bluuebunny/crossref_metadata_2025 huggingface dataset:
Plant Volatile Methyl Salicylate Primes Wheat Defense Against the Grain Aphid by Altering the Synthesis of Defense Metabolites
Authors: Li Zhenxiang , Jing Shizhao , Wang Da , Song Zichao , An Boyang , Wang Saige , Liu Fanghua , Di Ning , Aradottir Gudbjorg Inga , Sun Jianghua , Tan Xiaoling , Qu Cheng , Kang Zhiwei
Published: December 2024

Wheat (Triticum aestivum L.) is one of the most important staple crops all over the world. Its productivity is adversely affected by aphid infestation. Plant volatiles play a critical role in plant communication, inducing direct and indirect defenses against insect pests. However, little is known about the priming mechanism of key volatiles in wheat. To determine whether and how plant volatile induced defense priming in wheat against the grain aphid Sitobion avenae, a combination of insect bioassays, phytohormone and defense metabolite quantification, and transcriptome analyses were performed using an important aphid damage‐induced plant volatile, methyl salicylate (MeSA). MeSA treatment primed wheat for enhanced accumulation of salicylic acid, flavonoid and benzoxazinoids (BXs), and increased resistance to S. avenae and attractiveness to an aphid parasitoid Aphelinus asychis. Supplementation with a BX (2,4‐dihydroxy‐7‐methoxy‐2H‐1,4‐benzoxazin‐3(4H)‐one) and two flavonoids (xanthohumol and isobavachalcone) in artificial diet impaired the survival, development and fecundity of S. avenae. Moreover, MeSA treatment induced wheat volatile emission especially MeSA. Functional investigation of odorant‐binding proteins (OBPs) in A. asychis revealed that AasyOBP4 is responsible for the recognition of MeSA. Taken together, our results provide insights into the molecular mechanism of MeSA‐mediated defense in wheat and propose MeSA as a phytoprotectant for crop protection and sustainable agriculture.
Videodermoscopy as a Diagnostic Tool for Pili Trianguli and Canaliculi Syndrome
Authors: Sechi Andrea , Bolzon Anna , Tartaglia Jacopo , Tosti Antonella , Mariano Luca
Published: December 2024

Pili trianguli et canaliculi syndrome is a rare hair shaft disorder characterized by frizzy hair that cannot be smoothed flat. Affected hair shafts are triangular or kidney‐shaped with longitudinal grooving. Diagnosis typically requires electron microscopy, which may be cost‐prohibitive, or alternatively, the distinctive features of hair shafts can be identified through histological examination of cross sections, that is time‐consuming. To overcome these challenges, we describe a novel videodermoscopy technique as a cost‐effective and simple alternative, suitable for outpatient settings.
Beyond Classification: A Unique Case of Self‐Resolving Cutaneous Mucinosis Associated With Streptococcal Infection in a Child
Authors: Safir Ari , Furman Moran , Gat Andrea , Zemser Valentina , Bergman Reuven , Sprecher Eli , Samuelov Liat , Friedel Nadav
Published: December 2024

A 3‐year‐old boy presented with an unusual combination of indurated skin, sclerotic plaques with lichenification, and yellowish papules. Histopathology revealed diffuse dermal mucin deposits, and laboratory tests showed a positive throat culture for Group A streptococcus and elevated serum anti‐streptolysin titers. An 10‐day course of oral amoxicillin was associated with near‐complete resolution of all dermatological findings within 4 months. This case represents a unique presentation of a self‐resolving cutaneous mucinosis, likely associated with a streptococcal infection.
Photodynamic therapy of cancer‐associated infections
Authors: Kassab Giulia , Chen Juan , Zheng Gang
Published: December 2024

Pathogens can be involved in tumor initiation, promotion, and progression through different mechanisms, and their treatment can prevent new cancer cases, improve outcomes, and revert poor‐prognostic phenotypes. Photodynamic therapy (PDT) successfully treats different types of cancers and infections and, therefore, has a unique potential to address their combination. However, we believe this potential has been underutilized, and few researchers have investigated the impacts of PDT of both infection‐related and cancer‐related outcomes at once. This review presents the main agents behind cancer‐associated infections (CAIs), the PDT protocols that have been tested on them, and their key findings. Additionally, we discuss the key aspects of PDT that make it ideal for CAI treatment, and what knowledge gaps need to be filled in order to make it successful.
Expanding Perceived Capacity of Public Sector Workers: Experimental Evidence on the Impact of a Counter‐Stereotypical Narrative on Public Perceptions of Correctional Officers
Authors: Harney Jessie
Published: December 2024

Understanding variation in perceptions of different types of street‐level bureaucrats (SLBs) is crucial, as is improving perceptions of the capacity of government to better serve its community in an ethical and authentic manner. In this U.S.‐based survey experiment (n = 1642), participants who were randomly assigned to be initially presented with a counter‐stereotypical narrative of a correctional officer (CO) – a limitedly studied SLB – perceived COs as significantly more dedicated, compassionate and skilled than those who were presented this narrative after survey outcomes, with no impacts on perceptions of other public sector workers. Additionally, there was strong support for the claim that people, with access to the right type of training and education, can do most types of work. Collectively, this study may help guide future research to understand the viability of myriad changes to the way the United States handles justice, especially in relation to alternative models that rely on greater presence of public sector health and wellness practitioners.
The Utility of Interferon‐γ Release Assays in the Diagnosis of Tuberculosis in Patients With Cancer
Authors: Batista Marjorie V. , Sassine Joseph , Khawaja Fareed , Kulkarni Prathit A. , Angelidakis Georgios , Kmeid Joumana , El Chaer Firas , Ariza‐Heredia Ella J. , Graviss Edward A. , Mulanovich Victor E. , Chemaly Roy F.
Published: December 2024

Background

Patients with cancer are at elevated risk for tuberculosis (TB) reactivation. Diagnosis of latent TB infection and TB disease remains challenging in this patient population despite the advent of interferon‐γ release assays (IGRA).

