bluuebunny/crossref_metadata_2025 huggingface dataset:
The impact of preoperative ultrasound and intraoperative findings on surgical outcomes in patients at high risk of placenta accreta spectrum
Authors: Hussein Ahmed M. , Fox Karin , Bhide Amar , Elbarmelgy Rasha A. , Elbarmelgy Rana M. , Thabet Mohamed M. , Jauniaux Eric
Published: August 2022

Objective

To assess whether preoperative ultrasound imaging and intraoperative features predict surgical outcomes in patients at high risk for placenta accreta spectrum (PAS).

Design

Cohort study.

Setting

Cairo University Maternity, Egypt.

Population or sample

Pregnant patients with one or more prior caesarean deliveries presenting with a low‐lying/placenta praevia with or without PAS confirmed by histopathology.

Methods

Logistic regression and multivariable analyses.

Main outcomes measures

Need for primary caesarean hysterectomy, numbers of red blood cell (RBC) units transfused and patients requiring transfusion of >5 units.

Results

Ninety consecutive records were reviewed, including 58 (64.4%) PAS cases. Sixty (66.7%, 95% confidence interval (CI) 56–76) required hysterectomy. Odds of hysterectomy were significantly (p = 0.005) increased with complete praevia. Significantly higher odds of hysterectomy were associated with subplacental hypervascularity (7.23, 95% CI 2.72–19.2, p < 0.001), lacunar scores 2+ and 3+ (12.6, 95% CI 4.15–38.5, p < 0.001), lacunar feeder vessels (5.69, 95% CI 1.77–18.3, p = 0.004) or bridging vessels (2.00, 95% CI 1.29–3.10, p = 0.002) on ultrasound, and increased lower segment vascularization at laparotomy (5.42, 95% CI 2.09–14.1, p = 0.001). Transfusion >5 RBC units was associated with number of lacunae (odds ratio [OR] 1.48, 95% CI 1.14–1.93, p = 0.004) and presence of feeder vessels (OR 1.62, 95% CI 1.24–2.11, p = 0.001). The multivariable analysis indicated that parity, placental location and PAS were significantly (p = 0.007; p = 0.01; p < 0.001, respectively) associated with hysterectomy.

Conclusions

Preoperative ultrasound imaging can assist in triaging and counselling patients regarding the odds of PAS, intraoperative blood losses and need for hysterectomy, and intraoperative features can assist the surgeon in evaluating the need for multidisciplinary support.
Investigating the factors affecting participation in natural resources development cooperatives: The case study of Ardabil Province
Authors: Hamidi Ali , Mehrabi Aliakbar , Javadi Seyed Akbar , Imani Aliakbar
Published: August 2022

Natural resources development cooperatives (NRDCs) are leading enterprises that develop sustainable community‐based solutions. Basically, such cooperatives attempt to engage beneficiaries in environmental conservation through collective action. However, there exist remarkable shortcomings in administering these types of cooperatives. This paper aims to investigate beneficiaries' willingness to participate and invest in NRDCs based on three educational, economic, and social sections, each represented by their corresponding components, which represent the variables (sub‐factors) of each section. The current research was performed using a descriptive‐survey approach. Semi‐structured interviews were conducted with 63 cooperatives' board members located in Ardabil Province in Iran. Results discovered that three variables of information, participation acceptance rate and top‐down planning from educational factors alongside those of conservation effectiveness and projected outlook from the economic factor significantly affect participation levels in NRDCs. Similarly, the lack of rangeland ownership, cooperatives' limited problem‐solving capabilities, and concerns about environmental conservation of formerly demolished lands, all components of the social section investigated in this study, highly influenced beneficiaries' participation in cooperatives. Correlation coefficient analysis between the efficient factors showed that education levels have no significant relationship with the two remaining factors; however, the economic and social factors positively and significantly (p < 0.01) relate to beneficiaries' participation level. Nonparametric correlation analysis determined that variables from the economic factor analysis, such as the financial capital size, awareness levels, indigenous culture, people's experiences interacting with the administrative bodies of NRDCs, the state‐run economy, and the lack of support for beneficiaries by cooperatives from the social factor analysis each have independent and distinct relationships that affect participation in cooperatives. However, from the educational factor analysis, all variables were influenced reciprocally and were of inferior importance to participation in NRDCs.
Perinatal outcome and long‐term infectious hospitalizations of offspring born to women with known drug allergy
Authors: Mahamid Assil , Wainstock Tamar , Sheiner Eyal , Rosenberg Elli , Kluwgant Dvora , Pariente Gali
Published: August 2022

Problem

Maternal drug allergy has been associated with altered immune status and an inflammatory environment, which may affect the risk of future infectious diseases in the offspring.

Objectives

We aimed to evaluate perinatal outcomes and long‐term infectious hospitalization in the offspring of women with documented drug allergy.

Method of study

The study was conducted at the Soroka University Medical Center (SUMC), a tertiary medical center. For perinatal outcomes, generalized estimation equation (GEE) models were used controlling for maternal age, maternal diabetes mellitus, smoking, and hypertensive disorders. The study groups were followed until 18 years of age for infectious‐related hospitalizations. A Kaplan–Meier survival curve was used to compare the cumulative incidence of long‐term infectious hospitalizations. A Cox proportional hazards model was conducted to control for confounders.

