bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence and associated factors of self‐reported halitosis among institutionalized adolescents: Cross‐sectional study
Authors: Muniz Francisco Wilker Mustafa Gomes , Moreno Laura Barreto , da Silviera Taciane Menezes , Rösing Cassiano Kuchenbecker , Colussi Paulo Roberto Grafitti
Published: September 2022

Objective

To assess the prevalence and associated factors of self‐reported halitosis in institutionalized adolescents in a city in southern Brazil.

Methods

This cross‐sectional study involved male institutionalized adolescents, aged 15–19 years old, at the Socio‐Educational Assistance Center in the city of Passo Fundo, Brazil. Data collection was performed by a research team composed of two interviewers, two clinical examiners of oral health and two examiners of salivary flow. A structured questionnaire was applied, which included demographical, socioeconomical, general health behaviour, presence of health problems and oral health self‐perception variables. Decayed, Missing, Filled Index was used for the clinical examination. The salivary flow collection was performed using the mechanically stimulated total saliva method, in which only the liquid component was measured.

Results

The prevalence of self‐reported halitosis in this sample was 51.5% (n = 35). In the final multivariate analysis, halitosis was significantly associated with the non‐white racial group (prevalence ratio [RP]:1.703; 95% confidence interval [95%CI]:1.101–2.634), use of crack (RP:1.857; 95%CI:1.270–2.714) and number of decayed teeth (PR: 1.123; 95%CI:1.008–1.252). The use of alcohol and access to dental care in the last 12 months were not significantly associated with self‐reported halitosis.

Conclusion

It was concluded that non‐white and crack‐user youngsters had a high occurrence of self‐reported halitosis. Higher rates of dental caries are also associated with halitosis.
Changes of pattern of myofibrils and collagen of smooth muscle from large intestine of porcine using alkali tenderisation process combined with enzymes
Authors: Cheng Chengpeng , He Zhifei , Su Chang , Wu Han , Li Hongjun
Published: September 2022

The aim of this study was to investigate the changes in myofibrillar and collagen patterns of Porcine large intestine smooth muscle (PSM) and their effect on smooth muscle tenderness using an alkali tenderisation process combined with enzymes. The shear force of the PSM in the enzyme‐alkali combined treatment group decreased (P < 0.05) from 22.72 N to 4.21 N. The combined treatment of papain and alkali caused the increased (P < 0.05) in MFI value and collagen solubility and the decreased (P < 0.05) in collagen content. The stained sections and scanning electron microscope (SEM) results showed that the enzyme‐alkali combined treatment group had a greater effect on PSM than papain and alkali treatment alone, with a greater degree of damage to the internal structural integrity of myogenic fibres. The results reveal that regulated the collagen and myofibril structure could change the tenderness of PSM.
Outcomes of artificial urinary sphincter implantation in patients with diabetes mellitus: A subgroup analysis
Authors: Kaiho Yasuhiro , Masuda Hitoshi , Takei Mineo , Hirayama Takahiro , Kitta Takeya , Yokoyama Minato , Kawamorita Naoki , Mitsui Takahiko , Nakagawa Haruo , Iwamura Masatsugu , Arai Yoichi
Published: September 2022

Objectives

To estimate the surgical and quality‐of‐life outcomes of artificial urinary sphincter implantation in patients with diabetes mellitus (DM). Subanalyses were performed using the same population as that in our previous multicenter, prospective, observational study.

Methods

A total of 135 male patients who underwent primary artificial urinary sphincter implantation were divided into two groups: those with and without DM. The revision‐free rates, that is, the percentage of patients who did not require revision surgery, were compared between patients with and without DM. The number of urinary pads required per day, International Consultation on Incontinence Questionnaire‐Short Form, and King's Health Questionnaire were used to compare the continence status and quality of life (QOL) between the two groups preoperatively and at 1, 3, and 12 months after surgery.

Results

Revision‐free rates were significantly lower in the DM group (83.9%, 77.4%, and 67.8% at 1, 2, and 3 years after implantation, respectively) than in the non‐DM group (95.5%, 92.5%, and 85.5% at 1, 2, and 3 years after implantation, respectively). Both continence status and QOL, assessed by questionnaires, markedly improved after surgery in patients with and without DM.

Conclusions

Despite differences in the durability of the artificial urinary sphincters, patients with DM can obtain as much benefit from artificial urinary sphincter implantation regarding continence and quality‐of‐life improvement as patients without DM. Therefore, DM was not considered a comorbidity that contraindicated artificial urinary sphincter implantation. Additional large‐scale studies are required to verify our findings.
Analysis of the factors and moderating role of self‐care ability among patients with breast cancer‐related lymphedema
Authors: Jiang Wenting , Chen Lijun
Published: September 2022

Aims and objectives

To analyse the status quo and influencing factors of self‐care ability in breast cancer‐related lymphedema (BCRL) patients and explore the moderating role of social support between self‐efficacy and self‐care ability, to provide references for clinical intervention.

Background

The ‘gold standard’ for the treatment of lymphedema is two‐stage Complete Decongestion Therapy (CDT). Due to the high frequency of patients seeking treatment and CDT is not covered by medical insurance, resulting the medical cost is high, and a set integrated course of edema treatment cannot be completed. Nevertheless, with sufficient self‐care ability, patients can reduce the frequency of outpatient and inpatient treatments, and initiate detumescence procedures with affordable home care. Accordingly, it is necessary to pay attention to the self‐care ability of BCRL patients.

