bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of chlorhexidine in preventing infections among patients undergoing cardiac surgeries: a meta-analysis and systematic review
Authors: Wei Jianhua , He Lingying , Weng Fengxia , Huang Fangfang , Teng Peng
Published: October 2021

Background

Although several meta-analyses reported the impact of chlorhexidine (CHX) use in patients undergoing various types of surgery, no meta-analysis summarized the overall effectiveness of CHX specifically for cardiac surgery. This meta-analysis aimed to examine the impact of CHX on infections after cardiac surgery compared with other cleansers or antiseptics.

Methods

PubMed, Embase, and the Cochrane Library were searched from inception up to October 2020 for potentially eligible studies: (1) population: patients who underwent cardiac surgery; (2) intervention or exposure: any type of CHX use in the treatment or exposed group; (3) outcome: number of patients with infections; (4) comparison: placebo or other antiseptic agents; (5) English. The primary outcome was surgical site infection (SSI).

Results

Fourteen studies were included, with 8235 and 6901 patients in the CHX and control groups. CHX was not protective against SSI (OR = 0.77, 95% CI: 0.57–1.04, P = 0.090). CHX was protective for superficial wound infection (OR = 0.42, 95% CI: 0.26–0.70, P = 0.001), but not with deep wound infection (P = 0.509). CHX was not protective against urinary tract of infection (P = 0.415) but was protective for bloodstream infection (OR = 0.36, 95% CI: 0.16–0.80, P = 0.012), nosocomial infections (OR = 0.55, 95% CI: 0.44–0.69, P < 0.001), and pneumonia (OR = 0.26, 95% CI: 0.11–0.61, P = 0.002).

Conclusions

In patients undergoing cardiac surgery, CHX does not protect against SSI, deep wound infection, and urinary tract infections but might protect against superficial SSI, bloodstream infection, nosocomial infections, and pneumonia.
Different causes and diverse outcomes of extremely rare septic cavernous sinus thrombosis complicated with internal carotid artery stenosis
Authors: Chen Bo-An , Liu Zhuo-Hao , Chuang Chi-Cheng , Lee Cheng-Chi
Published: October 2021

Background

Cases of acute sphenoid sinusitis complicated by septic cavernous sinus (CS) thrombosis and internal carotid artery (ICA) stenosis are rarely reported. Different causative pathogens have been reported for this condition. We present two extremely rare and special cases with diverse clinical presentations and outcomes. Case 1 involved a female patient with less extensive sinusitis, but critical ICA occlusion. Case 2 involved a male patient with extensive pansinusitis, meningitis, cerebritis, and vasculitis due to fungal infection, but less stenosis of the ICA lumen. Both patients underwent surgical debridement and received broad-spectrum antibiotics. Additional anti-fungal medication was also administered in Case 2. However, outcomes differed considerably between cases.

Discussion

Case 1 recovered with minimal neurological deficits and had Glasgow Outcome Scale (GOS) and modified Rankin Scale (mRS) scores of 5 and 2, respectively; however, the Case 2 had GOS and mRS scores of 3 and 4, respectively. Although rare, septic CS thrombosis with ICA stenosis can lead to unexpected and severe neurological sequelae. Fungal infection can result in catastrophic complications and poorer prognosis.

Conclusion

In addition to early detection, aggressive surgical debridement and adequate antimicrobial treatment are crucial to satisfactory outcomes in patients with septic CS thrombosis complicated with ICA stenosis.
Comparative effects of enzymatic soybean, fish meal and milk powder in diets on growth performance, immunological parameters, SCFAs production and gut microbiome of weaned piglets
Authors: Li Yingjie , Liu Yang , Wu Jiangnan , Chen Qiuhong , Zhou Qiang , Wu Fali , Zhang Ruinan , Fang Zhengfeng , Lin Yan , Xu Shengyu , Feng Bin , Zhuo Yong , Wu De , Che Lianqiang
Published: October 2021

Background

The objective of this study was to evaluate the replacement effects of milk powder (MK) and fish meal (FM) by enzymatic soybean (ESB) in diets on growth performance, immunological parameters, SCFAs production and gut microbiome of weaned piglets.

