammatory changes and necrosis in the gut results in activation of brain microglia and subsequent neurodevelopmental impairment. Chondroitin sulfate (CS) is a glycosaminoglycan in human breast milk that is absent in conventional formulas. We hypothesized that oral formula supplementation with CS during a murine model of experimental NEC would not only attenuate intestinal injury, but also brain injury.

STUDY DESIGN:

NEC was induced in mouse pups on postnatal days (PNDs) 5 to 8. Three conditions were studied: (1) breastfed controls, (2) NEC, and (3) NEC+enteral CS (formula+200 mg/kg/d of CS). Pups were euthanized on PND 9 or reunited with dams by the evening of PND 8. Intestinal segments were H&E stained, and immunohistochemistry was performed on brain tissue for Iba-1 to assess for microglial morphology and cortical changes. Neurodevelopmental assays were performed on mice reunited with foster dams on PND 9. Single-cell RNA-sequencing analysis was performed on human intestinal epithelial cells exposed to (1) nothing, (2) hydrogen peroxide (H2O2) alone, or (3) H2O2 + CS to look at the differential gene expression between groups. Groups were compared with ANOVA or Kruskal–Wallis tests as appropriate with p < 0.05 considered significant.

RESULTS:

Compared with NEC, mice treated with oral CS showed improved clinical outcomes, decreased intestinal injury, and attenuated microglial activation and deleterious cortical change. Mice with CS performed better on early neurodevelopmental assays when compared with NEC alone. Single-cell analysis of HIEC-6 cells demonstrated that CS treatment down regulated several inflammatory pathways including nuclear factor κB—suggesting an explanation for the improved Th17 intestinal cytokine profile.

CONCLUSIONS:

Oral CS supplementation improved both physiological, clinical, and developmental outcomes. These data suggest that CS is a safe compound for formula supplementation for the prevention of NEC.
Aging and intraocular pressure homeostasis in mice
Authors: Li Guorong , van Batenburg-Sherwood Joseph , Safa Babak N. , Fraticelli Guzmán Nina Sara , Wilson Andrea , Bahrani Fard Mohammad Reza , Choy Kevin , De Ieso Michael L. , Cui J. Serena , Feola Andrew J , Weisz Tara , Kuhn Megan , Rickman Cathy Bowes , Farsiu Sina , Ethier C. Ross , Stamer W. Daniel
Published: October 2023

Age and elevated intraocular pressure (IOP) are the two primary risk factors for glaucoma, an optic neuropathy that is the leading cause of irreversible blindness. In most people, IOP is tightly regulated over a lifetime by the conventional outflow tissues. However, the mechanistic contributions of age to conventional outflow dysregulation, elevated IOP and glaucoma are unknown. To address this gap in knowledge, we studied how age affects the morphology, biomechanical properties and function of conventional outflow tissues in C57BL/6 mice, which have an outflow system similar to humans. As reported in humans, we observed that IOP in mice was maintained within a tight range over their lifespan. Remarkably, despite a constellation of age-related changes to the conventional outflow tissues that would be expected to hinder aqueous drainage and impair homeostatic function (decreased cellularity, increased pigment accumulation, increased cellular senescence and increased stiffness), outflow facility, a measure of conventional outflow tissue fluid conductivity, was stable with age. We conclude that the murine conventional outflow system has significant functional reserve in healthy eyes. However, these age-related changes, when combined with other underlying factors, such as genetic susceptibility, are expected to increase risk for ocular hypertension and glaucoma.
A fast and reliable larval sampling method for improving the monitoring of fruit flies in soft and stone fruits
Authors: Zriki Ghais , Belois Rémy , Fournier Christine , Tergoat-Bertrand Léa , Poupart Pierre-Yves , Bardel Amélie , Gard Benjamin , Rode Nicolas O.
Published: October 2023