Results

During the study period, 243 682 deliveries met the inclusion criteria, of which 9756 (4.0%) occurred in women with documented drug allergy. Using GEE, maternal drug allergy was found to be a significant independent risk factor for hypertensive disorders, diabetes mellitus, intra‐uterine growth restriction (IUGR), and preterm delivery. Offspring also had significantly higher rates of long‐term infectious hospitalizations. Kaplan–Meier survival curves demonstrated significantly higher cumulative incidence rates of infectious hospitalization (log‐rank p < .001). In a Cox proportional hazards model, being born to a mother with documented drug allergy was independently associated with infectious hospitalization of the offspring in the long term.

Conclusions

Maternal documented drug allergy is independently associated with an adverse perinatal outcome such as IUGR and preterm delivery and increased risk of long‐term infectious hospitalization of the offspring.
Natural killer cell profiles in recurrent pregnancy loss: Increased expression and positive associations with TACTILE and LILRB1
Authors: Habets Denise H. J. , Schlütter Anna , van Kuijk Sander M. J. , Spaanderman Marc E. A. , Al‐Nasiry Salwan , Wieten Lotte
Published: August 2022

Problem

NK cells are important for healthy pregnancy and aberrant phenotypes or effector functions have been associated with RPL. We compared expression of a broad panel of NK cell receptors, including immune checkpoint receptors, and investigated their clinical association with RPL as this might improve patient stratification and prediction of RPL.

Method of study

Peripheral blood mononuclear cells were isolated from 52 women with RPL and from 2 women with an uncomplicated pregnancy for flowcytometric analysis and plasma was used to determine anti‐CMV IgG antibodies.

Results

Between RPL and controls, we observed no difference in frequencies of T‐, NKT or NK cells, in CD56dimCD16+ or CD56brightCD16‐ NK cell subsets or in the expression of KIRs, NKG2A, NKG2C, NKG2D, NKp30, NKp44, NKp46 or DNAM1. NK cells from women with RPL had a higher expression of LILRB1 and TACTILE and this was associated with the number of losses. The immune checkpoint receptors PD1, TIM3 and LAG3 were not expressed on peripheral blood NK cells. In RPL patients, there was a large variation in NKG2C expression and higher levels could be explained by CMV seropositivity.

Conclusion

Our study identified LILRB1 and TACTILE as NK cell receptors associated with RPL. Moreover, we provide first support for the potential role of CMV in RPL via its impact on the NK cell compartment. Thereby our study could guide future studies to confirm the clinical association of LILRB1, TACTILE and NKG2C with RPL in a larger cohort and to explore their functional relevance in reproductive success.
Long‐term outcomes of sporadic rectal cancer versus ulcerative colitis‐associated rectal cancer: a matched case‐control study
Authors: Tatar Cihad , Lightner Amy L. , Jia Xue , Liska David , Kalady Matthew , Steele Scott R. , Gorgun Emre
Published: August 2022

Background

Although patients with ulcerative colitis (UC) are at increased risk of rectal cancer compared to the general population, it remains unclear whether their oncologic outcomes are different than sporadic rectal cancer (S‐RC).We aimed to compare survival and oncologic outcomes in S‐RC versus UC‐associated rectal cancer (UC‐RC).

Methods

We performed a retrospective case‐control study of patients who underwent surgical resection for rectal cancer between 2005 and 2015. Data collected included patient demographics, intraoperative variables, postoperative outcomes, and oncological outcomes.

Results

A total of 138 patients were included; 92 patients with S‐RC and 46 with UC‐RC. Both groups were comparable in terms of demographics, oncologic characteristics, oncologic treatment strategies, perioperative complications and operative factors except for preoperative radiotherapy. At a median follow‐up time of 3.7 years the 3‐and 5‐year OS rates; the 1‐and 3‐year DFS rates were comparable between the groups.

Conclusion

Ulcerative colitis‐associated rectal cancer patients have similar survival and oncologic outcomes as sporadic rectal cancer patients.
Effects of hysterectomy on pelvic floor function and sexual function—A prospective cohort study
Authors: Forsgren Catharina , Amato Martina , Johannesson Ulrika
Published: August 2022

Introduction

Hysterectomy is one of the most common major surgical procedures in women. The effects of hysterectomy on pelvic floor and sexual function are uncertain. Our objective was to investigate the effects of hysterectomy for benign indications on pelvic floor and sexual function and to compare different modes of surgery.

Material and methods

We performed a prospective clinical cohort study. In all, 260 women scheduled for hysterectomy answered validated questionnaires (Pelvic Floor Impact Questionnaire, Pelvic Floor Distress Inventory and Female Sexual Function Index). Participants were followed 6 months and 1 year after surgery. Data were analyzed using nonparametric statistics and mixed effect models.

Results

Women with subtotal hysterectomy, vaginal hysterectomy, laparoscopic assisted vaginal hysterectomy, and previous prolapse/incontinence surgery were excluded from further analysis, leaving the remaining cohort to 242 patients. The response rate at 6 months and 1 year follow‐up was 180/242 (74.3%) and 169/242 (69.8%), respectively. There was an improvement of pelvic floor function at both follow‐ups; mean score of Pelvic Floor Impact Questionnaire at baseline was 42.5 (51.7), at 6 months 19.9 (42.2) and at 1 year 23.7 (50.3) (p < 0.001). The mean score of Pelvic Floor Distress Inventory at baseline was 69.6 (51.1), at 6 months 49 (43.2) and at 1 year 49 (43.2) (p < 0.001). There was an improvement of sexual function after 6 months (mean score of Female Sexual Function Index at baseline 17.9 [SD 11.7] and at 6 months 21.0 [SD 11.7]) (p < 0.001). There was no difference in pelvic floor or sexual function when comparing surgical techniques.