Methods

We retrospectively reviewed medical records of all patients with cancer who had IGRA testing (QuantiFERON–TB [QFT‐TB] or T‐SPOT.TB) at a major cancer center in the United States from June 2010 to July 2017. The results were analyzed with respect to the likelihood of latent TB infection and TB disease.

Results

A total of 1299 patients were included with 1599 tests performed: 586 QFT‐TB and 1013 T‐SPOT.TB. Forty‐nine (4%) patients were diagnosed with latent TB, and four (1%) with TB disease. T‐SPOT.TB was more likely to yield an actionable result (positive or negative) than QFT‐TB (89% vs. 65%, p < 0.001). The rate of indeterminate results for QFT‐TB was higher than the rate of invalid results for T‐SPOT.TB (35% and 10%, respectively, p < 0.001). On multivariate analysis, independent predictors of an invalid T‐SPOT.TB included prior receipt of alemtuzumab, lower hemoglobin, absolute lymphocyte count, or serum albumin (p < 0.05 each), whereas the independent predictors of an indeterminate QFT‐TB were female gender, prior receipt of systemic corticosteroids, and lower hemoglobin, or serum albumin or higher absolute neutrophil count (p < 0.05 each).

Conclusions

T‐SPOT.TB yielded more actionable results than QFT‐TB in patients with cancer. T‐SPOT.TB might be a better IGRA for screening for latent TB infection in patients with cancer, although a direct comparison would be needed to definitively determine this.

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Outcomes Associated With Blastomycosis in Solid Organ and Hematopoietic Cell Transplant Recipients
Authors: Nair Vaisak O. , Johnson Bradley , Vergidis Paschalis , Ranganath Nischal
Published: December 2024

Introduction

With reports of expanding epidemiology of blastomycosis across the United States, the purpose of this study was to evaluate the incidence and outcomes associated with blastomycosis in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients.

Methods

We conducted a retrospective case series of adult SOT and HCT recipients at a tertiary care medical center between January 1, 2005 and September 30, 2023. Cases were defined as culture‐proven blastomycosis. We performed descriptive statistical analysis to evaluate diagnosis, management, and outcomes (mortality) of blastomycosis in SOT.

Results

The cumulative incidence of blastomycosis was 0.11% with a median time to infection following transplant of 743 days. Of the 19 cases, the majority of patients were SOT recipients (90%). Supratherapeutic immunosuppression within 30 days of diagnosis was observed in 42% of cases with documented drug monitoring. Urine antigen testing was highly sensitive (100%). Fourteen (73.7%) patients received induction therapy with liposomal amphotericin B followed by azole therapy for a minimum of 12 months. Despite appropriate treatment, 1‐year mortality was high at 26.3%, with attributable mortality of 21.1%.

Conclusions

While rates of blastomycosis remain low among SOT and HCT recipients, infection is associated with poor posttransplant outcomes. Antigen testing can aid in timely assessment of disease severity and initiation of appropriate therapy. Among survivors, no relapses were observed while on lifelong secondary suppression. Future studies should aim to better define risk factors associated with developing blastomycosis and establish effective strategies for prevention.
INVESTIGATION OF THE PHYSICO-CHEMICAL CHARACTERISTICS OF IRRIGATION WATER QUALITY AT AN AGRICULTURAL SITE IN PASIR PUTEH, KELANTAN, MALAYSIA
Authors: Anua Siti Marwanis , Naim Faridah , Che Azid Md Khairul Azuan , Jusoh Juskasmini , Hassan Noor Artika
Published: December 2024

This study was conducted to assess the physico-chemical characteristics of irrigation water quality, focusing on both chemical and physical elements at an agriculture site in Pasir Puteh, Kelantan, Malaysia. Eight sampling points were selected near four different crops namely corn, cucumber, longbean and luffa, with two sampling points located 10 meters apart for each crop. Water samples were analyzed in-situ and ex-situ in evaluating their physico-chemical characteristics including temperature, pH, salinity, conductivity, total dissolved solids (TDS), turbidity, chemical oxygen demand (COD), dissolved oxygen (DO) and biochemical oxygen demand (BOD). The findings revealed that the values of the observed water quality parameters did not exceed the specified standards aligning with the National Water Quality Standards (NWQS) water quality index Class IV – Irrigation. TDS levels at all sampling points were below the NWQS standard for Class I water (<500 mg/L). Although there is no specific turbidity standard for Class IV water, the highest turbidity value was recorded at sampling point 2 (246.50 ± 0.71 NTU). The average COD concentration across all sampling points was 43.63 ± 9.72 mg/L, with a DO value of 3.45 ± 0.55 mg/L, and a mean BOD of 5.80 ± 6.43 mg/L, all falling within Class III NWQS. In conclusion, all measured water quality parameters met the NWQS Class IV irrigation standards, indicating that the water is suitable for irrigation purposes.
THE IMPACT OF PROLONGED OCCUPATIONAL NOISE ON STAFF WELL-BEING IN HOSPITAL KITCHENS
Authors: Noor Effendi Nurul Afifah , Mohd Nawi Mohd Nasrom , Mamat Mohd Noor , Mohd Nawi Mohd Nazhari , Hamzah Nurul Ainun
Published: December 2024