Design

A descriptive and cross‐sectional study following the STROBE guideline checklist.

Methods

From June 2021 to January 2022, 156 BCRL patients were selected as convenience samples. Questionnaires were administered to the patients using the sociodemographic information questionnaire, the exercise of self‐care agency scale, Chinese version of strategies used by people to promote health, and social support rating scale. Spearman rank correlation was used to analyse the relationship among the three, and univariate and multiple linear regression were used for factor analysis and process to explore the moderating role of social support.

Results

The total score of self‐care ability of BCRL patients was 41.00 (32.50, 51.00). The self‐efficacy and social support of BCRL patients were positively correlated with the total score and its dimensions of self‐care ability. Disease duration, severity and difficulty raising limbs were negative correlation factors influencing the self‐care ability of BCRL patients, and self‐efficacy and social support were positive correlation factors, which could explain 77.8% of the total variation. The moderating role of social support between self‐efficacy and self‐care ability was significant, and its moderating role boundary value was 15.70.

Conclusions

The self‐care ability of BCRL patients is at a low level. The longer duration of lymphedema, the more serious degree of edema, the more difficulty raising limbs, the lower self‐efficacy and the less social support, the poorer self‐care ability of BCRL patients. Self‐efficacy has a greater impact on the self‐care ability of patients with high levels of social support.

Relevance to clinical practice

Factors and moderator‐based models are the first to identify predictors of self‐care ability and the moderating role of social support in Chinese BCRL patients, which may facilitate healthcare practitioners to develop appropriate interventions to manage self‐care ability.
Rectocele: Incidental or important? Observe or operate? Contemporary diagnosis and management in the multidisciplinary era
Authors: Bharucha Adil E. , Knowles Charles H.
Published: September 2022

Background

More common in older women than younger women, rectoceles may be secondary to pelvic floor weakness and/or pelvic floor dysfunction with impaired rectal evacuation. Rectoceles may be small (<2 cm), medium (2–4 cm), or large (>4 cm). Arguably, large rectoceles are more likely to be associated with symptoms (e.g., difficult defecation). It can be challenging to ascertain the extent to which a rectocele is secondary to pelvic floor dysfunction and/or whether a rectocele, rather than associated pelvic floor dysfunction, is responsible for symptoms. Surgical repair should be considered when initial treatment measures (e.g., bowel modifying agents and pelvic floor biofeedback therapy) are unsuccessful.

Purpose

We summarize the clinical features, diagnosis, and management of rectoceles, with an emphasis on outcomes after surgical repair. This review accompanies a retrospective analysis of outcomes after multidisciplinary, transvaginal rectocele repair procedures undertaken by three colorectal surgeons in 215 patients at a large teaching hospital in the UK. A majority of patients had a large rectocele. Some patients also underwent an anterior levatorplasty and/or an enterocele repair. All patients were jointly assessed, and some patients underwent surgery by colorectal and urogynecologic surgeons. In this cohort, the perioperative data, efficacy, and harms outcomes are comparable with historical data predominantly derived from retrospective series in which patients had a good outcome (67%–78%), symptoms of difficult defecation improved (30%–50%), and patients had a recurrent rectocele 2 years after surgery (17%). Building on these data, prospective studies that rigorously evaluate outcomes after surgical repair are necessary.
The experiences of children with a cardiac transplant, their families and health care providers in the COVID‐19 pandemic
Authors: Zulla Rosslynn T. , Nicholas David B. , West Lori J. , Chan Sarah , McCoy Marie , Urschel Simon
Published: September 2022

Background

The COVID‐19 pandemic has had deleterious impacts on pediatric patients and families, as well as the healthcare providers who have attended to their care needs.

Methods

In this qualitative study, children with a cardiac transplant, as well as their families and healthcare providers were interviewed to explore the impact of the COVID‐19 pandemic on pediatric care, as well as on patients' and their families' daily lives. Participants were recruited from a children's hospital in western Canada. Fifteen caregiving parents of transplanted children, 2 young patients, and 8 healthcare providers participated in interviews.

Results

Findings highlighted how families and their healthcare providers experienced pandemic‐related shifts. Themes highlighted experiences, which entailed (1) initially hearing about the COVID‐19 pandemic; (2) learning about their new reality; (3) adjusting to the pandemic; (4) adjusting to shifts in pediatric services; (5) evolving a view on the future, and (6) offering recommendations for cardiac care in a pandemic.

Conclusions

Study implications emphasize the need to critically reflect on, and advance, methods of helping young patients and their families in pandemic circumstances, and supporting healthcare providers.
Dutch‐booking indicative conditionals
Authors: Fusco Melissa
Published: September 2022

Recent literature on Stalnaker's Thesis, which seeks to vindicate it from Lewis (1976)'s triviality results, has featured linguistic data that is prima facie incompatible with Conditionalization in iterated cases (McGee 1989, 2000; Kaufmann 2015; Khoo & Santorio, 2018). In a recent paper (2021), Goldstein & Santorio make a bold claim: they hold that these departures light the way to a new, non‐conditionalizing theory of rational update.