Conclusions

Robotic assisted laparoscopic hysterectomy, laparoscopic hysterectomy and abdominal hysterectomy improve pelvic floor function to the same extent at 6 months and 1 year after surgery. There was an overall improvement of sexual function 6 months after hysterectomy, but this did not persist after 1 year.
Clinical characteristics and risk factors of myopic retinoschisis in an elderly high myopia population
Authors: Li Menghan , Yu Jiayi , Chen Qiuying , Zhou Hao , Zou Haidong , He Jiangnan , Zhu Jianfeng , Fan Ying , Xu Xun
Published: August 2022

Purpose

To investigate the clinical characteristics, internal correlations and risk factors for different locations of retinoschisis (RS) in an elderly high myopia (HM) population.

Methods

A total of 448 eyes (304 participants) were analysed and classified into no retinoschisis (no‐RS), paravascular retinoschisis (PVRS), peripapillary retinoschisis (PPRS) and macular retinoschisis (MRS) groups. Each participant underwent comprehensive ophthalmic examinations, and posterior scleral height (PSH) was measured in swept‐source optical coherence tomography images. PSH, vitreoretinal interface abnormities and myopic atrophy maculopathy (MAM) were compared among groups.

Results

Retinoschisis was found in 195 (43.5%) eyes, among which 170 (37.9%) had PVRS, 123 (27.5%) had PPRS, and 103 (23.0%) had MRS. MRS was found to be combined with PVRS in 96 of 103 (93.2%) eyes. MAM was one of the risk factors for RS (odds ratio [OR], 2.459; p = 0.005). Higher nasal PSH was the only risk factor for PVRS (OR, 9.103; p = 0.008 per 1‐mm increase). Elongation of axial length (AL) (OR, 1.891; p < 0.001 per 1‐mm increase), higher PSH in nasal (OR, 5.059; p = 0.009 per 1‐mm increase) and temporal (OR, 13.021; p = 0.012 per 1‐mm increase), epiretinal membrane (ERM; OR, 2.841; p = 0.008) and vitreomacular traction (VMT; OR, 7.335; p = 0.002) were risk factors for MRS.

Conclusions

Paravascular retinoschisis is the most common type of RS in HM and MRS is mostly combined with PVRS. MAM is one of the risk factors for RS. In addition to longer AL and higher PSH, the presence of VMT and ERM also play an important role in the formation of MRS.
Retinal oxygen saturation in monoclonal gammopathies patients: A pilot study
Authors: Hübnerová Petra , Karhanová Marta , Krhovská Petra , Minařík Jiří , Mlčák Petr , Pašková Barbora , Schreiberová Zuzana , Šínová Irena , Zapletalová Jana , Šín Martin
Published: August 2022

Purpose

The aim of this pilot study was to assess oxygen saturation in retinal blood vessels in patients with monoclonal gammopathies (MGs).

Methods

Thirty‐one patients with MGs (11 women and 20 men, mean age 65.9 ± 8.9 years) were enrolled during 2016–2020. The patients were diagnosed at the Haemato‐Oncology Department and subsequently examined at the Ophthalmology Department before initiating systemic therapy. All patients were subjected to automatic retinal oximetry (Oxymap ehf.) and had their fundus photographed (Topcon TRC‐50DX retinal camera). We assessed the association between retinal oxygen saturation (SatO2) – arterial SatO2, venous SatO2 and arterio‐venous (AV) difference—and MGs parameters: serum monoclonal immunoglobulin (M‐protein) level and serum immunoglobulin‐free light chains (FLC kappa and lambda), total protein, serum viscosity, haemoglobin, albumin, lactate dehydrogenase, C‐reactive protein, creatinine and serum calcium level. Hyperviscosity‐related retinopathy was also evaluated.

Results

Statistical analysis showed a significant positive correlation (r = 0.462; p = 0.009) between the AV difference and the haemoglobin level. A significant, medium strong negative correlation was found between the AV difference and the serum levels of the monoclonal light lambda chains (r = −0.450; p = 0.011). Contrary to expectations, no statistically significant correlation was found between retinal oxygen saturation and the total protein or viscosity.

Conclusion

This study found correlation between retinal oxygen saturation and certain parameters in the blood of patients with MGs. Increasing levels of monoclonal immunoglobulin seem to reduce oxygen absorption in retinal arterioles, resulting in a lower AV difference, particularly in patients with a high free light chain level.
Survey showed that very few paediatric residents in Southwest Nigeria were interested in specialising in gastroenterology
Authors: Senbanjo Idowu O. , Abolurin Olufunmilola O. , Ezegamba Comfort O. , Akinbami Felix O. , Allen Stephen J.
Published: August 2022

Aim

Paediatric gastroenterology remains an under‐recognised sub‐speciality in Africa. We determined the preferred sub‐specialities among paediatric residents in Southwest Nigeria and what influenced whether they chose paediatric gastroenterology.

Methods

This was a cross‐sectional survey of paediatric residents in seven teaching hospitals in Southwest Nigeria. A self‐administered questionnaire was used to obtain information on their socio‐demographics, educational attainment, choice of sub‐speciality and the factors influencing that choice.

