bluuebunny/crossref_metadata_2025 huggingface dataset:
Endovascular Aortic Repair for a Symptomatic Mycotic Aneurysm With Listeria monocytogenes: A Case Report
Authors: Masuda Noriyasu , Azuma Takashi , Furukawa Hiroshi , Uwabe Kazuhiko
Published: January 2023

Purpose

To report a case of successful endovascular aortic repair for a symptomatic mycotic abdominal aortic aneurysm infected with Listeria monocytogenes.

Case Report

We report the case of an 88-year-old woman who presented with acute abdominal pain and vomiting. Approximately a year prior to her presentation, the patient was diagnosed with a mycotic abdominal aortic aneurysm with Listeria monocytogenes and was treated conservatively for more than 2 months at another hospital. At our hospital, contrast-enhanced computed tomography revealed an abdominal aortic aneurysm and an aneurysm of the left internal iliac artery. Endovascular aortic repair was performed successfully. At 16 months after the surgery, the patient remained asymptomatic on long-term antibiotics, and there was no enlargement of the aneurysm.

Conclusion

Endovascular aortic repair and lifelong antibiotics may be an alternative therapy for mycotic abdominal aortic aneurysms. However, the risk of recurrent infection is high and warrants long-term follow-up.
Jordanian Undergraduate Students’ Views of Participation in Clinical Trials: The COVID-19 Example
Authors: Ahram Mamoun , Al-Qaryouti Rahaf A. , Qarkash Dania S. , Salaymeh Omar F. , Shaqqour Raghad A.
Published: January 2023

The emergence of the COVID-19 pandemic has necessitated broad public participation in clinical trials. Knowledge of the attitudes of the relatively young would provide a perspective on future representative public enrollment in clinical trials. This study investigated the attitudes of undergraduate university students toward participation in COVID-19 clinical trials and determined the predictors of their attitudes. Using a validated, web-based questionnaire, 61.2% of the 425 respondents had heard about clinical trials before. Web-based media were the main sources of this knowledge. Less than 20% expressed willingness to participate in COVID-19 clinical trials or support the participation of a family member. The predictors were personal and family protection from the disease. On the contrary, being a female, possible political exploitation of the vaccine or drug, and their potential inefficacy were predictors of unwillingness to participate. This study may inform different stakeholders in developing effective study recruitment strategies to combat current and emerging pathogens.
Research Integrity Attitudes and Behaviors are Difficult to alter: Results from a ten Year Follow-up Study in Norway
Authors: Hofmann Bjørn , Thoresen Magne , Holm Søren
Published: January 2023

Background: Research integrity has obtained much attention in research communities, but also in the general public. To improve research integrity is difficult as it involves complex systems of knowledge, attitudes, and practices. The objective of this study is to investigate the knowledge, attitudes, and practices of cohorts of PhD candidates at one faculty (of medicine) over time and compare this to finished PhDs of the same cohorts. Material and method: Researchers (n  =  186) awarded the degree PhD at the Faculty of Medicine at the University of Oslo in 2019 were invited to answer a questionnaire about knowledge, attitudes and actions related to scientific dishonesty. 94 responded (50.5%). The results were compared with results among first-year PhD candidates who responded to the same questionnaire during 2010–20 (n  =  536) and to those who finished PhDs in 2016 (n  =  86). Results: For the years 2010–2020 1.1% of the PhD candidates report to have engaged in severe scientific misconduct (FFP) while 0.9% report to have presented results in a misleading way. 2.3% report that they know of persons at their department who have engaged in FFP the last 12 months. In total 1.5% report to have experienced pressure to engage in severe scientific misconduct (FFP) while 2.1% report to have experienced pressure to present results in a misleading way. On average 12.8% report to have been exposed to unethical pressure concerning inclusion or ordering of authors during the last 12 months, and 28.8% report to have knowledge about their department's written policies about research integrity. While some attitudes improve over the years, attitudes in general are not much changed from 2010–2020. None of the PhDs that received a PhD from the Faculty of Medicine at the University of Oslo in 2019 reported to have engaged in FFT or having experienced pressure to do so.1.1% experienced pressure to present results in other misleading ways, while 26.6% of respondents had experienced unethical pressure in relation to authorship during the course of the PhD fellowship. 4.3% knew about someone at their department who had presented results in a misleading manner. Some attitudes were not in line with traditional conceptions of research integrity, but most agreed that their research environment displayed research integrity. Conclusion: This long-term follow up study shows that few PhD-candidates report to engage in severe scientific misconduct, that they experience little pressure to do so, and with some exceptions, attitudes in in line with good research integrity. However, pressure in relation to authorship is relatively common. There is some improvement in research integrity from PhD candidates to recently finished PhDs, but in general research integrity is stable over time.
Post-Sexual Assault Decision Making: Centering Black Women’s Experiences
Authors: Kelley Shamika M.
Published: January 2023

Existing research has identified various reasons most sexual assault victims do not seek help. There remains a need, however, to highlight Black women’s experiences to better understand and adequately meet their needs when they seek help. This project extends existing bodies of knowledge by centering Black women, situating their experiences within a Black feminist framework, and evaluating their experiences as they seek help to understand factors that shape their reporting decisions. Findings suggest that as Black women seek medical help, they consider culture-specific and real rape factors during the police reporting decision. Key findings, implications, and policy recommendations are discussed.
Glutamate acts as a key neurotransmitter for itch in the mammalian spinal cord
Authors: Chen Qi-Yu , Zhuo Min
Published: January 2023