Occupational noise in hospital kitchens can significantly impact staff well-being due to prolonged exposure. This study evaluated noise levels in cooking, washing, and preparation areas of a hospital kitchen to assess compliance with the 2019 Noise Exposure Regulation and to understand how noise exposure varies by location and time. Measurements were conducted during peak hours during working activities showed that all areas were within the safe exposure limits, with the cooking area (77.620 dB) typically experiencing higher noise levels than the washing (76.338 dB) and preparation areas (75.302 dB). Noise levels significantly varied between peak and non-peak hours in the cooking and washing areas (p>0.05) but remained consistent in the preparation area (p=0.001). A weak yet significant positive correlation (p=0.001, r=0.145) was observed between noise levels and proximity to noise-generating distance of equipment, suggesting that reducing distance from noise sources may slightly increase exposure risks. These findings underline the need for ongoing monitoring and targeted noise reduction strategies in hospital kitchens to safeguard staff health, not hospital patients.
Persistence of human Aichi virus infectivity from raw surface water to drinking water
Authors: Sdiri-Loulizi Khira , Khachou Amira , Lemaire Stephanie , Bour Jean-Baptiste , Ayouni Siwar , Kaplon Jérôme , Sakly Nabil , Aouni Mahjoub , Belliot Gael , de Rougemont Alexis
Published: December 2024

Human Aichi virus 1 (AiV-1) is a water- and food-borne infection-associated picornavirus that causes gastroenteritis in humans. Recent studies on environmental waters showed a high frequency and abundance of AiV-1, suggesting that it might be an appropriate indicator of fecal contamination. We screened 450 surface and drinking water samples from a Tunisian drinking water treatment plant (DWTP) and the Sidi Salem dam for AiV-1 by real time reverse transcriptase PCR (RT-qPCR). The persistence of infectious particles was evaluated using an integrated cell culture approach coupled with quantitative molecular detection (ICC-RT-qPCR). In all, 85 (18.9%) water samples were positive for AiV-1 with viral loads ranging from 0.47 to 11.62 log
10
cp/L and a median of 4.97 log
10
cp/L, including 30/100 raw, 18/50 decanted, 14/50 flocculated, 9/100 treated, 1/50 tap, and 13/100 surface water samples. Of these, 15 (17.6%) samples contained infectious AiV-1 genotype A particles, including five raw, four decanted, one surface, three flocculated, and two treated water samples. Our data suggest that the persistence of infectious AiV-1 particles in environmental waters might represent a potential threat to public health. This study also indicates that the ICC-RT-qPCR is a practical tool for monitoring human waterborne viral risk in aquatic environments.

IMPORTANCE

Human Aichi virus 1 (AiV-1) is a water- and food-borne infection-associated picornavirus that causes gastroenteritis in humans. Its high frequency and abundance in environmental waters would suggest that it might be an appropriate indicator of fecal contamination. The analysis of surface and drinking water samples from a Tunisian drinking water treatment plant (DWTP) and the Sidi Salem dam using an integrated cell culture approach coupled with a quantitative molecular detection (ICC-RT-qPCR) confirmed the persistence of infectious AiV-1 particles in samples at all stages of the treatment process, except in tap water. This suggests that the persistence of AiV-1 infectivity in environmental waters might represent a potential threat to public health. This study also indicates that the ICC-RT-qPCR is a practical tool for monitoring human waterborne viral risk in aquatic environments.
Assessing environmental gradients in relation to dark CO
2
fixation in estuarine wetland microbiomes
Authors: Grüterich Luise , Woodhouse Jason Nicholas , Mueller Peter , Tiemann Amos , Ruscheweyh Hans-Joachim , Sunagawa Shinichi , Grossart Hans-Peter , Streit Wolfgang R.
Published: December 2024

The rising atmospheric concentration of CO
2
is a major concern to society due to its global warming potential. In soils, CO
2
-fixing microorganisms are preventing some of the CO
2
from entering the atmosphere. Yet, the controls of dark CO
2
fixation are rarely studied
in situ
. Here, we examined the gene and transcript abundance of key genes involved in microbial CO
2
fixation along major environmental gradients within estuarine wetlands. A combined multi-omics approach incorporating metabarcoding, deep metagenomic, and metatranscriptomic analyses confirmed that wetland microbiota harbor four out of seven known CO
2
fixation pathways, namely, the Calvin cycle, reverse tricarboxylic acid cycle, Wood–Ljungdahl pathway, and reverse glycine pathway. These pathways are transcribed at high frequencies along several environmental gradients, albeit at different levels depending on the environmental niche. Notably, the transcription of the key genes for the reverse tricarboxylic acid cycle was associated with high nitrate concentration, while the transcription of key genes for the Wood–Ljungdahl pathway was favored by reducing, O
2
-poor conditions. The transcript abundance of the Calvin cycle was favored by niches high in organic matter. Taxonomic assignment of transcripts implied that dark CO
2
fixation was mainly linked to a few bacterial phyla, namely,
Desulfobacterota
,
Methylomirabilota
,
Nitrospirota
,
Chloroflexota
, and
Pseudomonadota
.