Results

Of 144 eligible paediatric residents, 124 (86.1%) completed the survey. Their mean age was 35.0 ± 1.7 years, and 83 (66.9%) were females. The majority (94.4%) had already chosen their sub‐speciality, and nearly two‐thirds (65.0%) made the decision during training. The most popular sub‐speciality was neonatology (30.6%), and only three (2.4%) residents chose gastroenterology. Factors influencing the choice of sub‐speciality were perceived ability (85.3%) and academic experience (83.8%). Financial reasons were less frequent (32.5%). Lack of diagnostic equipment (30.6%) and role models (21.0%) were the most frequent reasons for residents being disinterested in paediatric gastroenterology.

Conclusion

Few residents were interested in paediatric gastroenterology and there is a need to encourage interest in this subject at an early stage in their training and provide more diagnostic equipment and greater mentorship.
To forgive or not to forgive an organisation: Perceived integrity versus competence transgressions shape consumers' forgiveness of transgressing organisations
Authors: Noor Masi , Chao Melody M. , Doosje Bertjan
Published: August 2022

Forgiveness can de‐escalate conflicts and transform resentment into constructive responses. Although we have learned much about interpersonal and intergroup forgiveness in the last two decades (Fehr et al., 2010; Noor, 2016; Van Tongeren et al., 2014), we still know little about the dynamics underpinning individuals' forgiveness of organisational transgressions. We report two studies that investigated the importance of perceived transgression types (lack of integrity vs. lack of competence vs. control) in determining forgiveness towards transgressing organisations. In both studies, organisations were less forgivable when their transgressions were attributed to the lack of integrity (vs. competence or control condition). Forgiveness mediated the negative impact of transgression on punitiveness, highlighting the buffering role of forgiveness in the aftermath of organisational failings. Our findings generalised across both public and private organisations, different designs and cultural contexts.
Incidence and preventability of hospital admissions for adverse drug reactions in France: A prospective observational study (IATROSTAT)
Authors: Laroche Marie‐Laure , Gautier Sophie , Polard Elisabeth , Rabier Marie‐Blanche , Chouchana Laurent , Lebrun‐Vignes Bénédicte , Faillie Jean‐Luc , Petitpain Nadine , Lagarce Laurence , Jonville‐Bera Annie‐Pierre ,   for the IATROSTAT study group
Published: August 2022

Aims

In the last French study in 2007, the incidence of hospital admissions (HAs) related to adverse drug reactions (ADRs) was 3.6%. The objective was to assess the current ADR‐HA incidence in France and to describe both its characteristics and preventability.

Methods

A prospective multicentre study was conducted among randomly selected French public hospital medical wards (April–July 2018). Patients admitted during a week period were included. ADR‐HA cases were collected by the French Regional Pharmacovigilance Centres network. An independent committee validated potential cases and ADR preventability.

Results

ADR‐HA incidence was 8.5% (95% confidence interval [CI]: 7.6–9.4%), increasing with age (3.3% [95%CI: 1.8–5.5%] ≤16 y vs. 10.6% [95%CI: 9.3–12.0%] ≥65 y). The most common ADRs were haemorrhagic events (8.8%), haematological disorders (6.5%), acute renal failure (6.3%), fluid and electrolyte disorders (6.0%), and falls (5.2%). New drugs were involved: targeted therapies (22.8% of antineoplastics), direct oral anticoagulants (29.6% of antithrombotics) and incretin‐based drugs (20.0% of antidiabetics). ADRs were preventable in 16.1% of cases because the drugs involved had not been used in accordance with monographies, package leaflets or other therapeutic guidelines. The main situations of noncompliance addressed either dose or duration of use (27.9%), warning (23.2%), use precaution (18.6%) and inappropriate self‐medication or misuse by patients (11.6%).

Conclusion

In France, ADR‐HA incidence dramatically increased over the last decade. A significant proportion was related to new pharmacological classes and considered as preventable. These findings should lead to in‐depth thought on preventive actions on at‐risk drug classes.
Dystopian Eugenics and Mestizo Futurisms in Eduardo Urzaiz'sEugenia
Authors: Sanchez‐Rivera R.
Published: August 2022

Set in 2218, the novelEugeniaenvisions a contradictory utopian and dystopian future premised upon eugenical engineering. Here, I analyse Urzaiz's vision of the beginnings of eugenics in Mexico. Ultimately, I argue that Villautopia is presented as ever‐vigilant and always responding to threats of degeneracy and social disorder, which accurately the reflect eugenicist underpinnings of Urzaiz's time. An analysis of Urzaiz himself and the Yucatán context is key as it envisions, translates and produces new eugenic ideas that deterritorialise eugenics and portrays it both in a ‘positive’ way while providing a series of ‘negative’ possibilities as a probable outcome.
Effectiveness of endoscopic screening for gastric cancer: The Japan Public Health Center‐based Prospective Study
Authors: Narii Nobuhiro , Sobue Tomotaka , Zha Ling , Kitamura Tetsuhisa , Iwasaki Motoki , Inoue Manami , Yamaji Taiki , Tsugane Shoichiro , Sawada Norie
Published: August 2022