Here, I consider whether this new form of update is subject to a Dutch book. On the official, invariantist version of the theory, I show that the answer is “yes”. On a competing, contextualist theory of indicative conditionals (Bacon, 2015), the answer is “no”, for reasons that have familiar connections to the limits of textbook Bayesianism. After presenting a concrete case, I explore the dialectical ramifications. The upshot is some hard choices for theories that seek to save the linguistic phenomena.
Structures, architecture, vertical profiles, palaeohydrology and taphonomy of an upper‐flow‐regime‐dominated fluvial system, the Triassic Dockum Group of the Palo Duro Canyon, Texas
Authors: Walker Samuel , Holbrook John
Published: September 2022

Triassic strata of the Tecovas and Trujillo formations in the Palo Duro Canyon of West Texas record deposition dominated throughout by upper‐flow‐regime channel flow. These strata provide an opportunity for new insights into the architecture, floodplain/channel processes, vertical profiles, palaeohydrology and taphonomy typical of broader upper‐flow‐regime‐dominated fluvial systems. Thicker channel‐fills (ca 2 m, aspect ratio ca 24) host upper‐plane‐bed, symmetrical antidune, breaking‐antidune, chute‐and‐pool, and cyclic‐step structures. The thinner channel‐fill population (<1 m, aspect ratio ca 35) comprises upper‐plane‐bed and some antidune structures. Some of the larger channel fills developed low‐angle downstream‐accreting bars, with rare examples of laterally accreting side‐attached bars. This appears to be the first documentation of an ancient upper‐flow‐regime side‐attached bar. Lamina orientation of structures parallel accretion surfaces because these followed the original bed surface, and structures drop in flow regime down the bar surfaces as formative Froude numbers also declined. A generalized vertical sequence for large upper‐flow‐regime channel storeys has upper‐plane‐bed structures above the basal scour, transitioning upward into higher flow regime structures (for example, antidunes, cyclic steps, etc.), then back to a mix of upper‐plane‐bed and antidunes or lower‐flow‐regime structures towards the top. The Tecovas Formation and overlying Trujillo Sandstone both bear layers of cross‐cutting laterally amalgamated valley fills, multivalleys, and are separated by a regional sequence boundary. Calculated palaeodischarges for Tecovas (ca 90 m3/s) and Trujillo (ca 76 m3/s) rivers record flow at the stage where symmetrical antidunes were deposited. These discharges occurred at some point on the falling limb of a flood hydrograph of currently unknown shape. Slopes for the rivers were on the order of 10−4 to 10−5, consistent with typical continental‐interior rivers. Large and flashy discharge was, thus, the likely cause for supercritical‐flow conditions instead of excessive slopes. Rivers in both the Tecovas and Trujillo formations record a fluvial system developed in a tropical to subtropical megamonsoonal environment. The tendency for preservation of metre‐scale channel‐fills and catastrophic inundations of floodplains and lakes in single floods has also made the Dockum Group a prolific preserver of large Triassic vertebrates.
Social Ontologies of Race and their Development
Authors: Gray David Miguel
Published: September 2022

The theme of this year's Spindel Conference was Social Ontologies of Race. This editorial introduction serves as both a general introduction to the topic of racial ontology and an introduction to this volume's contributions and their development of the debate.
Extracorporeal photopheresis in paediatric patients: A retrospective comparison between different ‘off‐line’ protocols
Authors: Sebastián Elena , Andrés Esteban Eva María , González‐Vicent Marta , González de Pablo Jesús , Zubicaray Josune , Gálvez Eva , Guillén María , Ruiz Pato Julia , Molina Blanca , Albi Gustavo , Ramírez Manuel , Castillo Ana , Pérez Maroto Florencio , Madero Luis , Díaz Miguel Ángel , Sevilla Julián
Published: September 2022

Background and Objectives

Extracorporeal photopheresis (ECP) has been shown to be an effective treatment for graft‐versus‐host disease (GvHD). However, information regarding lymphocyte collection for ECP in children is limited. The aim of this study was to analyse and compare lymphocyte collection for ECP in children using different devices and protocols. Moreover, we have studied both safety and variables of the infused product related to treatment efficacy.

Patients and Methods

This was a retrospective study of 91 patients who underwent 1524 apheresis procedures with either the COBE Spectra or Spectra Optia system. The comparison study between the Optia protocols (MNC and CMNC) was prioritized. We analysed 578 procedures using the Optia blood cell separator: 204 and 374 using the MNC and the CMNC protocol, respectively.

Results

The Optia CMNC protocol showed better collection efficiency, with increased lymphocyte collection per kg of body weight (p < 0.001). On multivariate analysis, the type of protocol showed no relationship with haematocrit or platelet loss. Most procedures were well‐tolerated, with the most frequent adverse events related to venous access (21.7%). Seventy‐one percent of patients had either partial or complete clinical GvHD response. In the multivariate model, only two variables were associated with a better response to ECP, younger age and a greater increase of B lymphocytes after treatment.