The spotted-wing drosophila,Drosophila suzukii(Matsumura) (Diptera: Drosophilidae), threatens both the soft-skinned and stone fruit industry in Asia, Europe and America. Integrated pest management requires monitoring for infestation rates in real-time. Although baited traps are widely used for field monitoring, trap captures are weakly correlated to infestation rates. Thus, monitoring for larvae instead of adult flies represents the most reliable monitoring technique. Current methods for larval monitoring (e.g. dunk flotation) are both time-consuming and labor-intensive. In this study, we develop the sleeve method, a new method for monitoring larval infestation in strawberries through the inspection of fruits individually crushed within transparent plastic sleeves. Based on count data from both specialist and non-specialist observers, the estimation of larval infestation with the sleeve method is fast, precise and highly repeatable within and among all observers. Mean processing time is twice faster than previous methods and varies from 33 to 80 seconds per sample, depending on infestation levels. As the accuracy of the sleeve method decreases with infestation levels, we suggest ways to improve its accuracy by incubating fruits for 48h and calibrating data with exact counts. This new method is easier to use, faster and more cost-effective than previous monitoring methods. It could be used to monitorD. suzukiiinfestations in various fruit crops and is scalable to the farm-level for fruit growers or for academic research. Finally, the method represents a promising monitoring tool for effective management programs ofD. suzukiiand other insect pests of soft and stone fruits.
Yes1-mediated Cul9 phosphorylation promotes the metabolic reprogramming in gastric cancer
Authors: Wu Youliang , Zhang Heng , Zhang Shangxin , Wang Mingliang , Wang Huizhen , Huang He , Hong Xuehui , Zhang Zhiyong , Li Yongxiang
Published: October 2023

Although Cul9 has been implicated in human carcinogenesis, its upstream regulators and roles remain unknown. Herein, we indicate that the Cul9 promoter is hypermethylated in GCs. Bioinformatics, mass spectrometry, and unbiased-kinase screen identify the tyrosine kinase Yes1 as a key regulator of Cul9. Yes1 phosphorylates Cul9 at Y1505, promoting its selective autophagy. Patient-associated mutation of Yes1 or helicobacter pylori infection induces Cul9-Y1505 phosphorylation which switches Cul9 from a tumor-suppressor to an oncogene, as evidenced by the fact that Cul9-Y1505D knockin mice are more susceptible to gastric tumorigenesis than wild-type counterparts. Metabolic profiling and ATAC sequencing reveal that Cul9-Y1505D mutant promotes pyrimidine and purine synthesis pathways in GC. DNA-demethylating drug decitabine or HG78 compound upregulates Cul9 expression and limits GC cell proliferation in a Yes1-dependent manner. The Yes1 inhibitor CH6953755 or Leflunomide and Mycophenolate mofetil (MMF) also impair the malignancy of GC with Cul9 dysregulation. Cul9 in turn binds Yes1 and disrupts Yes1 stability, establishing a feedback circuit. Collectively, our project reveals an unrecognized role of the Yes1-Cul9 loop in GC, suggesting potential therapeutic targets.
Towards Parsimonious Generative Modeling of RNA Families
Authors: Calvanese Francesco , Lambert Camille N. , Nghe Philippe , Zamponi Francesco , Weigt Martin
Published: October 2023

Generative probabilistic models emerge as a new paradigm in data-driven, evolution-informed design of biomolecular sequences. This paper introduces a novel approach, called Edge Activation Direct Coupling Analysis (eaDCA), tailored to the characteristics of RNA sequences, with a strong emphasis on simplicity, efficiency, and interpretability. eaDCA explicitly constructs sparse coevolutionary models for RNA families, achieving performance levels comparable to more complex methods while utilizing a significantly lower number of parameters. Our approach demonstrates efficiency in generating artificial RNA sequences that closely resemble their natural counterparts in both statistical analyses and SHAPE-MaP experiments, and in predicting the effect of mutations. Notably, eaDCA provides a unique feature: estimating the number of potential functional sequences within a given RNA family. For example, in the case of cyclic di-AMP riboswitches (RF00379), our analysis suggests the existence of approximately 1039functional nucleotide sequences. While huge compared to the known < 4, 000 natural sequences, this number represents only a tiny fraction of the vast pool of nearly 1082possible nucleotide sequences of the same length (136 nucleotides). These results underscore the promise of sparse and interpretable generative models, such as eaDCA, in enhancing our understanding of the expansive RNA sequence space.