Upper gastrointestinal endoscopy for gastric cancer screening has been implemented in Japan. However, its effectiveness for gastric cancer prevention has not been fully studied. We aimed to investigate the effectiveness of endoscopic screening to reduce mortality from gastric cancer. In a large prospective population‐based cohort study including 80,272 participants, we compared the risk of mortality and incidence of gastric cancer among participants who underwent endoscopic or radiographic screening compared with those who did not undergo any screening using multivariable Cox proportional hazards models. In the 1,023,364 person‐year observation period (median; 13.0 years), 1977 cases of gastric cancer were diagnosed, and 783 patients with gastric cancer died. In the endoscopic screening group, the mortality from gastric cancer and incidence of advanced gastric cancer were reduced by 61% (hazard ratio [HR] = 0.39 [95% CI: 0.30–0.51]) and 22% (HR = 0.78 [95% CI: 0.67–0.90]), respectively. The radiographic screening reduced the mortality from gastric cancer (HR = 0.63 [95% CI: 0.54–0.73]), but its effectiveness was lower than that of endoscopic screening. In conclusion, endoscopic screening reduced the incidence of advanced gastric cancer and mortality from gastric cancer in the Japanese population.
Efficient Sufficiency: A qualitative evaluation of a 1 year pilot study of young people and parents accessing a mental health drop‐in centre in a paediatric hospital
Authors: Catanzano Matteo , Bennett Sophie D. , Fifield Kate , Xu Laila , Sanderson Charlotte , Coughtrey Anna E. , Kerry Ellie , Liang Holan , Heyman Isobel , Shafran Roz
Published: August 2022

Background

Children and young people with long‐term physical health conditions (LTC) are known to have higher levels of co‐morbid mental health problems than medically healthy children. Evidence‐based treatments for mental health problems are effective in children who also have an LTC. This study aimed to explore the factors associated with participants' perceived acceptability and impact of a transdiagnostic mental health centre offering brief psychological assessment and treatment for children and young people and/or their families with mental health needs in the context of long term physical conditions.

Methods

One‐hundred twenty‐eight patients attending the drop‐in centre were invited to participate. Overall, 35 participated (31 parents/carers; 4 children and young people) in semi‐structured interviews (either in person or by phone) exploring their experience of the centre. Interviews were audio‐recorded, transcribed and checked. Framework analysis was then conducted on all transcripts.

Results

Overall, participants found the drop‐in centre highly acceptable and reported a positive experience. Reasons for this varied but broadly focused around four themes: (1) efficient sufficiency; (2) autonomy; (3) fusion of process and content factors and (4) (dis)parities of esteems and ‘seeing both sides of the coin’.

Conclusions

Participants found the intervention acceptable. A mental health drop‐in centre in a paediatric hospital appears to be a positive and valued adjunct to supplement existing mental health services.
The future is present in the past: A meta‐analysis on the longitudinal associations of parent–adolescent relationships with peer and romantic relationships
Authors: Schulz Susanne , Nelemans Stefanie , Hadiwijaya Hana , Klimstra Theo , Crocetti Elisabetta , Branje Susan , Meeus Wim
Published: August 2022

Positive peer and romantic relationships are crucial for adolescents' positive adjustment and relationships with parents lay the foundation for these relationships. This longitudinal meta‐analysis examined how parent–adolescent relationships continue into later peer and romantic relationships. Included longitudinal studies (k = 54 involving peer relationships, k = 38 involving romantic relationships) contained demographically diverse samples from predominantly Western cultural contexts. Multilevel meta‐regressions indicated that supportive and negative parent–adolescent relationships were associated with supportive and negative future peer and romantic relationships. Meta‐analytic structural equation modeling (k = 54) indicated that supportive parent–adolescent relationships unidirectionally predicted supportive and negative peer relationships, while negative parent–adolescent relationships were bidirectionally associated with supportive and negative peer relationships. Maintaining mutually supportive relationships with parents may help adolescents to develop positive social relationships.
Identification of a de novo mutation of the elastin gene by targeted exome sequencing in autosomal dominant cutis laxa
Authors: Makino Teruhiko , Terada Yoshiyuki , Mizawa Megumi , Hirono Keiichi , Adachi Yuichi , Aoki Satomi , Kubo Akiharu , Shimizu Tadamichi
Published: August 2022

Cutis laxa (CL) comprises a heterogeneous group of entities mainly classified as X-linked, autosomal dominant and recessive forms, which differ in severity. We encountered a CL baby with no familial history. We performed targeted exome sequencing, and detected a de novo heterozygous frameshift mutation in the elastin gene of the baby.
Exposure to oestrogen and risk of anastomotic leakage after colorectal cancer surgery – A clue to the different leak rates in men and women
Authors: Rutegård Martin , Moshtaghi‐Svensson John , Weibull Caroline E. , Ottander Ulrika , Nordenvall Caroline , Sund Malin
Published: August 2022

Background

Colorectal anastomotic leakage is consistently more common in men, regardless of tumour location. This fact is largely unexplained but might be a consequence of biological differences including hormonal exposure and not only related to anatomy.

Methods

This was a retrospective, nationwide registry‐based observational study of post‐menopausal women operated for colorectal cancer with an anastomosis between 2007 and 2016. Hormonal exposure before surgery, as defined by prescribed drugs affecting oestrogen levels, was related to postoperative anastomotic leakage, using mixed‐effects logistic regression models with adjustment for confounding. Odds ratios (ORs) with corresponding 95% confidence intervals (CIs) were derived. In addition, separate estimates according to tumour location were computed, and a sensitivity analysis excluding topical oestrogen hormone exposure was conducted.