Methods

A total of 128 piglets with initial body weight at 6.95 ± 0.46 kg, were randomly assigned into 4 dietary treatments with 8 replicates per treatment and 4 piglets per replicate for a period of 14 d. Piglets were offered iso-nitrogenous and iso-energetic diets as follows: CON diet with MK and FM as high quality protein sources, ESB plus FM diet with ESB replacing MK, ESB plus MK diet with ESB replacing FM, and ESB diet with ESB replacing both MK and FM.

Results

No significant differences were observed in growth performance among all treatments (P > 0.05). However, piglets fed ESB plus FM or ESB diet had increased diarrhea index (P<0.01), and lower digestibility of dry matter (DM), gross energy (GE) or crude protein (CP), relative to piglets fed CON diet (P <  0.01). Moreover, the inclusion of ESB in diet markedly decreased the plasma concentration of HPT and fecal concentration of butyric acid (BA) (P<0.01). The High-throughput sequencing of 16S rRNA gene V3−V4 region of gut microbiome revealed that the inclusion of ESB in diet increased the alpha diversity, and the linear discriminant analysis effect size (LEfSe) showed that piglets fed with ESB plus FM or ESB diet contained more gut pathogenic bacteria, such as g_Peptococcus, g_Veillonella and g_Helicobacter.

Conclusion

The inclusion of ESB in diet did not markedly affect growth performance of piglets, but the replacement of MK or both MK and FM by ESB increased diarrhea index, which could be associated with lower nutrients digestibility and more gut pathogenic bacteria. However, piglets fed diet using ESB to replace FM did not markedly affect gut health-related parameters, indicating the potential for replacing FM with ESB in weaning diet.
NORHA, a novel follicular atresia-related lncRNA, promotes porcine granulosa cell apoptosis via the miR-183-96-182 cluster and FoxO1 axis
Authors: Yao Wang , Pan Zengxiang , Du Xing , Zhang Jinbi , Liu Honglin , Li Qifa
Published: October 2021

Background

Follicular atresia has been shown to be strongly associated with a low follicle utilization rate and female infertility, which are regulated by many factors such as microRNAs (miRNAs), which constitute a class of noncoding RNAs (ncRNAs). However, little is known about long noncoding RNAs (lncRNAs), which constitute another ncRNA family that regulate follicular atresia.

Results

A total of 77 differentially expressed lncRNAs, including 67 upregulated and 10 downregulated lncRNAs, were identified in early atretic follicles compared to healthy follicles by RNA-Sequencing. We characterized a noncoding RNA that was highly expressed in atretic follicles (NORHA). As an intergenic lncRNA, NORHA was one of the upregulated lncRNAs identified in the atretic follicles. To determine NORHA function, RT-PCR, flow cytometry and western blotting were performed, and the results showed that NORHA was involved in follicular atresia by influencing GC apoptosis with or without oxidative stress. To determine the mechanism of action, bioinformatics analysis, luciferase reporter assay and RNA immunoprecipitation assay were performed, and the results showed that NORHA acted as a ‘sponge’, that directly bound to the miR-183-96-182 cluster, and thus prevented its targeted inhibition of FoxO1, a major sensor and effector of oxidative stress.

Conclusions

We provide a comprehensive perspective of lncRNA regulation of follicular atresia, and demonstrate that NORHA, a novel lncRNA related to follicular atresia, induces GC apoptosis by influencing the activities of the miR-183-96-182 cluster and FoxO1 axis.
Successional dynamics and alternative stable states in a saline activated sludge microbial community over 9 years
Authors: Wang Yulin , Ye Jun , Ju Feng , Liu Lei , Boyd Joel A. , Deng Yu , Parks Donovan H. , Jiang Xiaotao , Yin Xiaole , Woodcroft Ben J. , Tyson Gene W. , Hugenholtz Philip , Polz Martin F. , Zhang Tong
Published: October 2021

Background

Microbial communities in both natural and applied settings reliably carry out myriads of functions, yet how stable these taxonomically diverse assemblages can be and what causes them to transition between states remains poorly understood. We studied monthly activated sludge (AS) samples collected over 9 years from a full-scale wastewater treatment plant to answer how complex AS communities evolve in the long term and how the community functions change when there is a disturbance in operational parameters.