Itch sensation is one of the major sensory experiences of humans and animals. Recent studies using genetic deletion techniques have proposed that gastrin-releasing peptide (GRP) is a key neurotransmitter for itch in the spinal cord. However, these studies are mainly based on behavioral responses and lack direct electrophysiological evidence that GRP indeed mediates itch information between primary afferent fibers and spinal dorsal horn neurons. In this review, we reviewed recent studies using different experimental approaches and proposed that glutamate but not GRP acts as the key neurotransmitter in the primary afferents in the transmission of itch. GRP is more likely to serve as an itch-related neuromodulator. In the cerebral cortex, we propose that the anterior cingulate cortex (ACC) plays a significant role in both itch and pain sensations. Only behavioral measurement of itch (scratching) is not sufficient for itch measurement, since scratching the itching area also produces pleasure. Integrative experimental approaches as well as better behavioral scoring models are needed to help to understand the neuronal mechanism of itch and aid future treatment for patients with pruritic diseases.
Scapholunate ligament reconstruction using a part of the extensor carpi radialis brevis tendon through a dorsal approach
Authors: Oeckenpöhler Simon , Wieskötter Britta , Aitzetmüller Matthias , Klietz Marie Luise , Royeck Thorben , Langer Martin Franz
Published: January 2023

Thirty-six patients were assessed after scapholunate ligament reconstruction using a portion of the extensor carpi radialis brevis through a dorsal approach. The median age was 53 years. Most (27/38) were graded as scapholunate advanced collapse Grade I. At a median of 47 months after treatment, hand function using the Disabilities of Arm, Shoulder and Hand Questionnaire was 12. The postoperative range of wrist flexion and extension movement was 77% and grip strength 92% compared with the uninjured side. The median patient satisfaction was rated as 9/10. Median pain scores without and with load, using the numeric pain scale (0–10), were 1 and 3, respectively. This reconstruction leads to initial normalization of radiological features, such as scapholunate interval, scapholunate and radiolunate angles, but a notable loss of the immediate postoperative reduction was observed in long-term follow-up, which was not accompanied by any deterioration in the clinical examination. This technique, even in scapholunate advanced collapse type I wrists, resulted in long-term, improved outcomes compared with other techniques.

Level of evidence: IV
An analytics approach to health and healthcare in citizen science communications on Twitter
Authors: Martínez-Martínez Fernando , Roldán-Álvarez David , Martín Estefanía , Hoppe H Ulrich
Published: January 2023

Background

Citizen science is a growing practice in which volunteers, including non-scientists, conduct or contribute to research by collecting and analyzing data. The increasing importance of citizen science in the last years has led to an increased interest in detecting how citizen science can contribute to scientific advancements in different areas. Recent research shows that citizen science has become a means of engagement between scientist and the public, encouraging scientific curiosity and promoting scientific knowledge.

Methods

In this article, we report on how to apply computational analysis techniques to Twitter messages to reveal the impact of citizen science in health-related areas. The main objectives are (1) to characterize central topics of these discussions, and (2) to identify particularly important actors in these social media networks.

Results

For the topics, our findings suggest that sustainable development goals, technologies and health, and COVID-19 are those most addressed by the users. Other topics represented in the data are cancer, public health, mental health, and health and well being of sea and earth living creatures related to sustainable development goals.

Conclusion

Based on our results, those entities or actors who are most cited and retweeted are Twitter accounts of projects and not primarily individual professionals or citizen scientists.
Practice, Performance, and Anxiety: A Pilot Study on Student Perception of Parental Involvement and Formal Music Lessons
Authors: Ryan Charlene , Boucher Hélène , Ryan Gina
Published: January 2023

Parents play a variety of important roles in their children's musical development. However, whether they impact upon children's music performance education and experience has only begun to be considered. The current study sought to examine whether student perception of parent involvement in music and performance education is related to their experience of music performance anxiety. Sixty-two piano students aged 11 to 17 completed a questionnaire regarding their piano studies, their parents’ involvement in them, and their parents’ prior music education. They also completed measures of performance anxiety and self-esteem. Results indicated that parents’ prior music education was significantly associated with performance anxiety in their children. Participant age, self-esteem, and practice time were also significant variables. Measures of parent involvement in music studies and parent response to weak performances were not found to be significantly related to performance anxiety scores. Implications of these findings and directions for furthering this line of research are discussed.
Chronic Illness Patients’ Perceptions of Quality of Care During Hospitalization: A Qualitative Study
Authors: Tunsi Afnan , Alhelal Raneem , Mujalled Raneem , Alhadrami Erghad , Alsulami Rahaf , Alhofaian Aisha , Alaamri Marym , Babkair Lisa
Published: January 2023

Introduction

The rising prevalence of patients living with chronic illnesses and frequent hospitalizations represent many challenges in delivering high-quality care. Assessing patients’ perceptions and needs regarding the quality of health care services is a critical step in improving quality of care.