Conclusion

Lymphocyte collection for ECP is well‐tolerated in most children, achieving complete or partial response in more than half of GvHD patients. CMNC is the optimal software to perform lymphocyte collection in children.
Six Sigma in blood transfusion services: A dream too big in a third world country?
Authors: Jindal Aikaj , Maini Nandita
Published: September 2022

Background and Objectives

Transfusion errors can occur anywhere from blood donation to final blood transfusion. They are a source of increased cost and patient mortality. Automated workflows can reduce transcription errors, but resource‐poor centres still use semi‐automated/manual method for testing including manual labelling of column agglutination cards/testing tubes. Missing out any details on these cards can lead to errors in reporting results, wastage and loss of resources and effort. The aim of this study was to implement Six Sigma DMAIC (Define, Measure, Analyse, Improve and Control) methodology to reduce transcription errors while labelling gel card in immunohaematology lab to zero defect.

Materials and Methods

In this prospective study, transcription errors while manually performing 200 tests with 1400 opportunities were analysed. Baseline variables like number of errors, defects per million opportunities and sigma level in our current setup were measured. With the application of DMAIC methodology, root cause analysis for each error using Ishikawa diagram and structured Interviews were done to identify causes. A multipronged approach to deal with errors was done to improve critical areas using brainstorming sessions and developing training sheets for practice. After implementing the changes, baseline variables were reanalysed.

Results

Application of DMAIC resulted in an overall reduction in defects from 34.86% to 0.56% with sigma level improvement from 1.89 to 4.08.

Conclusion

Six Sigma methodology can be used in a resource‐poor setting even with lack of automation to ensure error‐free process flow.
Laser incubation for the rapid detection of red cell alloantibodies in human blood samples
Authors: Manderson Clare A. , McLiesh Heather , Tanner Joanne , Alves Diana , Manolios Jim , Garnier Gil
Published: September 2022

Background and Objectives

Pre‐transfusion antibody screening requires the detection and identification of immunoglobulin G (IgG) antibodies against red blood cells (RBCs). Using the indirect antiglobulin test (IAT), plasma–RBC solutions are incubated at 37°C in gel cards, typically by heating block technology. Here, we apply the newly developed laser incubation method to detect RBC alloantibodies in the plasma from human donors.

Materials and Methods

Donated human plasma samples (N = 128) containing clinically significant IgG antibodies directed against Rh (D, C, c, Cw and E), Kell (K and Kpa), Duffy (Fya and Fyb), Kidd (Jka) and MNS (S) blood group system antigens were tested by the indirect antiglobulin test (IAT). Samples were heated to 37°C by infrared laser (980 nm) for incubations of up to 5 min. Samples were also incubated in a heating block for comparison.

Results

When heating by laser, the presence of an alloantibody is detected after only a 1‐min incubation for 96% of samples. No samples required longer than 3 min of laser incubation in order to detect the antibody. For all samples, incubation by laser gave the same or stronger result within 5 min. No samples required longer than 5 min to achieve an equivalent result to that of the 5‐min heating block incubation. The laser was not found to damage cells or antibodies.

Conclusion

Laser incubation provides comparable results in shorter time frames than the heating block. Laser incubation can rapidly detect even very weak antibodies.
Performance Investigation of Airfoils for Axial Flow Fans in Low Solidity Cascades Operating at High Inlet Flow Angles
Authors: Cravero Carlo , Milanese Gabriele
Published: September 2022

Axial flow fans are usually characterized by blade sections with low solidity and high inlet flow angles. Two main approaches are followed in the preliminary design phase, to take into account blade interaction effects: the use of available airfoil cascades data (or related correlations) and that of isolated airfoil data together with interference coefficients. The working conditions of low solidity airfoil cascades with highly tangential inflow are not widely studied in the literature, leaving the designer the possibility to rely on limited cascade data or often on the use of isolated airfoil data, with the assumption of negligible interference effects. A systematic investigation of the above working conditions for airfoil cascades is performed with Reynolds-averaged Navier–Stokes simulations. Three different airfoils are used to evaluate the influence of the design lift coefficient and maximum blade thickness. The results provide a better insight into the aerodynamic behavior of airfoil sections in such operating conditions, showing that interactions cannot be neglected. The use of metamodeling coupled with computational fluid dynamics (CFD) simulations is presented as a suitable tool for treating interference effects within the fan design process. The main findings of the present work can be used as a support for design choices as well as for developing design strategies both for the fan blades and for the airfoil sections.
The Effects of Swirling Flows in Entropy Wave Convection Through High-Pressure Turbine Stage
Authors: Pinelli Lorenzo , Marconcini Michele , Pacciani Roberto , Notaristefano Andrea , Gaetani Paolo
Published: September 2022