Results

Here, we show that a microbial community in activated sludge (AS) system fluctuated around a stable average for 3 years but was then abruptly pushed into an alternative stable state by a simple transient disturbance (bleaching). While the taxonomic composition rapidly turned into a new state following the disturbance, the metabolic profile of the community and system performance remained remarkably stable. A total of 920 metagenome-assembled genomes (MAGs), representing approximately 70% of the community in the studied AS ecosystem, were recovered from the 97 monthly AS metagenomes. Comparative genomic analysis revealed an increased ability to aggregate in the cohorts of MAGs with correlated dynamics that are dominant after the bleaching event. Fine-scale analysis of dynamics also revealed cohorts that dominated during different periods and showed successional dynamics on seasonal and longer time scales due to temperature fluctuation and gradual changes in mean residence time in the reactor, respectively.

Conclusions

Our work highlights that communities can assume different stable states under highly similar environmental conditions and that a specific disturbance threshold may lead to a rapid shift in community composition.
COVID-19 vaccination intention and vaccine characteristics influencing vaccination acceptance: a global survey of 17 countries
Authors: Wong Li Ping , Alias Haridah , Danaee Mahmoud , Ahmed Jamil , Lachyan Abhishek , Cai Carla Zi , Lin Yulan , Hu Zhijian , Tan Si Ying , Lu Yixiao , Cai Guoxi , Nguyen Di Khanh , Seheli Farhana Nishat , Alhammadi Fatma , Madhale Milkar D. , Atapattu Muditha , Quazi-Bodhanya Tasmi , Mohajer Samira , Zimet Gregory D. , Zhao Qinjian
Published: October 2021

Background

The availability of various types of COVID-19 vaccines and diverse characteristics of the vaccines present a dilemma in vaccination choices, which may result in individuals refusing a particular COVID-19 vaccine offered, hence presenting a threat to immunisation coverage and reaching herd immunity. The study aimed to assess global COVID-19 vaccination intention, vaccine characteristics influencing vaccination acceptance and desirable vaccine characteristics influencing the choice of vaccines.

Methods

An anonymous cross-sectional survey was conducted between 4 January and 5 March 2021 in 17 countries worldwide. Proportions and the corresponding 95% confidence intervals (CI) of COVID-19 vaccine acceptance and vaccine characteristics influencing vaccination acceptance were generated and compared across countries and regions. Multivariable logistic regression analysis was used to determine the factors associated with COVID-19 vaccine hesitancy.

Results

Of the 19,714 responses received, 90.4% (95% CI 81.8–95.3) reported likely or extremely likely to receive COVID-19 vaccine. A high proportion of likely or extremely likely to receive the COVID-19 vaccine was reported in Australia (96.4%), China (95.3%) and Norway (95.3%), while a high proportion reported being unlikely or extremely unlikely to receive the vaccine in Japan (34.6%), the U.S. (29.4%) and Iran (27.9%). Males, those with a lower educational level and those of older age expressed a higher level of COVID-19 vaccine hesitancy. Less than two-thirds (59.7%; 95% CI 58.4–61.0) reported only being willing to accept a vaccine with an effectiveness of more than 90%, and 74.5% (95% CI 73.4–75.5) said they would accept a COVID-19 vaccine with minor adverse reactions. A total of 21.0% (95% CI 20.0–22.0) reported not accepting an mRNA vaccine and 51.8% (95% CI 50.3–53.1) reported that they would only accept a COVID-19 vaccine from a specific country‐of‐origin. Countries from the Southeast Asia region reported the highest proportion of not accepting mRNA technology. The highest proportion from Europe and the Americas would only accept a vaccine produced by certain countries. The foremost important vaccine characteristic influencing vaccine choice is adverse reactions (40.6%; 95% CI 39.3–41.9) of a vaccine and effectiveness threshold (35.1%; 95% CI 33.9–36.4).