IMPORTANCE

The increasing concentration of atmospheric CO
2
has been identified as the primary driver of climate change and poses a major threat to human society. This work explores the mostly overlooked potential of light-independent CO
2
fixation by soil microbes (a.k.a. dark CO
2
fixation) in climate change mitigation efforts. Applying a combination of molecular microbial tools, our research provides new insights into the ecological niches where CO
2
-fixing pathways are most active. By identifying how environmental factors, like oxygen, salinity and organic matter availability, influence these pathways in an estuarine wetland environment, potential strategies for enhancing natural carbon sinks can be developed. The importance of our research is in advancing the understanding of microbial CO
2
fixation and its potential role in the global climate system.
Influenza B virus infection alters the regenerative potential of murine alveolar type 2 pneumocytes
Authors: Nakano Satoko , Hamele Cait E. , Tata Aleksandra , Tata Purushothama Rao , Heaton Nicholas S.
Published: December 2024

Respiratory epithelial cells can survive direct infection by influenza viruses, and the long-term consequences of that infection have been characterized in a subset of proximal airway cell types. The impact on the cells that survive viral infection in the distal lung epithelia, however, is much less well-characterized. Utilizing a Cre-expressing influenza B virus (IBV) and a lox-stop-lox tdTomato reporter mouse model, we identified that alveolar type 2 (AT2) pneumocytes, a progenitor cell type in the distal lung, can survive viral infection. We show that survival of infection is associated with transcriptional dysregulation compared to bystander AT2 pneumocytes from the same lung. Furthermore,
ex vivo
experiments revealed a significant reduction in proliferation rates in survivor AT2 pneumocytes compared to matched, non-directly infected bystander cells. Our findings not only enhance our understanding of the AT2 pneumocyte response to IBV infection but could also have broader implications for the mechanisms of respiratory epithelial repair post-viral infection.

IMPORTANCE

Alveolar type 2 (AT2) pneumocytes are a cell type critical for repair of the distal lung after an injury, such as a viral infection. After epithelial damage, AT2 pneumocytes proliferate for both self-renewal and differentiation into type I pneumocytes to repopulate the epithelium. Theoretically, some of the long-term lung sequelae associated with viral infections could be the result of inappropriate AT2 behavior. Here, the authors report that during an influenza B virus infection, some of the actively infected AT2 pneumocytes can ultimately eliminate all traces of the viral RNA and persist in the host long term. As a consequence of having been infected, however, the cells display an altered transcriptional profile and decreased proliferative capacity. These data together suggest a mechanism for how an acute viral infection can have long-term impacts on the pulmonary system.
Decomposition of the pangenome matrix reveals a structure in gene distribution in the
Escherichia coli
species
Authors: Chauhan Siddharth M. , Ardalani Omid , Hyun Jason C. , Monk Jonathan M. , Phaneuf Patrick V. , Palsson Bernhard O.
Published: December 2024

Thousands of complete genome sequences for strains of a species that are now available enable the advancement of pangenome analytics to a new level of sophistication. We collected 2,377 publicly available complete genomes of
Escherichia coli
for detailed pangenome analysis. The core genome and accessory genomes consisted of 2,398 and 5,182 genes, respectively. We developed a machine learning approach to define the accessory genes characterizing the major phylogroups of
E. coli
plus
Shigella
: A, B1, B2, C, D, E, F, G, and
Shigella
. The analysis resulted in a detailed structure of the genetic basis of the phylogroups’ differential traits. This pangenome structure was largely consistent with a housekeeping-gene-based MLST distribution, sequence-based Mash distance, and the Clermont quadruplex classification. The rare genome (consisting of genes found in <6.8% of all strains) consisted of 163,619 genes, about 79% of which represented variations of 315 underlying transposon elements. This analysis generated a mathematical definition of the genetic basis for a species.

IMPORTANCE

The comprehensive analysis of the pangenome of
Escherichia coli
presented in this study marks a significant advancement in understanding bacterial genetic diversity. By employing machine learning techniques to analyze 2,377 complete
E. coli
genomes, the study provides a detailed mapping of core, accessory, and rare genes. This approach reveals the genetic basis for differential traits across phylogroups, offering insights into pathogenicity, antibiotic resistance, and evolutionary adaptations. The findings enhance the potential for genome-based diagnostics and pave the way for future studies aimed at achieving a global genetic definition of bacterial phylogeny.
Deciphering the biosynthetic landscape of biofilms in glacier-fed streams
Authors: Geers Aileen Ute , Michoud Grégoire , Busi Susheel Bhanu , Peter Hannes , Kohler Tyler J. , Ezzat Leïla ,   The Vanishing Glaciers Field Team, Battin Tom J. , Styllas Michael , Schön Martina , Tolosano Matteo , Staercke Vincent de , Peter Hannes , Kohler Tyler , Battin Tom J.
Published: December 2024