Objective

This study sought to explore the perception of quality of care from the perspectives and experiences of chronically ill patients during hospitalization.

Methods

This study was conducted using a qualitative descriptive design. Face-to-face semi-structured individual interviews were conducted with 15 chronically ill patients at their bedside during their current hospital admission. Analysis followed Braun and Clarke's thematic analysis approach.

Results

Overall patients were pleased with their hospitalization experience; however, they highlighted many aspects of care that can be addressed to improve the quality of care provided. Five themes were identified from the analysis as follows: defining quality of care; aspects related to the healthcare providers; unmet care needs; patient's involvement in healthcare decisions and care expectations and outcomes.

Conclusion

A key finding of this study was the association between quality of care and healthcare providers’ skills, clinical competence, and attitudes. Poor communication and discoordination of care were the most significant impediment expressed. Actively involving patients in care may be effective when combined with meeting expectations. The findings of this study helped to identify the strength points and areas of improvement that are the cornerstone for developing tailored and patient-centered strategies to improve the quality of care during hospitalizations among chronically ill Saudis.
Knowledge, Attitudes, and Practices of Hypertensive Patients Towards Stroke Prevention Among Rural Population in Saudi Arabia: A Cross-Sectional Study
Authors: Alhowaymel Fahad M. , Abdelmalik Mohammed A. , Mohammed Almoez M. , Mohamaed Mohamaed O. , Alenezi Atallah
Published: January 2023

Introduction

Stroke is a significant health problem and is considered one of the leading causes of mortality and permanent disability worldwide. Hypertension is a primary risk factor for stroke. Thus, hypertensive patients’ knowledge, attitudes, and practices (KAP) are essential in preventing stroke.

Objective

To examine hypertensive patients’ KAP towards stroke prevention among rural population in Saudi Arabia.

Methods

The study utilized a cross-sectional design. The data were collected using a convenience sampling technique from hypertensive patients in the northwestern rural areas of Riyadh Province. A self-administered questionnaire was adapted from the Stroke Recognition Questionnaire (SRQ) and utilized to assess KAP towards stroke prevention among rural hypertensive patients. The STrengthening of the Reporting of OBservational studies in Epidemiology (STROBE) checklist was used to report the study.

Results

A total of 196 hypertensive patients participated in the study. The total mean scores categorization into three quartiles showed that most respondents had poor levels of KAP towards stroke prevention. Weak positive correlations were found between KAP of patients. There were statistically significant differences between respondents’ attitudes and practices with their age, education, marital status, and occupational status.

Discussion

This study denoted poor levels of KAP towards stroke prevention among hypertensive patients living in rural areas. This study showed the importance of further considering rural population by which improving their health and quality of life. Extending health educational programs and behavior-changing strategies to rural areas is essential to increase hypertensive patients and general public awareness about their stroke prevention and other health-related concerns.
Comparing Analysis Blinding With Preregistration in the Many-Analysts Religion Project
Authors: Sarafoglou Alexandra , Hoogeveen Suzanne , Wagenmakers Eric-Jan
Published: January 2023

In psychology, preregistration is the most widely used method to ensure the confirmatory status of analyses. However, the method has disadvantages: Not only is it perceived as effortful and time-consuming, but reasonable deviations from the analysis plan demote the status of the study to exploratory. An alternative to preregistration is analysis blinding, in which researchers develop their analysis on an altered version of the data. In this experimental study, we compare the reported efficiency and convenience of the two methods in the context of the Many-Analysts Religion Project. In this project, 120 teams answered the same research questions on the same data set, either preregistering their analysis ( n = 61) or using analysis blinding ( n = 59). Our results provide strong evidence (Bayes factor [BF] = 71.40) for the hypothesis that analysis blinding leads to fewer deviations from the analysis plan, and if teams deviated, they did so on fewer aspects. Contrary to our hypothesis, we found strong evidence (BF = 13.19) that both methods required approximately the same amount of time. Finally, we found no and moderate evidence on whether analysis blinding was perceived as less effortful and frustrating, respectively. We conclude that analysis blinding does not mean less work, but researchers can still benefit from the method because they can plan more appropriate analyses from which they deviate less frequently.
Transforming the Academic System into a Trimester System in Higher Education: Case Study at KAU
Authors: Almarghalani Shada , Alqahtani Arwa , Alzahrani Shahad , Alqahtani Haya , Elhag Salma
Published: January 2023

The government of the Kingdom of Saudi Arabia is keen on the continuous development of higher education and the organization of continuous initiatives to improve the efficiency of the educational process and increase the quality of educational outputs. For this reason, it was adopted to transform the academic system in Saudi universities from the semester system to the trimester system as part of the transformation plan for the education system in the country. This study was applied to the Faculty of Computing and Information Technology at King Abdulaziz University (KAU), to study the effect of using a trimester system in achieving the goals of the faculty’s strategic plan and contribute towards improving the quality of educational outcomes. A survey was implemented targeting the faculty students, to know their impressions and expectations about the system. The results summarize suggestions for implementing the system flexibly, contributing to facilitating students’ adaptation to this system and achieving its positive effects on their academic interests.
Childhood tuberculosis in a developed country
Authors: Mortensen J , Lange P , Storm HK , Viskum K
Published: January 2023