Conclusions

The inter-regional and individual country disparities in COVID-19 vaccine hesitancy highlight the importance of designing an efficient plan for the delivery of interventions dynamically tailored to the local population.

Graphic Abstract
Descriptive analysis of adverse drug reaction reports in children and adolescents from Germany: frequently reported reactions and suspected drugs
Authors: Dubrall Diana , Leitzen Sarah , Toni Irmgard , Stingl Julia , Schulz M. , Schmid Matthias , Neubert Antje , Sachs Bernhardt
Published: October 2021

Background

Adverse drug reactions (ADRs) in the pediatric population may differ in types and frequencies compared to other populations. Respective studies analyzing ADR reports referring to children have already been performed for certain countries. However, differences in drug prescriptions, among others, complicate the transferability of the results from other countries to Germany or were rarely considered. Hence, the first aim of our study was to analyze the drugs and ADRs reported most frequently in ADR reports from Germany referring to children contained in the European ADR database (EudraVigilance). The second aim was to set the number of ADR reports in relation to the number of drug prescriptions. These were provided by the Research Institute for Ambulatory Health Care in Germany.

Methods

For patients aged 0–17 years 20,854 spontaneous ADR reports were received between 01/01/2000–28/2/2019. The drugs and ADRs reported most frequently were identified. Stratified analyses with regard to age, sex and drugs used “off-label” were performed. Reporting rates (number of ADR reports/number of drug prescriptions) were calculated.

Results

Methylphenidate (5.5%), ibuprofen (2.3%), and palivizumab (2.0%) were most frequently reported as suspected. If related to the number of drug prescriptions, the ranking changed (palivizumab, methylphenidate, ibuprofen). Irrespective of the applied drugs, vomiting (5.4%), urticaria (4.6%) and dyspnea (4.2%) were the ADRs reported most frequently. For children aged 0–1 year, drugs for the treatment of nervous system disorders and foetal exposure during pregnancy were most commonly reported. In contrast, methylphenidate ranked first in children older than 6 years and referred 3.5 times more often to males compared to females. If age- and sex-specific exposure was considered, more ADR reports for methylphenidate referred to children 4–6 years and females 13–17 years. Drugs for the treatment of nervous system disorders ranked first among “off-label” ADR reports.

Conclusions

Our analysis underlines the importance of putting the number of ADR reports of a drug in context with its prescriptions. Additionally, differences in age- and sex-stratified analysis were observed which may be associated with age- and sex-specific diseases and, thus, drug exposure. The drugs most frequently included in “off-label” ADR reports differed from those most often used according to literature.
Structural characterization of polysaccharide from jujube (Ziziphus jujuba Mill.) fruit
Authors: Ji Xiaolong , Cheng Yanqiu , Tian Jingyuan , Zhang Siqi , Jing Yongshuai , Shi Miaomiao
Published: October 2021

Background

Jujube (Ziziphus jujuba Mill.) fruit is one of the largest productions in China and its increasing production has drawn considerable attention from researchers. Polysaccharide is one of the most abundant components of jujube, and it represents a major group of biolotegically active constituents. This study intended to investigate the special structure of a homogeneous acidic polysaccharide (PZMP4) produced from Ziziphus Jujuba cv. Muzao fruit using novel methods, including DEAE-Sepharose Fast Flow and Sephacryl S-300 column chromatography.

Results

The structure of PZMP4 was determined via high-performance gel permeation chromatography (HPGPC), gas chromatography (GC), Fourier transform infrared spectroscopy (FT-IR), methylation analysis, nuclear magnetic resonance spectroscopy (NMR), scanning electron microscopy (SEM), and atomic force microscopy (AFM). The results reveal that PZMP4 with a molecular weight of 27.90 kDa was composed of rhamnose, arabinose, mannose, glucose, galactose, and galacturonic acid at a ratio of 2.32:2.21:0.22:0.88:2.08:8.83. Advanced structural analysis revealed a netted structure with molecular aggregates of PZMP4. Structural features demonstrated that the basic backbone of PZMP4 appeared to mainly consist of (1→4)-linked GalpA with three branches bonded to O-3 of (1→3)-linked Araf, (1→2)-linked Rhap, and terminated with GalpA.