First stages of aeronautical high-pressure turbines are subjected to significant inlet distortions generated by the combustor system. These disturbances are characterized by velocity and temperature fluctuations convected downstream by the flow. Such perturbations are commonly defined as vorticity and entropy waves and interact with the turbine stages affecting the aerodynamic performance, the heat exchange, and generating indirect noise. Moreover, the presence of a swirling flow highly influences the convection and migration of the entropy wave and thus its interaction with the stage. This article presents an in-depth study of the impact of the swirling flows on the entropy wave evolution by means of experimental campaigns and numerical simulations. Experimental campaigns have been carried out at Politecnico di Milano where a high-pressure turbine rig was equipped with a novel combustor simulator able to generate entropy waves and swirl profiles. Numerical simulations have been performed at the University of Florence by applying time accurate simulation schemes, including incoming disturbances, implemented in the CFD TRAF code. Two different entropy waves (featuring frequencies of 10 and 110 Hz) injected in a counterclockwise swirling region at mid-span have been analyzed at two clocking positions: passage aligned and vane aligned. An excellent agreement is found between experimental acquisitions and numerical results: both show an important reduction of the temperature fluctuations through the stage and highlight the effect of the swirling profile on secondary flows and blade wakes. The extensive comparison reported in this article validates the numerical approach (based on unsteady simulations postprocessed by a dedicated filtering technique), which has been further applied to study the impact of swirling flows with an opposite rotation (clockwise). The broad numerical investigation combined with the extensive experimental campaign leads to a deeper understanding of the aerodynamic, thermal, and acoustic implications related to entropy wave evolution in a swirling flow, highlighting the interaction phenomena and suggesting how to minimize the impact of entropy waves by comparing the results of the different injection positions and swirling flow directions.
Ion slippage through Li
+
-centered G-quadruplex
Authors: Cho Seok-Kyu , Lee Kyung Min , Kang So-Huei , Jeong Kihun , Han Sun-Phil , Lee Ji Eun , Lee Seungho , Shin Tae Joo , Ryu Ja-Hyoung , Yang Changduk , Kwak Sang Kyu , Lee Sang-Young
Published: September 2022

Single-ion conductors have garnered attention in energy storage systems as a promising alternative to currently widespread electrolytes that allow migration of cations and anions. However, ion transport phenomena of most single-ion conductors are affected by strong ion (e.g., Li
+
)–ion (immobilized anionic domains) interactions and tortuous paths, which pose an obstacle to achieving performance breakthroughs. Here, we present a Li
+
-centered G-quadruplex (LiGQ) as a class of single-ion conductor based on directional Li
+
slippage at the microscopic level. A guanine derivative with liquid crystalline moieties is self-assembled to form a hexagonal ordered columnar structure in the LiGQ, thereby yielding one-dimensional central channels that provide weak ion-dipole interaction and straightforward ionic pathways. The LiGQ exhibits weak Li
+
binding energy and low activation energy for ion conduction, verifying its viability as a new electrolyte design.
Making a case for femto-phono-magnetism with FePt
Authors: Sharma Sangeeta , Shallcross Sam , Elliott Peter , Dewhurst J. Kay
Published: September 2022

In the field of femtomagnetism, magnetic matter is controlled by ultrafast laser pulses; here, we show that coupling phonon excitations of the nuclei to spin and charge leads to femto-phono-magnetism, a powerful route to control magnetic order at ultrafast times. With state-of-the-art theoretical simulations of coupled spin, charge, and lattice dynamics, we identify strong nonadiabatic spin-phonon coupled modes that dominate early time spin dynamics. Activating these phonon modes that we show leads to an additional (up to 40% extra) loss of moment in iron-platinum occurring within 40 femtoseconds of the pump laser pulse. Underpinning this enhanced ultrafast loss of spin moment, we identify a physical mechanism in which minority spin current drives an enhanced intersite minority charge transfer, in turn promoting increased on-site spin flips. Our finding demonstrates that the nuclear system, often assumed to play the role of an energy and angular momentum sink, when selectively preexcited, can play a profound role in controlling femtosecond spin dynamics in materials.
A self-generated Toddler gradient guides mesodermal cell migration
Authors: Stock Jessica , Kazmar Tomas , Schlumm Friederike , Hannezo Edouard , Pauli Andrea
Published: September 2022

The sculpting of germ layers during gastrulation relies on the coordinated migration of progenitor cells, yet the cues controlling these long-range directed movements remain largely unknown. While directional migration often relies on a chemokine gradient generated from a localized source, we find that zebrafish ventrolateral mesoderm is guided by a self-generated gradient of the initially uniformly expressed and secreted protein Toddler/ELABELA/Apela. We show that the Apelin receptor, which is specifically expressed in mesodermal cells, has a dual role during gastrulation, acting as a scavenger receptor to generate a Toddler gradient, and as a chemokine receptor to sense this guidance cue. Thus, we uncover a single receptor–based self-generated gradient as the enigmatic guidance cue that can robustly steer the directional migration of mesoderm through the complex and continuously changing environment of the gastrulating embryo.
Pseudomonas aeruginosa Strains from Both Clinical and Environmental Origins Readily Adopt a Stable Small-Colony-Variant Phenotype Resulting from Single Mutations in c-di-GMP Pathways
Authors: Besse Alison , Groleau Marie-Christine , Trottier Mylène , Vincent Antony T. , Déziel Eric
Published: September 2022

P. aeruginosa
is an opportunistic pathogen that thrives in many environments. It poses a significant health concern, notably because this bacterium is the most prevalent pathogen found in the lungs of people with cystic fibrosis.
Transient Glycolytic Complexation of Arsenate Enhances Resistance in the Enteropathogen Vibrio cholerae
Authors: Bueno Emilio , Pinedo Víctor , Shinde Dhananjay D. , Mateus André , Typas Athanasios , Savitski Mikhail M. , Thomas Vinai C. , Cava Felipe
Published: September 2022

Even though resistance to arsenate has been extensively investigated in environmental bacteria, how enteric pathogens tolerate this toxic compound remains unknown. Here, we found that the cholera pathogen
V. cholerae
exhibits increased resistance to arsenate compared to closely related enteric pathogens.
Complete Genome Sequence of Dickeya chrysanthemi Bacteriophage DchS19
Authors: Mutusamy Prasanna , Jaya Jothi Sasireigga , Kumarasan Yukgehnaish , Loke Stella , Lee Su Yin , Rajandas Heera , Parimannan Sivachandran
Published: September 2022