Glacier-fed streams are permanently cold, ultra-oligotrophic, and physically unstable environments, yet microbial life thrives in benthic biofilm communities. Within biofilms, microorganisms rely on secondary metabolites for communication and competition. However, the diversity and genetic potential of secondary metabolites in glacier-fed stream biofilms remain poorly understood. In this study, we present the first large-scale exploration of biosynthetic gene clusters (BGCs) from benthic glacier-fed stream biofilms sampled by the
Vanishing Glaciers
project from the world’s major mountain ranges. We found a remarkable diversity of BGCs, with more than 8,000 of them identified within 2,868 prokaryotic metagenome-assembled genomes, some of them potentially conferring ecological advantages, such as UV protection and quorum sensing. The BGCs were distinct from those sourced from other aquatic microbiomes, with over 40% of them being novel. The glacier-fed stream BGCs exhibited the highest similarity to BGCs from glacier microbiomes. BGC composition displayed geographic patterns and correlated with prokaryotic alpha diversity. We also found that BGC diversity was positively associated with benthic chlorophyll
a
and prokaryotic diversity, indicative of more biotic interactions in more extensive biofilms. Our study provides new insights into a hitherto poorly explored microbial ecosystem, which is now changing at a rapid pace as glaciers are shrinking due to climate change.

IMPORTANCE

Glacier-fed streams are characterized by low temperatures, high turbidity, and high flow. They host a unique microbiome within biofilms, which form the foundation of the food web and contribute significantly to biogeochemical cycles. Our investigation into secondary metabolites, which likely play an important role in these complex ecosystems, found a unique genetic potential distinct from other aquatic environments. We found the potential to synthesize several secondary metabolites, which may confer ecological advantages, such as UV protection and quorum sensing. This biosynthetic diversity was positively associated with the abundance and complexity of the microbial community, as well as concentrations of chlorophyll
a
. In the face of climate change, our study offers new insights into a vanishing ecosystem.
Prediction of functional remission in patients with schizophrenia after antipsychotic discontinuation (FURSAD): protocol for a real-world case-control study
Authors: Lu Chang , Dong Yuke , Zhai Zhaolin , Gao Tianhao , Luo Mengyi , Feng Tienan , Ma Xiangyi , Chang Di , Chen Jing , Xue Jingxin , Zhao Yuqing , Li Xuan , Shao Chunhong , Liu Dengtang
Published: December 2024

Introduction

Although maintenance treatment is recommended for the prevention of relapse, in real-world settings, a subset of patients discontinue antipsychotics while having a good prognosis. The prediction of functional remission in patients with schizophrenia after antipsychotic discontinuation (FURSAD) study aims to obtain real-world knowledge regarding the characteristics of schizophrenia (SCZ) patients who achieve functional remission after antipsychotic discontinuation for 1 year or more. This study also aims to establish a prediction model to identify patients likely to benefit from antipsychotic discontinuation.

Methods and analysis

The FURSAD study employs a real-world case-control design. Researchers will first screen patients with a diagnosis of SCZ (ICD-10) from the Shanghai Mental Health Center discharged patient pool to identify 480 participants who have been off-antipsychotic for at least 1 year. They will be assigned to the functional remission group or the functional non-remission group according to their social functioning assessment scores, including the self-assessment questionnaire WHO Quality of Life abbreviated version (WHOQoL-BREF) and the peer-assessment scale Functional Remission of General Schizophrenia (FROGS) Scale. Sociodemographic, symptom and treatment information of participants during their hospitalisation and after discharge will be extracted from the Hospital Information System and collected via interviews, respectively, to find independent variables for good prognosis after antipsychotic discontinuation. A nomogram will visualise the prediction model results to help psychiatrists make decisions.

Ethics and dissemination

Full ethical approval for the study (study design, data acquisition license and informed consent) was granted by the ethics committee at Shanghai Mental Health Center, Shanghai, China (approval letter number: 2022–59). The findings of the FURSAD study will be published in peer-reviewed journals or disseminated in conference presentations.

Trial registration number

NCT05667961.
Assessing the impact of different donor milk treatments on infant health and growth: a systematic review protocol
Authors: Klotz Daniel , Bzikowska-Jura Agnieszka , Giribaldi Marzia , Cassidy Tanya , Cavallarin Laura , Gandino Serena , Karcz Karolina , Peila Chiara , Smith Carolyn , Walczak Bartłomiej , Wesolowska Aleksandra
Published: December 2024

Introduction

Donor human milk (DHM) is the first alternative if mother’s own milk is unavailable or contraindicated. Much DHM research has focused on its nutritional, immunological and biochemical composition in response to various maternal variables, standard human milk banking procedures and storage protocols. The current systematic review protocol, however, aims to systematically gather and analyse existing data pertaining to the impact of these aforementioned factors on the clinical, health-related and developmental outcomes observed in infants fed with DHM.

Methods and analysis

We will apply a predefined search strategy including Cochrane Central Register of Controlled Trials, Global Index Medicus, CINAHL on Ebscohost, Medline, Embase, Emcare, Pubmed, Global Health on OVID, Google Scholar, clinicaltrials.gov, the WHO International Trials Registry and Platform and the European Union/European Economic Area Clinical Trials Register. No setting, patient population, date or language restrictions will be applied. The search strategy will consist of search words on the key concepts of ‘donated human milk’ and ‘effect on infants’. Published or unpublished primary research studies are eligible for inclusion if there is an abstract available in English. Conference proceedings, animal studies and publications with no original data will be excluded.