Results

Some 16,535 post‐menopausal women were included, of which 16.2% were exposed to drugs increasing oestrogen levels before surgery. In this exposed group compared to the unexposed, leak rates were 3.1 and 3.8%, respectively. After adjustment, a reduction of anastomotic leakage in the exposed group was detected (OR: 0.77; 95% CI: 0.59–0.99). This finding was largely attributed to the rectal cancer subgroup (OR: 0.55; 95% CI: 0.36–0.85), while the exclusion of topical oestrogen drugs further reduced the estimates of the main analysis (OR: 0.63; 95% CI: 0.38–1.02).

Conclusions

Anastomotic leakage rates are lower in women exposed to hormone replacement therapy before surgery for colorectal cancer, which might explain some of the difference in leak rates between men and women, especially regarding rectal cancer.
Incidence and risk factors for secondary failure after acute obstetric sphincter injury repair – an audit of 239 women
Authors: Jain Anshini , Lew Chen , Thungathruthi Kaushik , Ng Suat Chin , Hiscock Richard , Mirbagheri Naseem
Published: August 2022

Aim

The rate of secondary failure after obstetric sphincter injury repair is unknown, with the literature reporting rates ranging from 0.1% to 53%. We aimed to perform an audit to identify the rate and risk factors for failure of sphincter repair in a cohort of postpartum women using endoanal ultrasound (EAUS) and manometry, assessing the risk factors and impact of these events.

Method

Prospective data were collected within a 2 year period from patients who attended the perineal clinic at Eastern Health. Variables of primary repair and presence of postpartum complications were recorded and subsequently analysed.

Results

Of 239 patients with obstetric anal sphincter injury (OASI) included, 100 (41.8%) had EUAS evidence of sphincter defects. Only 20% with secondary repair failure were symptomatic with faecal or flatal incontinence at a mean follow‐up of 23.4 months postpartum. Patients with secondary repair failure had lower anal resting (p = 0.006) and maximum squeeze pressures compared with patients with intact repairs (p < 0.001). In terms of variables that were investigated, namely location, operator hierarchy, type of repair and material used, none had a statistically significant correlation with secondary repair failure of OASI. Postpartum complications had an overall incidence of 12.7%, and those with any complication were found to have an increased rate of secondary failure of repair (p = 0.157).

Conclusion

Using EAUS to confirm secondary failure of repair, incidence was 41.4% in this cohort. There were no identifiable modifiable variables that reduced the risk of secondary failure of repair. Further prospective research with increased sample size and longer follow‐up periods is required to assess the validity of the findings.
Reasoning AboutWant
Authors: Harner Hillary , Khemlani Sangeet
Published: August 2022

No present theory explains the inferences people draw about the real world when reasoning about “bouletic” relations, that is, predicates that express desires, such aswantin “Lee wants to be in love”. Linguistic accounts ofwantdefine it in terms of a relation to a desirer's beliefs, and how its complement is deemed desirable. In contrast, we describe a new model‐based theory that posits that by default, desire predicates such aswantcontrast desires against facts. In particular,A wants Pimplies by default thatPis not the case, because you cannot want what is already true. On further deliberation, reasoners may infer thatA believes, but does not know for certain, thatPis not the case. The theory makes several empirical predictions about how people interpret, assess the consistency of, and draw conclusions from desire predicates likewant. Seven experiments tested and validated the theory's central predictions. We assess the theory in light of recent proposals of desire predicates.
Donor hypernatremia is associated with increased mortality after heart transplantation: A retrospective study
Authors: Oehler Daniel , Immohr Moritz Benjamin , Böttger Charlotte , Bruno Raphael Romano , Sigetti Dennis , Haschemi Jafer , Aubin Hug , Horn Patrick , Tudorache Igor , Westenfeld Ralf , Akhyari Payam , Kelm Malte , Lichtenberg Artur , Boeken Udo
Published: August 2022

Background and aims

Donor hypernatremia has been associated with primary graft dysfunction in heart transplantation (HTx) and is correlated with impaired outcome following liver and renal transplantation. However, controversial data exist regarding the impact of sodium dysregulation on survival. This study aims to investigate the impact of donor sodium levels on early morbidity and short‐ and midterm survival following HTx.

Methods

Between September 2010 and June 2021, a total of n = 218 patients underwent HTx in our center. From those, 214 could be included retrospectively in our study. For each donor, sodium levels were collected and different cut‐off levels from 145 to 159 mmol/L were investigated by Kaplan‐Meier‐analysis. Then, recipients were divided in three groups regarding donor sodium: Normonatremia (133–145 mmol/L, n = 73), mild hypernatremia (146–156 mmol/L, n = 105) and severe hypernatremia (>156 mmol/L, n = 35). Recipient and donor variables were reviewed and compared, including peri‐ and postoperative characteristics and recipient survival after up to 5 years after transplantation.

Results

All patients were comparable regarding baseline characteristics and perioperative parameters. Regarding early mortality, 90‐day survival was significantly reduced only in patients with severe donor hypernatremia in comparison to normonatremia (90% vs. 71%, p = .02), but not in mild hypernatremia (89%, p = .89). One‐year survival was comparable in all groups (p > .28).

Conclusion

Severe donor hypernatremia was associated with reduced short‐term survival, while the correlation weakens > 1 year after HTx. As our study is limited due to the nature of its retrospective, single‐center approach, future prospective studies are needed to evaluate the importance of donor management with regard to hypernatremia.
New insights into the formation of biodiversity hotspots of the Kenyan flora
Authors: Zhang Qiang , Ye Jian‐Fei , Le Chi‐Toan , Njenga Dennis Mwithukia , Rabarijaona Narindra Romer , Omollo Wyckliffe Omondi , Lu Li‐Min , Liu Bing , Chen Zhi‐Duan
Published: August 2022

Aim

This study aimed to investigate the distribution patterns of plant diversity in Kenya, how climatic fluctuations and orogeny shaped them, and the formation of its β‐diversity.