Conclusions

PZMP4’s unique structure could imply distinct bioactivities and have considerable utilization in functional food.

Graphic abstract
One-pot synthesis of (R)- and (S)-phenylglycinol from bio-based l-phenylalanine by an artificial biocatalytic cascade
Authors: Zhang Jiandong , Qi Ning , Gao Lili , Li Jing , Zhang Chaofeng , Chang Honghong
Published: October 2021

Chiral phenylglycinol is a very important chemical in the pharmaceutical manufacturing. Current methods for synthesis of chiral phenylglycinol often suffered from unsatisfied selectivity, low product yield and using the non-renewable resourced substrates, then the synthesis of chiral phenylglycinol remain a grand challenge. Design and construction of synthetic microbial consortia is a promising strategy to convert bio-based materials into high value-added chiral compounds. In this study, we reported a six-step artificial cascade biocatalysis system for conversion of bio-based l-phenylalanine into chiral phenylglycinol. This system was designed using a microbial consortium including two engineered recombinant Escherichia coli cell modules, one recombinant E. coli cell module co-expressed six different enzymes (phenylalanine ammonia lyase/ferulic acid decarboxylase/phenylacrylic acid decarboxylase/styrene monooxygenase/epoxide hydrolase/alcohol dehydrogenase) for efficient conversion of l-phenylalanine into 2-hydroxyacetophenone. The second recombinant E. coli cell module expressed an (R)-ω-transaminase or co-expressed the (S)-ω-transaminase, alanine dehydrogenase and glucose dehydrogenase for conversion of 2-hydroxyacetophenone into (S)- or (R)-phenylglycinol, respectively. Combining the two engineered E. coli cell modules, after the optimization of bioconversion conditions (including pH, temperature, glucose concentration, amine donor concentration and cell ratio), l-phenylalanine could be easily converted into (R)-phenylglycinol and (S)-phenylglycinol with up to 99% conversion and > 99% ee. Preparative scale biotransformation was also conducted on 100-mL scale, (S)-phenylglycinol and (R)-phenylglycinol could be obtained in 71.0% and 80.5% yields, > 99% ee, and 5.19 g/L d and 4.42 g/L d productivity, respectively. The salient features of this biocatalytic cascade system are good yields, excellent ee, mild reaction condition and no need for additional cofactor (NADH/NAD+), provide a practical biocatalytic method for sustainable synthesis of (S)-phenylglycinol and (R)-phenylglycinol from bio-based L-phenylalanine.
Secondary analysis of malaria rapid diagnostic tests from rounds 5–8 of WHO product testing with a focus on false-negative results
Authors: Xu Biao , Tu Bo , Chu Fang , Jalloh Mohamed , Mu Jin-Song , Zheng Jun-Jie , Chen Wei-Wei
Published: October 2021

Despite the widespread use of malaria rapid diagnostic test (RDT) in clinical practice, there are a lot of challenges. We conducted a secondary analysis of 129 malaria RDT data from rounds 5–8 of the World Health Organization (WHO) product testing summary and discuss the causes of false-negative (FN) results with a focus on low parasite density, improper RDT storage, operation and interpretation, and plasmodium falciparum with a pfhrp2/3 gene deletion. The results demonstrated that the malaria RDTs currently commercially available might cause FN results in practice.
Reaching people soon after a traumatic event: an exploratory observational feasibility study of recruitment in the emergency department to deliver a brief behavioral intervention via smartphone to prevent intrusive memories of trauma
Authors: Kanstrup Marie , Rudman Ann , Göransson Katarina , Andersson Emil , Lauri Klara Olofsdotter , Rapoport Emma , Sunnergård Linda , Bragesjö Maria , Andersson Erik , Iyadurai Lalitha , Holmes Emily A.
Published: October 2021

Background

The current study explored how to recruit patients soon after a traumatic event, to deliver a novel intervention in a new emergency department in Sweden. This brief behavioral intervention aims to prevent intrusive memories and is delivered soon after trauma in the emergency department. In the UK, it has shown promising results. Traumatic events resulting in admission to the emergency department (e.g., road traffic accidents) may result in subsequent mental health problems such as post-traumatic stress disorder, where intrusive memories of the trauma constitute a core clinical feature. Early interventions that prevent intrusive memories after psychological trauma are lacking.