From 1975 to 1985, 25 Danish children (aged less than 15 yrs) and 40 children of immigrants were notified for tuberculosis in Copenhagen for the first time. A follow-up was undertaken in 1987. The annual rate of tuberculosis per 100,000 among the Danish children was 5 and among immigrant children 68-200 depending on the nationality. At the time of diagnosis, no significant differences were present between Danes and immigrants as regards age, sex, occurrence of symptoms or previous BCG immunization, whereas there were significantly more bacteriologically proven cases among the immigrants. All Danish children had respiratory tuberculosis only, whereas 13 immigrant children had extrapulmonary manifestations including one case of miliary and two cases of meningeal tuberculosis. At follow-up, all patients were cured for tuberculosis and had experienced a normal physical development.
Bedside lung ultrasound for the diagnosis of pneumonia in children presenting to an emergency department in a resource-limited setting
Authors: Amatya Yogendra , Russell Frances M. , Rijal Suraj , Adhikari Sunil , Nti Benjamin , House Darlene R.
Published: January 2023

Background

Lung ultrasound (LUS) is an effective tool for diagnosing pneumonia; however, this has not been well studied in resource-limited settings where pneumonia is the leading cause of death in children under 5 years of age.

Objective

The objective of this study was to evaluate the diagnostic accuracy of bedside LUS for diagnosis of pneumonia in children presenting to an emergency department (ED) in a resource-limited setting.

Methods

This was a prospective cross-sectional study of children presenting to an ED with respiratory complaints conducted in Nepal. We included all children under 5 years of age with cough, fever, or difficulty breathing who received a chest radiograph. A bedside LUS was performed and interpreted by the treating clinician on all children prior to chest radiograph. The criterion standard was radiographic pneumonia, diagnosed by a panel of radiologists using the Chest Radiography in Epidemiological Studies methodology. The primary outcome was sensitivity and specificity of LUS for the diagnosis of pneumonia. All LUS images were later reviewed and interpreted by a blinded expert sonographer.

Results

Three hundred and sixty-six children were enrolled in the study. The median age was 16.5 months (IQR 22) and 57.3% were male. Eighty-four patients (23%) were diagnosed with pneumonia by chest X-ray. Sensitivity, specificity, positive and negative likelihood ratios for clinician’s LUS interpretation was 89.3% (95% CI 81–95), 86.1% (95%CI 82–90), 6.4, and 0.12 respectively. LUS demonstrated good diagnostic accuracy for pneumonia with an area under the curve of 0.88 (95% CI 0.83–0.92). Interrater agreement between clinician and expert ultrasound interpretation was excellent (k = 0.85).

Conclusion

Bedside LUS when used by ED clinicians had good accuracy for diagnosis of pneumonia in children in a resource-limited setting.
Pulmonary artery embolism: comprehensive transcriptomic analysis in understanding the pathogenic mechanisms of the disease
Authors: Gromadziński Leszek , Paukszto Łukasz , Lepiarczyk Ewa , Skowrońska Agnieszka , Lipka Aleksandra , Makowczenko Karol G. , Łopieńska-Biernat Elżbieta , Jastrzębski Jan P. , Holak Piotr , Smoliński Michał , Majewska Marta
Published: January 2023

Background

Pulmonary embolism (PE) is a severe disease that usually originates from deep vein thrombosis (DVT) of the lower extremities. This study set out to investigate the changes in the transcriptome of the pulmonary artery (PA) in the course of the PE in the porcine model.

Methods

The study was performed on 11 male pigs: a thrombus was formed in each right femoral vein in six animals, and then was released to induce PE, the remaining five animals served as a control group. In the experimental animals total RNA was isolated from the PA where the blood clot lodged, and in the control group, from the corresponding PA segments. High-throughput RNA sequencing was used to analyse the global changes in the transcriptome of PA with induced PE (PA-E).

Results

Applied multistep bioinformatics revealed 473 differentially expressed genes (DEGs): 198 upregulated and 275 downregulated. Functional Gene Ontology annotated 347 DEGs into 27 biological processes, 324 to the 11 cellular components and 346 to the 2 molecular functions categories. In the signaling pathway analysis, KEGG ‘protein processing in endoplasmic reticulum’ was identified for the mRNAs modulated during PE. The same KEGG pathway was also exposed by 8 differentially alternative splicing genes. Within single nucleotide variants, the 61 allele-specific expression variants were localised in the vicinity of the genes that belong to the cellular components of the ‘endoplasmic reticulum’. The discovered allele-specific genes were also classified as signatures of the cardiovascular system.

Conclusions

The findings of this research provide the first thorough investigation of the changes in the gene expression profile of PA affected by an embolus. Evidence from this study suggests that the disturbed homeostasis in the biosynthesis of proteins in the endoplasmic reticulum plays a major role in the pathogenesis of PE.
Morphological variability of wild-growing crown imperial (Fritillaria imperialis L.) germplasm in central region of Iran—implications for in-situ conservation initiatives
Authors: Moradi Mohammad , Khaleghi Alireza , Khadivi Ali
Published: January 2023

Background

Crown imperial (Fritillaria imperialis L.) is a threatened bulbous plant which has great ornamental and medicinal values and importance. In the present study, a total of 100 specimens of wild-growing F. imperialis from 10 natural areas of Markazi province, Iran, representing one of the main centers of genetic diversity of this species, were evaluated using 37 phenotypic attributes during April 2021.