Authors of unpublished or partially published studies will be contacted and eligible data added if provided. Risk of bias will be evaluated according to CASP using appropriate tools depending on study type (RoB 2, ROBINS-I, Newcastle Ottawa Scale). Data will be synthesised in a quantitative format describing significant results as well as presenting the results of the quality assessment of studies.

Ethics and dissemination

This systematic review does not require ethical approval, as we will not collect primary data. The review will be published in a peer-reviewed journal and disseminated electronically and in print.

PROSPERO registration number

CRD42024522015.
Monitoring low-value care in medical patients from Swiss university hospitals using a Findable, Accessible, Interoperable, Reusable (FAIR) national data stream and patient and public involvement: LUCID study protocol
Authors: Guffi Tommaso , Ehrsam Julien , Débieux Marie , Rossel Jean-Benoît , Crevier Marie-Josée , Reny Jean-Luc , Stirnemann Jerome , Meier Christoph A , Aujesky Drahomir , Bassetti Stefano , Aubert Carole Elodie , Méan Marie
Published: December 2024

Introduction

Healthcare practices providing minimal or no benefit to recipients have been estimated to represent 20% of healthcare costs. However, defining, measuring and monitoring low-value care (LVC) and its downstream consequences remain a major challenge. The purpose of the National Data Stream (LUCID NDS) is to identify and monitor LVC in medical inpatients using routinely collected hospital data.

Methods and analysis

This protocol describes a multistep approach to the identification and surveillance of LVC: (1) creating an NDS based on Findable, Accessible, Interoperable, Reusable (FAIR) principles using routinely collected hospital data from medical inpatients who signed a general consent for data reuse from 2014 onwards; (2) selecting recommendations applicable to medical inpatients using data from LUCID NDS to develop a comprehensive and robust set of LVC indicators; (3) establishing expert consensus on the most relevant and actionable recommendations to prevent LVC; (4) applying the Strength of Recommendation Taxonomy methodology to assess the level of evidence of recommendations; (5) involving patients and the public at various stages of LUCID NDS; and (6) designing monitoring rules within the LUCID NDS and validating quality measures.

Ethics and dissemination

The ethics committees of all five participating university hospitals (Basel, Bern, Geneva, Lausanne and Zurich) approved LUCID NDS as a national registry on quality of care. We will disseminate our findings in peer-reviewed journals, at professional conferences, and through short reports sent to participating entities and stakeholders; moreover, lay summaries are provided for patients and the broader public on our webpage (www.LUCID-nds.ch).
Treatment for peripheral nerve injury: a protocol for a systematic review and Bayesian network meta-analysis
Authors: Yang Yongke , Gu Wenlong , Xu Shuting , Wang Shuai , Shi Huiyan , Zhang Lili , Meng Xiang-gang , Hong Feng , Du Yuzheng
Published: December 2024

Introduction

Available therapies for peripheral nerve injury (PNI) include surgical and non-surgical treatments. Surgical treatment includes neurorrhaphy, grafting (allografts and autografts) and tissue-engineered grafting (artificial nerve guide conduits), while non-surgical treatment methods include electrical stimulation, magnetic stimulation, laser phototherapy and administration of nerve growth factors. However, the treatments currently available to best manage the different PNI manifestations remain undetermined. This systematic review and network meta-analysis (NMA) aims to address this and determine the best treatment or combination of treatments for PNI.

Methods and analysis

A comprehensive search of MEDLINE (via PubMed), Embase, Cochrane Library, Web of Science, Chinese Biomedical Database, China National Knowledge Infrastructure, VIP Database, Wanfang Database, WHO International Clinical Trials Registry Platform, ClinicalTrials.gov and the Chinese Clinical Trial Register will be completed using the following keywords: peripheral nerve injury, therapies and related entry terms. Studies will be included based on specific eligibility criteria, and the reference lists of the included studies will be manually searched. Relevant data will be extracted from the included studies using a specially designed data extraction sheet. The risk of bias in the included studies will be assessed, and the overall strength of the evidence will be summarised. A random-effects model was used for all pairwise meta-analyses (95% CI). Bayesian NMA is used to explore the relative benefits of various treatments. The review will be reported using the Preferred Reporting Items for Systematic Reviews incorporating NMA statement.

Ethics and dissemination

As the protocol for this systematic review and Bayesian NMA is based on studies with published results and does not involve patient interventions, no ethical review is required. The results will be published in a peer-reviewed journal.

PROSPERO registration number

CRD42023475135.
Value-based healthcare for social insurance medicine: key enablers for adoption in practice
Authors: Hagendijk Marije E , Zipfel Nina , Van Der Wees Philip J , Melles Marijke , Hoving Jan L , van der Burg-Vermeulen Sylvia J
Published: December 2024

Background

Driven by rising retirement age and increasing prevalence of chronic diseases impacting work participation, there is an increasing need for quality and efficiency improvement in social insurance medicine (SIM). SIM provides guidance to individuals facing long-term work disability, assess their functional abilities and eligibility for long-term disability benefits. Value-based healthcare (VBHC) targets quality and efficiency improvements in healthcare by placing a priority on improving patient value. So far, VBHC has been introduced with fundamental principles and essential components for its adoption in curative care. Hence, there is room for debate on what are key enablers for the adoption of value-based SIM.