Specific aims were to explore identification of eligible patients (aim 1), fitting in with emergency department staff routines to deliver the study protocol (aim 2), and using the patients’ own smartphones to deliver intervention/control task (aim 3). Two changes to the previous study were (i) extending the trauma types included (ii) a new control condition, also by smartphone.

Methods

This is an explorative observational study. Data was both analyzed descriptively and using the Framework method.

Results

We identified several possible ways to recruit patients, and establish a sense of embeddedness in the Swedish emergency department context and a positive appreciation from staff. The study protocol was tested with 8 participants. Tasks both in the intervention and control condition were readily delivered via patients’ own smartphones.

Conclusion

Recruitment of patients and smartphone delivery of the intervention indicates initial feasibility. Researcher presence and administration of study procedures was successfully fitted to emergency department routines and well received by staff. Further pilot work is warranted, underscoring the importance of our collaboration between nursing and psychology.
The genetic diversity of the genus Mus (Linnaeus, 1758) in the eastern part of the North Caucasus
Authors: Tembotova Fatimat , Kuchinova Ekaterina , Amshokova Albina , Kononenko Ekaretina
Published: October 2021

Background

There are two species of Mus in the Caucasus: M. musculus and M. macedonicus. M. musculus is widespread in the Caucasus, where the species is found everywhere from the Black to the Caspian Sea. M. macedonicus is ubiquitous Transcaucasia. The most north-astern border of its distribution in the Caucasus, according to the literature, is located in the Derbent region, near the border between Dagestan and Azerbaijan.

Results

Cytochrome b mt-DNA of genus Mus research in this study in the Eastern Caucasus. About 70% of M. musculus haplotypes from the lowlands of Dagestan were recorded for the first time. One of these haplotypes accounts for approximately 25% of the total species diversity of haplotypes. M. macedonicus was found in only one locality, the Sarykum barchans, where this species prevails in number and accounts for 70% of the total number mice of the genus Mus. The species is characterized by low values of genetic diversity and nucleotide variability, which may indicate that the population originated from a small number of founders and may explain its relative isolation from the main range. The dating of the appearance of the ancestors of M. musculus in the east of the Russian Caucasus corresponds to 99-66 thousand years ago (at a mutation rate of 3-10% per million years).

Conclusion

The results obtained suggest that the history of the appearance of M. musculus in the Eastern Caucasus is more ancient and is not associated with human agricultural activities.

We believe that possibly the ancestral range of M. musculus covered the eastern and western coasts of the Caspian Sea in the territory of southern Dagestan, Azerbaijan, and Iran. In this paper M. macedonicus, a Balkan-Asia Minor species, was registered for the first time in the North Caucasus. This species was registered in the center of Dagestan, where it inhabits sympatrically (on the territory) and syntopically (on the same biotope) with M. musculus. The low values of genetic diversity of M. macedonicus in the North Caucasus suggest that the population originated from a small group of founders.
Explicability of humanitarian AI: a matter of principles
Authors: Coppi Giulio , Moreno Jimenez Rebeca , Kyriazi Sofia
Published: October 2021

In the debate on how to improve efficiencies in the humanitarian sector and better meet people’s needs, the argument for the use of artificial intelligence (AI) and automated decision-making (ADMs) systems has gained significant traction and ignited controversy for its ethical and human rights-related implications.

Setting aside the implications of introducing unmanned and automated systems in warfare, we focus instead on the impact of the adoption of AI-based ADMs in humanitarian response. In order to maintain the status and protection conferred by the humanitarian mandate, aid organizations are called to abide by a broad set of rules condensed in the humanitarian principles and notably the principles of humanity, neutrality, impartiality, and independence. But how do these principles operate when decision-making is automated?