Results

High level of genetic variation within populations (75%) and low levels of genetic variation among populations (25%) was revealed. The highest coefficient of variation (CV) was found in leaf trichome (82.00%) and then margin of crown leaves (80.44%). In addition, flower color (CV = 50.86%), flower number (CV = 44.61%), peduncle diameter (CV = 33.44%), and plant length (CV = 32.55%)—all important from an ornamental point of view- showed relatively high CV values. The CV was the lowest for flower shape, filament color, bulb shape, bulblet number, and floral scent. Ward cluster analysis identified two main clusters, containing 14 and 86 specimens, respectively. The first group consisted mainly of specimens from the adjacent Shahbaz and Rasvand populations. According to the principal component analysis (PCA), the first six components of data accounted for 88.36% of total variance. The Shahbaz-1, Shahbaz-2, Shahbaz-6, Shahbaz-7, Shahbaz-9, and Bolagh-8 specimens showed the highest variation and were separated from others, which they can be used further in breeding programs, while Sarchal-2, Bolagh-3, and Chepeqli-4 specimens showed the lowest variability. Moreover, the studied populations were clustered into four distinct groups, each including populations that were geographically close to one another.

Conclusions

Although the examined specimens revealed high genetic diversity herein, the results indicated that wild-growing populations of F. imperialis are still at risk suffering from overcollection in the most of studied areas, especially in Deh-Sad and Tureh.
Goal-Directed Fluid Therapy and major postoperative complications in elective craniotomy. A retrospective analysis of a before-after multicentric study
Authors: Le Guen Morgan , Le Gall-Salaun Amandine , Josserand Julien , Gaudin de Vilaine Augustin , Viquesnel Simon , Muller Damien , Rozec Bertrand , Billet Kévin Buffenoir , Cinotti Raphaël ,   the Société Française d’Anesthésie-Réanimation–SFAR Research Network, Yavchitz Amélie , Sigault Stéphanie , Mazereaud Aurélien , Bezu Lucilia , Léger Maxime , Evain Jean-Noël
Published: January 2023

Background

Goal-Directed Fluid Therapy (GDFT) is recommended to decrease major postoperative complications. However, data are lacking in intra-cranial neurosurgery.

Methods

We evaluated the efficacy of a GDFT protocol in a before/after multi-centre study in patients undergoing elective intra-cranial surgery for brain tumour. Data were collected during 6 months in each period (before/after). GDFT was performed in high-risk patients: ASA score III/IV and/or preoperative Glasgow Coma Score (GCS) < 15 and/or history of brain tumour surgery and/or tumour greater size ≥ 35 mm and/or mid-line shift ≥ 3 mm and/or significant haemorrhagic risk. Major postoperative complication was a composite endpoint: re-intubation after surgery, a new onset of GCS < 15 after surgery, focal motor deficit, agitation, seizures, intra-cranial haemorrhage, stroke, intra-cranial hypertension, hospital-acquired related pneumonia, surgical site infection, cardiac arrythmia, invasive mechanical ventilation ≥ 48 h and in-hospital mortality.

Results

From July 2018 to January 2021, 344 patients were included in 3 centers: 171 in the before and 173 in the after (GDFT) period. Thirty-six (21.1%) patients displayed a major postoperative complication in the Before period, and 50 (28.9%) in the After period (p = 0.1). In the propensity score analysis, we matched 48 patients in each period: 9 (18.8%) patients in the After period and 14 (29.2%) patients in the Before period displayed a major perioperative complication (p = 0.2). Sixty-two (35.8%) patients received GDFT in the After period, with great heterogeneity among centers (p < 0.05).

Conclusions

In our before-after study, GDFT was not associated with a decrease in postoperative major complications in elective intra-cranial neurosurgery.
Bacterial co-infection and antibiotic stewardship in patients with COVID-19: a systematic review and meta-analysis
Authors: Calderon Maria , Gysin Grace , Gujjar Akash , McMaster Ashleigh , King Lisa , Comandé Daniel , Hunter Ewan , Payne Brendan
Published: January 2023

Introduction

Understanding the proportion of patients with COVID-19 who have respiratory bacterial co-infections and the responsible pathogens is important for managing COVID-19 effectively while ensuring responsible antibiotic use.

Objective

To estimate the frequency of bacterial co-infection in COVID-19 hospitalized patients and of antibiotic prescribing during the early pandemic period and to appraise the use of antibiotic stewardship criteria.

Methods

Systematic review and meta-analysis was performed using major databases up to May 5, 2021. We included studies that reported proportion/prevalence of bacterial co-infection in hospitalized COVID-19 patients and use of antibiotics. Where available, data on duration and type of antibiotics, adverse events, and any information about antibiotic stewardship policies were also collected.

Results

We retrieved 6,798 studies and included 85 studies with data from more than 30,000 patients. The overall prevalence of bacterial co-infection was 11% (95% CI 8% to 16%; 70 studies). When only confirmed bacterial co-infections were included the prevalence was 4% (95% CI 3% to 6%; 20 studies). Overall antibiotic use was 60% (95% CI 52% to 68%; 52 studies). Empirical antibiotic use rate was 62% (95% CI 55% to 69%; 11 studies). Few studies described criteria for stopping antibiotics.