Purpose

The study aims to explore key enablers for the adoption of VBHC in the practice of SIM.

Methods

In this exploratory qualitative study, participants consisted of 15 professionals with expertise either in SIM (n=10) or with expertise in the adoption of VBHC in the curative care sector (n=5). Each participant took part in both a semistructured individual interview and a focus group interview. Thematic coding was employed to analyse the data.

Results

Seven key enablers were identified: (1) investigate the meaning and implementation constraints of value in SIM, (2) integrate SIM into work-focused care networks, (3) explore the need and feasibility for specialisation based on functional problems, (4) identify the most important work outcomes for the patient, (5) identify proxy indicators for cost drivers, (6) identify value-driven financial incentives and (7) develop an information technology system to exchange data.

Conclusions

This paper provides understanding of what is needed to adopt value-based SIM. Future research should delve deeper into these seven key enablers to facilitate the adoption of VBHC, and thereby promote value creation in the practice of SIM.
Using the communication technique of Clean Language in healthcare: an exploratory survey
Authors: Dorman Saskie , Rees Judy
Published: December 2024

Communication is fundamental to effective healthcare. Misunderstandings can increase distress, risks and costs. Clean Language is a precision questioning technique—with specific Clean Language questions which minimise assumptions and bias. It is used in a variety of contexts but is under-researched in healthcare. An exploratory online survey was undertaken to develop an understanding of who uses Clean Language in healthcare, in what kind of roles, settings, contexts and what impacts they identify. 32 people responded, of whom 23 reported using Clean Language in a range of contexts, individually and in groups; 21 people had received training in Clean Language. Participants worked in a wide range of roles, specialties and settings, both clinical and non-clinical, and described Clean Language enabling engagement and encouragement; confidence, knowledge and power; surfacing and handling emotion and conflict in a safe way; clarity, depth, understanding and insights. Some respondents noted that Clean Language is not always intuitive and takes practice but can become natural and enjoyable to use. Communication skills training could include Clean Language questions as one way to enhance understanding. Further exploration of the impact of Clean Language, including from the perspective of patients and families, is warranted.
Essential roles of the unfolded protein response in intestinal physiology
Authors: Hetz Claudio , Silva-Agüero Juan Francisco , Ellerby Lisa M
Published: December 2024

The intestinal epithelium serves as an essential interface between the host and microbiota, regulating innate and adaptive immunity, absorption of nutrients and systemic metabolism, and mediating bidirectional communication with the nervous system. The intestinal epithelium suffers constant challenges to the proteostasis machinery due to its exposure to the dynamically changing and microbial laden lumenal gut environment and to the high secretory demand placed on multiple epithelial cell types to accommodate gut and systemic physiology—especially goblet, enteroendocrine and Paneth cells. In all cases, intestinal cells require an active unfolded protein response (UPR) to sustain their physiological function, the main pathway that monitors and adjusts secretory function changes in the environment. A specialised endoplasmic reticulum (ER) stress sensor uniquely expressed in epithelial cells lining mucosal surfaces, termed inositol-requiring transmembrane kinase/endoribonuclease β, has specific roles in intestinal epithelial homeostasis, regulating mucus production and communication with microbiota. Chronic ER stress or genetic mutations affecting key UPR mediators contribute to the occurrence of inflammatory bowel disease and ulcerative colitis, in addition to colon cancer. Here, we review recent advances linking the UPR and ER stress with gut physiology and intestinal disease. Therapeutic strategies to alleviate ER stress or enforce UPR function to improve intestinal function in ageing and in bowel diseases are also discussed.
Anesthetic approaches and 2-year recurrence rates in non-muscle invasive bladder cancer: a randomized clinical trial
Authors: Han Jang Hee , Yuk Hyeong Dong , Jeong Seung-Hwan , Jeong Chang Wook , Kwak Cheol , Kim Jin-Tae , Ku Ja Hyeon
Published: December 2024

Background

The effect of anesthesia methods on non-muscle invasive bladder cancer (NMIBC) recurrence post-resection remains uncertain. We aimed to compare the oncological outcomes of spinal anesthesia (SA) and general anesthesia (GA) in patients with NMIBC.

Methods

This prospective randomized controlled trial recruited 287 patients with clinical NMIBC at Seoul National University Hospital from 2018 to 2020. The patients underwent transurethral resection of the bladder tumor within 4 weeks of randomization. Intrathecal hyperbaric bupivacaine (0.5%) and a mixture of propofol (1–2 mg/kg) and fentanyl (50–100 μg/kg) were used as induction agents in the SA and GA groups, respectively, with desflurane or sevoflurane used for maintaining anesthesia. The primary and secondary outcome measures were disease recurrence and disease progression, respectively, at 2 years after resection. Cumulative incidence of outcomes was compared between the two groups using time-to-event analyses.

Results

15 patients required alternative anesthesia owing to clinical needs such as SA failure or significant obturator reflex, resulting in a modified intention-to-treat (ITT) population of 272 patients. Time-to-event analysis showed a significantly lower recurrence of NMIBC in the SA group than in the GA group, in both ITT (27.4% vs 39.8%) and modified ITT populations (26.8% vs 39.6%). Disease progression occurred more frequently in the GA than in the SA group (15.2% vs 7.8%), although the difference was not statistically significant.