Location

Kenya, East Africa.

Taxon

Angiosperms.

Methods

We quantified patterns of turnover and nestedness components of phylogenetic β‐diversity for angiosperm species among neighbouring sites using a well‐resolved phylogenetic tree and extensive distribution records from public databases and other published sources. We applied clustering methods to delineate biota based on pairwise similarities among multiple sites and used a random assembly null model to assess the effects of species abundance distribution on phylogenetic β‐diversity.

Results

The phylogenetic turnover of the Kenyan flora, intersecting with the biodiversity hotspots Eastern Afromontane, Coastal Forests of Eastern Africa, and Horn of Africa, shows a non‐monotonic pattern along a latitudinal gradient that is strongly structured into volcanic and coastal areas. The other areas are mainly dominated by phylogenetic nestedness, even in the eastern part of the equatorial region parallel to the volcanic area. Phylogenetic diversity and phylogenetic structure analyses explain the mechanism of the observed phylogenetic turnover and nestedness patterns. We identified five phytogeographical regions in Kenya: the Mandera, Turkana, Volcanic, Pan Coastal and West Highland Regions.

Conclusions

Variations in turnover gradient and coexistence are highly dependent on the regional biogeographical history resulting from climatic fluctuations and long‐lasting orogeny, which jointly shaped the biodiversity patterns of the Kenyan flora. The nestedness component dominated climatically unstable regions and is presumed to have been caused by heavy local species extinction and recolonization from the Volcanic Region. The high turnover component in climatically stable regions may have preserved old lineages and the prevalence of endemic species within narrow ranges.
Forecasting climate change response in an alpine specialist songbird reveals the importance of considering novel climate
Authors: DeSaix Matthew G. , George T. Luke , Seglund Amy E. , Spellman Garth M. , Zavaleta Erika S. , Ruegg Kristen C.
Published: August 2022

Aim

Species persistence in the face of climate change depends on both ecological and evolutionary factors. Here, we integrate ecological and whole‐genome sequencing data to describe how populations of an alpine specialist, the Brown‐capped Rosy‐Finch (Leucosticte australis) may be impacted by climate change.

Location

Southern Rocky Mountains in North America.

Methods

We sampled 116 Brown‐capped Rosy‐Finches from 11 sampling locations across the breeding range. Using 429,442 genetic markers from whole‐genome sequencing, we described population genetic structure and identified a subset of 436 genomic variants associated with environmental data. We modelled future climate change impacts on habitat suitability using ecological niche models (ENMs) and impacts on putative local adaptation using gradient forest models (a genetic‐environment association analysis; GEA). We used the metric of niche margin index (NMI) to determine regions of forecasting uncertainty due to climate shifts to novel conditions.

Results

Population genetic structure was characterized by weak genetic differentiation, indicating potential ongoing gene flow among populations. Precipitation as snow had high importance for both habitat suitability and changes in genetic variation across the landscape. Comparing ENM and gradient forest models with future climate predicted suitable habitat contracting at high elevations and population allele frequencies across the breeding range needing to shift to keep pace with climate change. NMI revealed large portions of the breeding range shifting to novel climate conditions.

Main conclusions

Our study demonstrates that forecasting climate vulnerability from ecological and evolutionary factors reveals insights into population‐level vulnerability to climate change that are obfuscated when either approach is considered independently. For the Brown‐capped Rosy‐Finch, our results suggest that persistence may depend on rapid adaptation to novel climate conditions in a contracted breeding range. Importantly, we demonstrate the need to characterize novel climate conditions that influence uncertainty in forecasting methods.
Barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior gestational diabetes: A systematic review and qualitative synthesis applying the theoretical domains framework
Authors: Neven Adriana C. H. , Lake Amelia J. , Williams Amelia , O'Reilly Sharleen L. , Hendrieckx Christel , Morrison Melinda , Dunbar James A. , Speight Jane , Teede Helena , Boyle Jacqueline A. ,   the ME‐MaGDA Study Group
Published: August 2022

Aims

Racial and ethnic disparities exist in gestational diabetes prevalence and risk of subsequent type 2 diabetes mellitus (T2DM). Postpartum engagement in healthy behaviours is recommended for prevention and early detection of T2DM, yet uptake is low among women from diverse cultural backgrounds. Greater understanding of factors impacting postpartum health behaviours is needed. Applying theTheoretical Domains Framework(TDF) andCapability,Opportunity,Motivation‐Behaviour(COM‐B) model, our aim was to synthesise barriers to and enablers of postpartum health behaviours among women from diverse cultural backgrounds with prior GDM and identify relevant intervention components.

Methods

Databases, reference lists and grey literature were searched from September 2017 to April 2021. Two reviewers screened articles independently against inclusion criteria and extracted data. Using an inductive–deductive model, themes were mapped to the TDF and COM‐B model.

Results

After screening 5148 citations and 139 full texts, we included 35 studies (N = 787 participants). The main ethnicities included Asian (43%), Indigenous (15%) and African (11%). Barriers and enablers focused onCapability(e.g. knowledge),Opportunity(e.g. competing demands, social support from family, friends and healthcare professionals, culturally appropriate education and resources) andMotivation(e.g. negative emotions, perceived consequences and necessity of health behaviours, social/cultural identity). Five relevant intervention functions are identified to link the barriers and enablers to evidence‐based recommendations for communications to support behaviour change.