We characterized the complete genome of a lytic
Dickeya chrysanthemi
bacteriophage, DchS19, which was isolated from a soil sample in Sungai Petani, Kedah, Malaysia. The phage, from the
Autographviridae
family, has a 39,149-bp double-stranded DNA genome containing 49 protein-coding genes and shares 94.65% average nucleotide identity with
Erwinia
phage pEp_SNUABM_12.
Synthesis, Molecular Docking, and Hemorheological Activity of New 4-(Thien-2-yl)-3-aminopyridine-2(1H)-one Derivatives
Authors: Palamarchuk I. V. , Shulgau Z. T. , Sergazy Sh. D. , Zhulikeeva A. M. , Seilkhanov T. M. , Kulakov I. V.
Published: September 2022

On the basis of 4-(thien-2-yl)-3-aminopyridine-2(1H)-one, the corresponding chloroacetamide and condensed 1H-pyrido[2,3-b][1,4]oxazine-2(3H)-one were synthesized by the reaction of acylation with chloroacetyl chloride. Thioureide derivatives of 3-aminopyridine-2(1H)-one were obtained by reactions with a number of isothiocyanates. It was shown that the carbamothionylmethacrylamide derivative cyclizes rather easily into substituted 1,3-thiazine. Molecular docking of synthesized derivatives for antithrombotic activity was carried out, which showed that the presence of a thiourea fragment in the pyridone core leads to an increase in affinity for the selected protein. The hemorheological study of the compounds using the in vitro model of the increased blood viscosity syndrome also showed activity at the level of the reference drug pentoxifylline.
Vibration of effect in more than 16 000 pooled analyses of individual participant data from 12 randomised controlled trials comparing canagliflozin and placebo for type 2 diabetes mellitus: multiverse analysis
Authors: Gouraud Henri , Wallach Joshua D , Boussageon Rémy , Ross Joseph S , Naudet Florian
Published: September 2022

Objective

To evaluate the impact of conducting all possible pooled analyses across different combinations of randomised controlled trials and endpoints.

Design

Multiverse analysis, consisting of numerous pooled analyses of individual participant data.

Setting

Individual patient data from 12 randomised controlled trials comparing canagliflozin treatment with placebo, shared on the Yale University Open Data Access project (https://yoda.yale.edu/) platform, up to 16 April 2021.

Participants

15 094 people with type 2 diabetes mellitus.

Main outcome measures

Pooled analyses estimated changes in serum glycated haemoglobin (HbA1c), major adverse cardiovascular events, and serious adverse events at weeks 12, 18, 26, and 52. The distribution of effect estimates was calculated for all possible combinations, and the direction and magnitude of the first and 99th centiles of effect estimates were compared.

Results

Across 16 332 distinct pooled analyses comparing canagliflozin with placebo for changes in HbA1c, standardised effect estimates were in favour of canagliflozin treatment at both the first centile (−0.75%) and 99th centile (−0.48%); 15 994 (97.93%) analyses showed significant results (P<0.05) in favour of canagliflozin. For major adverse cardiovascular events, estimated hazard ratios were 0.20 at the first centile and 0.90 at the 99th centile; 2705 of 8144 analyses (33.21%) were significant, all of which were in favour of canagliflozin treatment. For serious adverse events, estimated hazard ratios were 0.59 at the first centile and 1.14 at the 99th centile; 5793 of 16 332 (35.47%) analyses were significant, with 5754 in favour of canagliflozin and 39 in favour of placebo.

Conclusion

Results from pooled analyses can be subject to vibration of effects and should be critically appraised, especially regarding the risk for selection and availability bias in individual participant data retrieved.
Pilot study of physiotherapist-led versus music therapist-led breathing control exercises for young adults living with breathing pattern disorder: a randomised controlled trial protocol
Authors: Lewis Adam , Kal Elmar , Nolan Claire Marie , Cave Phoene , Grillo Lizzie , Conway Joy , Jones Mandy
Published: September 2022

Introduction

Breathing pattern disorder (BPD) is an abnormal breathing pattern associated with biochemical, biomechanical and psychophysiological changes. While physiotherapy is often offered, limited evidence-based therapies for BPD are available. Music therapy-based singing exercises have been shown to improve quality of life for individuals with respiratory conditions and may also be beneficial for individuals living with BPD. No study has previously compared these participatory interventions in the treatment of people living with BPD.

Methods and analysis

This is a study protocol for an assessor blinded 1:1 randomised controlled trial and qualitative interview study. Forty participants aged 18–40 years who score at least 19 on the Nijmegen Questionnaire (NQ) and do not have any underlying respiratory conditions will be recruited. Participants will be randomised to receive either physiotherapy-led or music therapy-led breathing exercises for 6 weeks. The primary outcome will be between-group difference in NQ post-intervention. Semistructured interviews with a purposive sample of participants will be performed. Qualitative data will be analysed using thematic analysis to better understand participants’ intervention and trial experiences.