Conclusions

A notable reduction in the 2-year recurrence rate was observed in patients who underwent SA than in those who underwent GA. Thus, SA may be considered the preferred anesthetic approach.

Trial registration number

NCT03597087.
Application of the COM-B model to facilitators and barriers to HIV and STI testing among people from Black African and Black Caribbean communities in the UK: a scoping review
Authors: Khanna Ritu , Gobin Maya
Published: December 2024

Objective

Individuals from Black African and Black Caribbean communities (black communities) in the UK bear a disproportionate burden of HIV and sexually transmitted infections (STIs), while exhibiting lower testing rates. The aim of the scoping review was to summarise interventions developed to increase HIV/STI testing among black communities in the UK and describe the facilitators and barriers that influence testing uptake in these populations, according to the Capability Opportunity Motivation Behaviour (COM-B) approach.

Methods

Six databases were systematically searched to identify quantitative, qualitative and mixed-method studies evaluating the effectiveness of HIV/STI testing interventions among black communities in the UK, published from 2000 onwards. The review was conducted in accordance with the Joanna Briggs Institute Framework of Evidence Synthesis and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Data were analysed using thematic analysis, and the factors were mapped onto the COM-B model components.

Results

Twenty-two studies, of which 11 were available as abstracts only, were included. Twelve studies included testing provision and health promotion, six studies testing provision only and four health promotion only. Nineteen studies looked at HIV testing interventions only. Facilitators to testing included interventions that provided an understanding of STI and HIV risk, assured privacy for testers and normalised testing through integration into existing services and delivery in non-traditional settings by appropriately trained staff. Barriers to testing included interventions that were stigmatising through the choice of intervention settings and/or targeting of groups, low perceived risk and limited knowledge about infections among people from black communities, and limited engagement and partnership working with relevant community organisations and groups.

Conclusion

Multifaceted interventions that include health promotion and opportunities for testing, co-designed with and by local communities, are crucial in addressing the range of barriers and facilitators experienced by people from black communities.
Clinical utility of routine postoperative labs in emergency general surgery patients
Authors: Empey Rebecca , Ko Hyunkyu , Nirula Ram
Published: December 2024

Background

Morning postoperative labs are often obtained for emergency general surgery (EGS) patients. Studies in other surgical fields indicate that routine postoperative day 1 (POD1) labs are sometimes being performed excessively and do not require intervention. The purpose of this study is to identify predictors indicating the need for POD1 labs in EGS patients based on likelihood of intervention.

Methods

This is a retrospective review of non-critically ill EGS patients from 2022 to 2023 who received POD1 morning labs. The odds of having an abnormal result and likelihood of intervention were measured through multivariate logistic regression accounting for patient characteristics and procedure. Least absolute shrinkage and selection operator (LASSO) regression analysis was performed to determine significant predictors of an abnormal result and intervention.

Results

502 EGS patients were included. LASSO revealed that procedure duration, fever, lysis of adhesions, preoperative systolic blood pressure <90 mm Hg, older age, heart failure, operative blood loss, chronic kidney disease, and anticoagulation use were independent predictors for any abnormal result (area under the receiver operation curve (AUC)=0.785). Independent predictors of intervention were procedure duration, older age, higher estimated blood loss (EBL), anticoagulant use, and lysis of adhesions (AUC=0.704). Procedures >400 min carried an 84.3% chance of an abnormal lab requiring intervention. EBL >200 mL carried a 75.5% chance of an abnormal lab requiring intervention.

Conclusion

POD1 labs for non-critically ill EGS patient rarely require intervention and can be safely omitted. Labs should be considered for longer procedures, higher EBLs, older patients, those on anticoagulation, or after lysis of adhesions.
A Context-Dependent CNN-Based Framework for Multiple Sclerosis Segmentation in MRI
Authors: Placidi Giuseppe , Cinque Luigi , Foresti Gian Luca , Galassi Francesca , Mignosi Filippo , Nappi Michele , Polsinelli Matteo
Published: December 2024

Despite several automated strategies for identification/segmentation of Multiple Sclerosis (MS) lesions in Magnetic Resonance Imaging (MRI) being developed, they consistently fall short when compared to the performance of human experts. This emphasizes the unique skills and expertise of human professionals in dealing with the uncertainty resulting from the vagueness and variability of MS, the lack of specificity of MRI concerning MS, and the inherent instabilities of MRI. Physicians manage this uncertainty in part by relying on their radiological, clinical, and anatomical experience. We have developed an automated framework for identifying and segmenting MS lesions in MRI scans by introducing a novel approach to replicating human diagnosis, a significant advancement in the field. This framework has the potential to revolutionize the way MS lesions are identified and segmented, being based on three main concepts: (1) Modeling the uncertainty; (2) Use of separately trained Convolutional Neural Networks (CNNs) optimized for detecting lesions, also considering their context in the brain, and to ensure spatial continuity; (3) Implementing an ensemble classifier to combine information from these CNNs. The proposed framework has been trained, validated, and tested on a single MRI modality, the FLuid-Attenuated Inversion Recovery (FLAIR) of the MSSEG benchmark public data set containing annotated data from seven expert radiologists and one ground truth. The comparison with the ground truth and each of the seven human raters demonstrates that it operates similarly to human raters. At the same time, the proposed model demonstrates more stability, effectiveness and robustness to biases than any other state-of-the-art model though using just the FLAIR modality.