Conclusions

We provide a conceptual model to inform recommendations regarding the development of messaging and interventions to support women from diverse cultural backgrounds in engaging in healthy behaviours to reduce risk of T2DM.
A systematic review and meta‐analysis on oncological radiotherapy in patients with a cardiac implantable electronic device: Prevalence and predictors of device malfunction in 3121 patients
Authors: Malavasi Vincenzo Livio , Imberti Jacopo Francesco , Tosetti Alberto , Romiti Giulio Francesco , Vitolo Marco , Zecchin Massimo , Mazzeo Ercole , Giuseppina De Marco , Lohr Frank , Lopez‐Fernandez Teresa , Boriani Giuseppe
Published: August 2022

Background

The number of patients with cardiac implantable electronic devices (CIEDs) undergoing radiotherapy (RT) for cancer treatment is growing. At present, prevalence and predictors of RT‐induced CIEDs malfunctions are not defined.

Methods

Systematic review and meta‐analysis conducted following the PRISMA recommendations. PubMed, Scopus and Google Scholar were searched from inception to 31/01/2022 for studies reporting RT‐induced malfunctions in CIEDs patients. Aim was to assess the prevalence of RT‐induced CIEDs malfunctions and identify potential predictors.

Results

Thirty‐two out of 3962 records matched the inclusion criteria and were included in the meta‐analysis. A total of 135 CIEDs malfunctions were detected among 3121 patients (6.6%, 95% confidence interval [CI]: 5.1%–8.4%). The pooled prevalence increased moving from pacemaker (PM) to implantable cardioverter defibrillator (ICD), and cardiac resynchronization therapy and defibrillator (CRT‐D) groups (4.1%, 95% CI: 2.9–5.8; 8.2% 95% CI: 5.9–11.3; and 19.8%, 95% CI: 11.4–32.2 respectively). A higher risk ratio (RR) of malfunctions was found when neutron‐producing energies were used as compared to non‐neutron‐producing energies (RR 9.98, 95% CI: 5.09–19.60) and in patients with ICD/CRT‐D as compared to patients with PM/CRT‐P (RR 2.07, 95% CI: 1.40–3.06). On the contrary, no association was found between maximal radiation dose at CIED >2 Gy and CIEDs malfunctions (RR 0.93; 95% CI: 0.31–2.76).

Conclusions

Radiotherapy related CIEDs malfunction had a prevalence ranging from 4% to 20%. The use of neutron‐producing energies and more complex devices (ICD/CRT‐D) were associated with higher risk of device malfunction, while the radiation dose at CIED did not significantly impact on the risk unless higher doses (>10 Gy) were used.
ShareChain: Blockchain‐enabled model for sharing patient data using federated learning and differential privacy
Authors: Javed Laraib , Anjum Adeel , Yakubu Bello Musa , Iqbal Majid , Moqurrab Syed Atif , Srivastava Gautam
Published: August 2022

Every individual in our technologically evolved world needs proper data security. The procedure of exchanging medical information is increasingly concerned with data privacy. Many techniques have been offered for preserving data security. These techniques use approaches such as ‐anonymity, ‐diversity, and others. However, such solutions are vulnerable to attribute disclosure, homogeneity, and background knowledge risks due to their syntactic nature. In this work, we describe a safe and secure architecture and semantic approach for data sharing that is based on blockchain, local differential privacy (LDP), and federated learning (FL). The proposed framework generates an atmosphere devoid of trust in which data owners are no longer required to have trust in the controllers. The FL models enable the whole network to decentralize its data‐driven learning. Interplanetary file system (IPFS) is used to provide data security in a distributed environment because each file in IPFS has a digital fingerprint that is computed using a cryptographic hash function on the file's whole contents. Due to the rigorous privacy guarantee, data owners no longer need to be worried about the security of their data. The proposed model's assessment parameters include latency, throughput, privacy, and accuracy. The data privacy of the proposed model is protected via LDP and FL, and its latency and throughput communication transactions on permissioned blockchain are calculated and compared with those of the benchmark model. The findings indicate that the proposed model delivers 85% more accurate privacy than the benchmark model.
Effect of microstructural heterogeneity on fatigue strength predicted by reinforcement machine learning
Authors: Awd Mustafa , Münstermann Sebastian , Walther Frank
Published: August 2022

The posterior statistical distributions of fatigue strength are determined using Bayesian inferential statistics and the Metropolis Monte Carlo method. This study explores how structural heterogeneity affects ultrahigh cycle fatigue strength in additive manufacturing. Monte Carlo methods and procedures may assist estimate fatigue strength posteriors and scatter. The acceptable probability in Metropolis Monte Carlo relies on the Markov chain's random microstructure state. In addition to commonly studied variables, the proportion of chemical composition was demonstrated to substantially impact fatigue strength if fatigue lifetime in crack propagation did not prevail due to high threshold internal notches. The study utilizes an algorithm typically used for quantum mechanics to solve the complicated multifactorial fatigue problem. The inputs and outputs are modified by fitting the microstructural heterogeneities into the Metropolis Monte Carlo algorithm. The main advantage here is applying a general‐purpose nonphenomenological model that can be applied to multiple influencing factors without high numerical penalty.