Ethics and dissemination

This study has received ethical approval by Brunel University London College of Health, Medicine and Life Science’s Research Ethics Committee (32483-MHR-Mar/2022-38624-3). The anonymised completed dataset will be made available as an open-access file via Brunel University London Figshare and the manuscript containing anonymised patient data will be published in an open-access journal.

Trial registration number

This trial is registered on the Open Science Framework Registry (https://osf.io/u3ncw).
Adverse pregnancy outcomes in women with systemic lupus erythematosus: can we improve predictions with machine learning?
Authors: Fazzari Melissa J , Guerra Marta M , Salmon Jane , Kim Mimi Y
Published: September 2022

Objectives

Nearly 20% of pregnancies in patients with SLE result in an adverse pregnancy outcome (APO). We previously developed an APO prediction model using logistic regression and data from Predictors of pRegnancy Outcome: bioMarkers In Antiphospholipid Antibody Syndrome and Systemic Lupus Erythematosus (PROMISSE), a large multicentre study of pregnant women with mild/moderate SLE and/or antiphospholipid antibodies. Our goal was to determine whether machine learning (ML) approaches improve APO prediction and identify other risk factors.

Methods

The PROMISSE data included 41 predictors from 385 subjects; 18.4% had APO (preterm delivery due to placental insufficiency/pre-eclampsia, fetal/neonatal death, fetal growth restriction). Logistic regression with stepwise selection (LR-S), least absolute shrinkage and selection operator (LASSO), random forest (RF), neural network (NN), support vector machines (SVM-RBF), gradient boosting (GB) and SuperLearner (SL) were compared by cross-validated area under the ROC curve (AUC) and calibration.

Results

Previously identified APO risk factors, antihypertensive medication use, low platelets, SLE disease activity and lupus anticoagulant (LAC), were confirmed as important with each algorithm. LASSO additionally revealed potential interactions between LAC and anticardiolipin IgG, among others. SL performed the best (AUC=0.78), but was statistically indistinguishable from LASSO, SVM-RBF and RF (AUC=0.77 for all). LR-S, NN and GB had worse AUC (0.71–0.74) and calibration scores.

Conclusions

We predicted APO with reasonable accuracy using variables routinely assessed prior to the 12th week of pregnancy. LASSO and some ML methods performed better than a standard logistic regression approach. Substantial improvement in APO prediction will likely be realised, not with increasingly complex algorithms but by the discovery of new biomarkers and APO risk factors.
Oral anticoagulants, time in therapeutic range and renal function over time in real-life patients with atrial fibrillation and chronic kidney disease
Authors: Batra Gorav , Modica Angelo , Renlund Henrik , Larsson Anders , Christersson Christina , Held Claes
Published: September 2022

Aims

To describe the use of warfarin and direct oral anticoagulants (DOACs) in patients with atrial fibrillation (AF) and chronic kidney disease (CKD), to evaluate changes in renal function over time and predictors of rapid decline, and to describe time in therapeutic range (TTR) and predictors of poor TTR among patients on warfarin.

Methods and results

Using data from AuriculA, the Swedish oral anticoagulation registry, patients with AF on warfarin or DOAC were identified between 2013 and 2018 (N=6567). Estimated glomerular filtration rate (eGFR) was calculated and categorised into normal (≥90 mL/min/1.73 m2), mild CKD (60–89 mL/min/1.73 m2), moderate CKD (30–59 mL/min/1.73 m2), severe CKD (15–29 mL/min/1.73 m2) and end-stage CKD (<15 mL/min/1.73 m2)/dialysis. TTR was estimated using international normalised ratio (INR) measurements. Predictors of eGFR decline over time and of poor TTR were estimated using regression analysis. Between 2013 and 2018, use of DOAC increased from 9.2% to 89.3%, with a corresponding decline in warfarin. A similar trend was observed in patients with mild to moderate CKD, while DOAC over warfarin increased slower among patients with severe to end-stage CKD/dialysis. In patients treated with warfarin, the median TTR was 77.1%. Worse TTR was observed among patients with severe CKD (70.0%) and end-stage CKD/dialysis (67.5%). A gradual annual decline in eGFR was observed (−1.1 mL/min/1.73 m2), with a more rapid decline among patients with older age, female sex, diabetes mellitus and/or heart failure.

Conclusion

In patients with AF, use of DOAC has steadily increased across different CKD stages, but not in patients with severe to end-stage CKD/dialysis despite these patients having poor INR control. Patients with AF have a gradual decline in renal function, with a more rapid decline among a subgroup of patients.
Remote self-collection of capillary blood using upper arm devices for autoantibody analysis in patients with immune-mediated inflammatory rheumatic diseases
Authors: Zarbl Joshua , Eimer Ekaterina , Gigg Camilla , Bendzuck Gerlinde , Korinth Marianne , Elling-Audersch Corinna , Kleyer Arnd , Simon David , Boeltz Sebastian , Krusche Martin , Mucke Johanna , Muehlensiepen Felix , Vuillerme Nicolas , Krönke Gerhard , Schett Georg , Knitza Johannes
Published: September 2022

Objectives

To evaluate the feasibility, accuracy, usability and acceptability of two upper arm self-sampling devices for measurement of autoantibodies and C reactive protein (CRP) levels in patients with immune-mediated rheumatic diseases (IMRDs).