Conclusion

There is currently insufficient evidence to support widespread empirical use of antibiotics in most hospitalised patients with COVID-19, as the overall proportion of bacterial co-infection is low. Furthermore, as the use of antibiotics during the study period appears to have been largely empirical, clinical guidelines to promote and support more targeted administration of antibiotics in patients admitted to hospital with COVID-19 are required.
Establishment of local diagnostic reference levels for common adult CT examinations: a multicenter survey in Addis Ababa
Authors: Kumsa Marema Jebessa , Nguse Teklehaimanot Mezgebe , Ambessa Haleluya Biredaw , Gele Tesfaye Tefera , Fantaye Wondemu Geteye , Dellie Seife Teferi
Published: January 2023

Background

In medical imaging, a computed tomography (CT) scanner is a major source of ionizing radiation. All medical radiation exposures should be justified and optimized to meet the clinical diagnosis. Thus, to avoid unnecessary radiation doses for patients, diagnostic reference levels (DRLs) have been used. The DRLs are used to identify unusually high radiation doses during CT procedures, which are not appropriate for the clinical diagnosis. It has been successfully implemented in Europe, Canada, Australia, the United States, several industrialized countries, and a few underdeveloped countries. The present study aimed to establish DRLs for the head, chest, and abdominopelvic (AP) CT procedures in Addis Ababa, Ethiopia.

Methods

A pilot study identified the most frequent CT examinations in the city. At the time of the pilot, eighteen CT scan facilities were identified as having functioning CT scanners. Then, on nine CT facilities (50% of functional CT scanners), a prospective analysis of volume CT dose index (CTDIvol) and dose length product (DLP) was performed. We collected data for 838 adult patients’ head, chest, and AP CT examinations. SPSS version 25 was used to compute the median values of the DLP and CTDIvol dose indicators. The rounded 75th percentile of CTDIvol and DLP median values were used to define the DRLs. The results are compared to DRL data from the local, regional, and international levels.

Result

The proposed DRLs using CTDIvol (mGy) are 53, 13, and 16 for the head, chest, and AP examinations respectively, while the DLP (mGy.cm) for the respective examinations were 1210, 635, and 822 mGy.cm.

Conclusion

Baseline CT DRLs figures for the most frequently performed in Addis Ababa were provided. The discrepancies in dose between CT facilities and as well as between identical scanners suggests a large potential for dose optimization of examinations. This can be actually achieved through appropriate training of CT technologists and continuous dose audits.
Prenatal diagnosis of Noonan syndrome in a set of monozygotic twins- a case report
Authors: Jian Wei , Yuan Huizhen , Liu Yu , Sun Jimei , Chen Fei , Li Yufan , Chen Min
Published: January 2023

Background

We report a pair of dichorionic diamniotic (DCDA) twin pregnancy affected by Noonan syndrome (NS) with a novel mutation of LZTR1 determined by genetic analysis.

Case presentation

A pregnant woman with monozygotic twins (DCDA) at 12 + 2 weeks gestation was referred to our center. This was her second pregnancy following a previous delivery of a healthy infant. Nuchal translucency of two fetuses was 11.2 mm (CRL 62.0 mm) and 6.9 mm (CRL 62.1 mm) respectively. Ultrasound examination indicated cystic hygroma and hypoplastic ear. The couple was not consanguineous, and both had normal phenotype. Familial hereditary disease was also excluded. Under ultrasound guidance, 30 mg of chorionic villi was obtained for karyotyping, quantitative fluorescent polymerase chain reaction (QF-PCR), chromosomal microarray analysis(CMA), and Trio-whole-exome sequencing(WES) examination. We used the “target region capture and sequencing” for WES, and the BWA (Burrows Wheeler Aligner) Multi-Vision software package for the data analysis. The results of all these tests were normal except WES detected a c.427 A > G mutation in the exonic region of the LZTR1 gene and a p. Asn143Asp novel heterozygous mutation associated with NS in this pair of twins. In addition, WES suggested that the mutation in the twin fetuses originated from the mother. When the mother got the genetic test report, she came to our fetal medicine department for genetic counseling and she declined the appointment with a clinical geneticist. The couple opted to terminate the pregnancy. Because the patient did not choose to terminate the pregnancy at our hospital, we were unable to take further examination. With the help of colleagues in another hospital, photos of the fetuses were taken. Compared with the prenatal ultrasound results, the appearance of the “cystic hygroma” and “hypoplastic ear” was consistent with the ultrasound. The couple were depressed after knowing this pathogenic result and although we advised the mother to take further investigation, they refused.

Conclusion

The mutant locus might be incompletely dominant, which led to an abnormal fetal phenotype such as cystic hygroma and hypoplastic ear.
Nontargeted metabolomics reveals the potential mechanism underlying the association between birthweight and metabolic disturbances
Authors: Zhai Xiao , Liu Jieying , Yu Miao , Zhang Qian , Li Ming , Zhao Nan , Liu Juntao , Song Yingna , Ma Liangkun , Li Rongrong , Qiao Zongxu , Zhao Guifen , Wang Ruiping , Xiao Xinhua
Published: January 2023

Aims

The aim of this study was to characterize the metabolites associated with small- and large-gestational-age newborns in maternal and cord blood, and to investigate potential mechanisms underlying the association between birthweight and metabolic disturbances.