Methods

70 consecutive patients with IMRD with previously documented autoantibodies were assigned to supervised and unsupervised self-collection of capillary blood with the Tasso+ or TAP II device. Interchangeability of 17 biomarkers with standard venesection was assessed by: concordance, correlation, paired sample hypothesis testing and Bland-Altman plots. Patients completed an evaluation questionnaire, including the System Usability Scale (SUS) and Net Promoter Score (NPS).

Results

While 80.0% and 77.0% were able to safely and successfully collect capillary blood using the Tasso+ and TAP II within the first attempt, 69 of 70 (98.6%) patients were successful in collecting capillary blood within two attempts. Concordance between venous and capillary samples was high; 94.7% and 99.5% for positive and negative samples, respectively. For connective tissue disease screen, anti-Ro52 and anti-proteinase 3 autoantibody levels, no significant differences were observed. Self-sampling was less painful than standard venesection for the majority of patients (Tasso+: 71%; TAP II: 63%). Both devices were well accepted (NPS; both: +28%), usability was perceived as excellent (SUS; Tasso+: 88.6 of 100; TAP II: 86.0 of 100) and 48.6 %/62.9% of patients would prefer to use the Tasso+/TAP II, respectively, instead of a traditional venous blood collection.

Conclusions

Remote self-collection of capillary blood using upper arm-based devices for autoantibody and CRP analysis in patients with autoimmune rheumatic diseases is feasible, accurate and well accepted among patients.

Trial registration number

WHO International Clinical Trials Registry (DRKS00024925).
Cervical and systemic innate immunity predictors of HIV risk linked to genital herpes acquisition and time from HSV-2 seroconversion
Authors: Govender Yashini , Morrison Charles S , Chen Pai-Lien , Gao Xiaoming , Yamamoto Hidemi , Chipato Tsungai , Anderson Sharon , Barbieri Robert , Salata Robert , Doncel Gustavo F , Fichorova Raina Nakova
Published: September 2022

Objectives

To examine innate immunity predictors of HIV-1 acquisition as biomarkers of HSV-2 risk and biological basis for epidemiologically established HIV-1 predisposition in HSV-2 infected women.

Methods

We analysed longitudinal samples from HIV-1 negative visits of 1019 women before and after HSV-2 acquisition. We measured cervical and serum biomarkers of inflammation and immune activation previously linked to HIV-1 risk. Protein levels were Box-Cox transformed and ORs for HSV-2 acquisition were calculated based on top quartile or below/above median levels for all HSV-2 negative visits. Bivariate analysis determined the likelihood of HSV-2 acquisition by biomarker levels preceding infection. Linear mixed-effects models evaluated if biomarkers differed by HSV-2 status defined as negative, incident or established infections with an established infection cut-off starting at 6 months.

Results

In the cervical compartment, two biomarkers of HIV-1 risk (low SLPI and high BD-2) also predicted HSV-2 acquisition. In addition, HSV-2 acquisition was associated with IL-1β, IL-6, IL-8, MIP-3α, ICAM-1 and VEGF when below median levels. Systemic immunity predictors of HSV-2 acquisition were high sCD14 and IL-6, with highest odds when concomitantly increased (OR=2.23, 1.49–3.35). Concomitant systemic and mucosal predictors of HSV-2 acquisition risk included (1) serum top quartile sCD14 with cervical low SLPI, VEGF and ICAM-1, or high BD-2; (2) serum high IL-6 with cervical low VEGF and ICAM-1, SLPI, IL-1β and IL-6; and (3) serum low C reactive protein with cervical high BD-2 (the only combination also predictive of HIV-1 acquisition). Most cervical biomarkers were decreased after HSV-2 acquisition compared with the HSV-2 negative visits, with incident infections associated with a larger number of suppressed cervical biomarkers and lower serum IL-6 levels compared with established infections.

Conclusions

A combination of systemic immunoinflammatory and cervical immunosuppressed states predicts HSV-2 acquisition. A persistently suppressed innate immunity during incident HSV-2 infection may add to the increased HIV-1 susceptibility.
How much to pay for a track and trace system: a simulation model for South Africa
Authors: van der Zee Kirsten , van Walbeek Corné , Ross Hana
Published: September 2022

Background

The illicit trade in tobacco reduces the effectiveness of tobacco-control policies. Independent track and trace (T&T) systems are considered one of the most effective measures available to reduce the illicit tobacco trade. South Africa, with an illicit trade estimated at over 35% of the total market, is yet to implement a T&T system.

Methods

An Excel-based simulation model is used to determine the break-even T&T marker cost per pack. At the break-even cost per pack, the government would recover all costs associated with implementing T&T by collecting additional revenues. We conduct a scenario analysis to provide a range of break-even marker costs.

Findings

A marker cost of between R2.68 (US$0.17) and R5.24 (US$0.34) per pack allows the South African government to collect enough additional revenue to recover all costs associated with T&T. Implementing such a system would reduce cigarette consumption by between 5% and 11.5%. Given that comparable systems cost significantly less than this range (roughly US$0.02 per pack), the government would in all likelihood be able to implement a system at a cost below the break-even rate, thus generating additional revenue.

Conclusion

The break-even simulation model provides a practical tool for the government to plan the implementation of T&T and to set up an evaluation criteria for the T&T tender process. The simulations illustrate that implementing T&T in South Africa would both reduce consumption (licit and illicit) and generate additional revenue. With some modifications, the model can be applied to other countries as well.