Research design and methods

We recorded detailed anthropometric data of mother-offspring dyads. Untargeted metabolomic assays were performed on 67 pairs of cord blood and maternal fasting plasma samples including 16 pairs of small-for-gestational (SGA, < 10th percentile) dyads, 28 pairs of appropriate-for-gestational (AGA, approximate 50 percentile) dyads, and 23 pairs of large-for-gestational (LGA, > 90th percentile) dyads. The association of metabolites with newborn birthweight was conducted to screen for metabolites with U-shaped and line-shaped distributions. The association of metabolites with maternal and fetal phenotypes was also performed.

Results

We found 2 types of metabolites that changed in different patterns according to newborn birthweight. One type of metabolite exhibited a “U-shaped” trend of abundance fluctuation in the SGA-AGA-LGA groups. The results demonstrated that cuminaldehyde level was lower in the SGA and LGA groups, and its abundance in cord blood was negatively correlated with maternal BMI (r = -0.352 p = 0.009) and weight gain (r = -0.267 p = 0.043). 2-Methoxy-estradiol-17b 3-glucuronide, which showed enrichment in the SGA and LGA groups, was positively correlated with homocysteine (r = 0.44, p < 0.001) and free fatty acid (r = 0.42, p < 0.001) in maternal blood. Serotonin and 13(S)-HODE were the second type of metabolites, denoted as “line-shaped”, which both showed increasing trends in the SGA-AGA-LGA groups in both maternal and cord blood and were both significantly positively correlated with maternal BMI before pregnancy. Moreover, cuminaldehyde, serotonin, 13(S)-HODE and some lipid metabolites showed a strong correlation between maternal and cord blood.

Conclusions

These investigations demonstrate broad-scale metabolomic differences associated with newborn birthweight in both pregnant women and their newborns. The U-shaped metabolites associated with both the SGA and LGA groups might explain the U-shaped association between birthweight and metabolic dysregulation. The line-shaped metabolites might participate in intrauterine growth regulation. These observations might help to provide new insights into the insulin resistance and the risk of metabolic disturbance of SGA and LGA babies in adulthood and might identify potential new markers for adverse newborn outcomes in pregnant women.
Changes in type 2 innate lymphoid cells and serum cytokines in sublingual immunotherapy in pediatric patients with allergic rhinitis
Authors: Wang Xiaoqiang , Shen Yang , Hong Suling , Kang Houyong , Ke Xia
Published: January 2023

Background

Type 2 innate lymphoid cells (ILC2) are upregulated in childhood allergic rhinitis (AR) and are associated with AR severity. This study aimed to investigate changes in the ILC2 milieu in pediatric patients with AR after sublingual immunotherapy (SLIT).

Methods

Forty- pediatric patients with AR received house dust mite (HDM) allergen extract for SLIT group and thirty pediatric patients received placebo in the study, respectively. The levels of ILC2, ILC2-related cytokines (IL-5/IL-13) and their transcription factors (GATA binding protein 3, retinoic acid-related orphan receptor α) in the circulation were assessed after 1- and 2-year SLIT. Moreover, peripheral blood mononuclear cells (PBMCs) in patients were prepared and stimulated by recombinant thymic stromal lymphopoietin, IL-25, and IL-33 after 2-year SLIT. Subsequently, the levels of ILC2, IL-5, and IL-13 were tested.

Results

The frequency of ILC2 and the levels of their transcription factors in the circulation were significantly decreased after SLIT in the SLIT group. The levels of ILC2-related cytokines in the SLIT group showed the same trend. The frequency of ILC2 was positively correlated with transcription factors and cytokines after SLIT. SLIT was observed to reduce the ability of HDM sensitization to generate the ILC2 milieu in PBMCs.

Conclusions

Changes in the ILC2 milieu may be correlated with the curative effect and immune regulation function of SLIT. Our results suggested that the regulatory effect on ILC2 is part of the therapeutic mechanism of SLIT.
Associated factors with depression and sleep quality in T1DM patients: a cross-sectional descriptive study
Authors: Cho Mi-Kyoung , Kim Mi Young
Published: January 2023

Background

Individuals with type 1 diabetes (T1DM) may experience sleep problems, usually due to low blood sugar levels during sleep or performance of blood sugar management (e.g., blood sugar monitoring). This study aimed to identify the disease-related characteristics, psychosocial aspects, and related factors underlying sleep quality in patients with T1DM.

Methods

This study employed a descriptive research design. The participants were 159 individuals with T1DM who completed online questionnaires. The data were analyzed using descriptive statistics, correlations, and multiple regression analyses.

Results

The average score for depression in T1DM patients was 23.77 (SD 5.31), and sleep quality received a score of 4.58 (SD 3.22). Depression was positively correlated with sleep quality and negatively correlated with the total resilience score. The factors linked to depression in T1DM patients were duration of disease, sleep latency, sleep duration, sleep disturbance, and resilience-acceptance of self and life sub-factors, with an explanatory power of 44.4% for the depression variance. The associated factors with sleep quality in T1DM patients were complications, resilience-personal competence sub-factors, and depression, with an explanatory power of 37.4% for sleep quality variance.

Conclusions

The results of this study suggest that to improve sleep quality in patients with T1DM, it is necessary to develop and support disease management to prevent complications and implement interventions for improving resilience and reducing negative emotions such as depression.
CRHR1 antagonist alleviates LPS-induced depression-like behaviour in mice
Authors: Sun Jie , Qiu Lili , Zhang Hui , Zhou Zhiqiang , Ju Lingsha , Yang Jiaojiao
Published: January 2023

Background

Maladaptation of the HPA (hypothalamic–pituitary–adrenal) axis plays an important role in depression-like behaviour, but the specific molecular mechanisms are unknown. Here, we determined the roles of CRHR1 (corticotrophin releasing hormone receptor 1) and nectin3 in LPS (lipopolysaccharide)-induced depression-like behaviour in mice.

Methods

C57BL/6 male mice were intraperitoneally injected with LPS (0.83 g/kg), and the open field, novelty-suppressed feeding, forced swimming, and tail suspension tests were performed after intraperitoneal injections of saline or antalarmin (20 mg/kg). The hippocampal mRNA levels of CRHR1 and nectin3 were determined by quantitative reverse transcription-PCR. The hippocampal protein levels of CRHR1, nectin3, and calbindin were measured by western blotting. The CORT (corticosterone) levels in the blood were measured by ELISA kits.

Results

Antalarmin alleviated LPS-induced depression-like behaviour in male mice. Furthermore, antalarmin significantly inhibited changes in CRHR1, nectin3 and calbindin levels in the hippocampus and reduced the increase in CORT levels in LPS-treated mice.

Conclusion

CRHR1antagonist showed antidepressant effects in LPS-induced depressive mice, and CRHR1/nectin3 signalling may play a crucial role in this process.
Stratifying non-small cell lung cancer patients using an inverse of the treatment decision rules: validation using electronic health records with application to an administrative database
Authors: Kim Min-Hyung , Park Sojung , Park Yu Rang , Ji Wonjun , Kim Seul-Gi , Choo Minji , Hwang Seung-Sik , Lee Jae Cheol , Kim Hyeong Ryul , Choi Chang-Min
Published: January 2023

Background

To validate a stratification method using an inverse of treatment decision rules that can classify non-small cell lung cancer (NSCLC) patients in real-world treatment records.

Methods

(1) To validate the index classifier against the TNM 7th edition, we analyzed electronic health records of NSCLC patients diagnosed from 2011 to 2015 in a tertiary referral hospital in Seoul, Korea. Predictive accuracy, stage-specific sensitivity, specificity, positive predictive value, negative predictive value, F1 score, and c-statistic were measured. (2) To apply the index classifier in an administrative database, we analyzed NSCLC patients in Korean National Health Insurance Database, 2002–2013. Differential survival rates among the classes were examined with the log-rank test, and class-specific survival rates were compared with the reference survival rates.

Results

(1) In the validation study (N = 1375), the overall accuracy was 93.8% (95% CI: 92.5–95.0%). Stage-specific c-statistic was the highest for stage I (0.97, 95% CI: 0.96–0.98) and the lowest for stage III (0.82, 95% CI: 0.77–0.87). (2) In the application study (N = 71,593), the index classifier showed a tendency for differentiating survival probabilities among classes. Compared to the reference TNM survival rates, the index classification under-estimated the survival probability for stages IA, IIIB, and IV, and over-estimated it for stages IIA and IIB.

Conclusion

The inverse of the treatment decision rules has a potential to supplement a routinely collected database with information encoded in the treatment decision rules to classify NSCLC patients. It requires further validation and replication in multiple clinical settings.
Genetic association of circulating C-reactive protein levels with idiopathic pulmonary fibrosis: a two-sample Mendelian randomization study
Authors: Zhang Kun , Li Anqi , Zhou Jiejun , Zhang Chaoguo , Chen Mingwei
Published: January 2023

Background

Several observational studies have found that idiopathic pulmonary fibrosis (IPF) is often accompanied by elevated circulating C-reactive protein (CRP) levels. However, the causal relationship between them remains to be determined. Therefore, our study aimed to explore the causal effect of circulating CRP levels on IPF risk by the two-sample Mendelian randomization (MR) analysis.

Methods

We analyzed the data from two genome-wide association studies (GWAS) of European ancestry, including circulating CRP levels (204,402 individuals) and IPF (1028 cases and 196,986 controls). We primarily used inverse variance weighted (IVW) to assess the causal effect of circulating CRP levels on IPF risk. MR-Egger regression and MR-PRESSO global test were used to determine pleiotropy. Heterogeneity was examined with Cochran's Q test. The leave-one-out analysis tested the robustness of the results.

Results

We obtained 54 SNPs as instrumental variables (IVs) for circulating CRP levels, and these IVs had no significant horizontal pleiotropy, heterogeneity, or bias. MR analysis revealed a causal effect between elevated circulating CRP levels and increased risk of IPF (ORIVW = 1.446, 95% CI 1.128–1.854, P = 0.004).

Conclusions

The present study indicated that elevated circulating CRP levels could increase the risk of developing IPF in people of European ancestry.