This article opens with an overview of AI and ADMs in the humanitarian sector, with special attention to the concept of algorithmic opacity. It then explores the transformative potential of these systems on the complex power dynamics between humanitarians, principled assistance, and affected communities during acute crises. Our research confirms that the existing flaws in accountability and epistemic processes can be also found in the mathematical and statistical formulas and in the algorithms used for automation, artificial intelligence, predictive analytics, and other efficiency-gaining-related processes.

In doing so, our analysis highlights the potential harm to people resulting from algorithmic opacity, either through removal or obfuscation of the causal connection between triggering events and humanitarian services through the so-called black box effect (algorithms are often described as black boxes, as their complexity and technical opacity hide and obfuscate their inner workings (Diakopoulos, Tow Center for Digital Journ, 2017). Recognizing the need for a humanitarian ethics dimension in the analysis of automation, AI, and ADMs used in humanitarian action, we endorse the concept of “explicability” as developed within the ethical framework of machine learning and human-computer interaction, together with a set of proxy metrics.

Finally, we stress the need for developing auditable standards, as well as transparent guidelines and frameworks to rein in the risks of what has been defined as humanitarian experimentation (Sandvik, Jacobsen, and McDonald, Int. Rev. Red Cross 99(904), 319–344, 2017). This article concludes that accountability mechanisms for AI-based systems and ADMs used to respond to the needs of populations in situation of vulnerability should be an essential feature by default, in order to preserve the respect of the do no harm principle even in the digital dimension of aid.

In conclusion, while we confirm existing concerns related to the adoption of AI-based systems and ADMs in humanitarian action, we also advocate for a roadmap towards humanitarian AI for the sector and introduce a tentative ethics framework as basis for future research.
Advanced cardiovascular risk prediction in the emergency department: updating a clinical prediction model – a large database study protocol
Authors: Reynard Charles , Martin Glen P. , Kontopantelis Evangelos , Jenkins David A. , Heagerty Anthony , McMillan Brian , Jafar Anisa , Garlapati Rajendar , Body Richard
Published: October 2021

Background

Patients presenting with chest pain represent a large proportion of attendances to emergency departments. In these patients clinicians often consider the diagnosis of acute myocardial infarction (AMI), the timely recognition and treatment of which is clinically important. Clinical prediction models (CPMs) have been used to enhance early diagnosis of AMI. The Troponin-only Manchester Acute Coronary Syndromes (T-MACS) decision aid is currently in clinical use across Greater Manchester. CPMs have been shown to deteriorate over time through calibration drift. We aim to assess potential calibration drift with T-MACS and compare methods for updating the model.

Methods

We will use routinely collected electronic data from patients who were treated using TMACS at two large NHS hospitals. This is estimated to include approximately 14,000 patient episodes spanning June 2016 to October 2020. The primary outcome of acute myocardial infarction will be sourced from NHS Digital’s admitted patient care dataset. We will assess the calibration drift of the existing model and the benefit of updating the CPM by model recalibration, model extension and dynamic updating. These models will be validated by bootstrapping and one step ahead prequential testing. We will evaluate predictive performance using calibrations plots and c-statistics. We will also examine the reclassification of predicted probability with the updated TMACS model.

Discussion

CPMs are widely used in modern medicine, but are vulnerable to deteriorating calibration over time. Ongoing refinement using routinely collected electronic data will inevitably be more efficient than deriving and validating new models. In this analysis we will seek to exemplify methods for updating CPMs to protect the initial investment of time and effort. If successful, the updating methods could be used to continually refine the algorithm used within TMACS, maintaining or even improving predictive performance over time.

Trial registration

ISRCTN number: ISRCTN41008456
Direct numerical simulation of hypersonic boundary layer transition over a lifting-body model HyTRV
Authors: Qi Han , Li Xinliang , Yu Changping , Tong Fulin
Published: October 2021

Direct numerical simulation (DNS) of transition over a hypersonic lifting body model HyTRV developed by China Aerodynamics Research and Development Center is performed. The free-stream parameters are: the free-stream Mach number is 6, the unit Reynolds number is 10000/mm, the free-stream temperature is 79 K, the angle of attack is 0, and the wall temperature is 300 K. Weak random blowing-and-suction perturbations in the leading range are used to trigger the transition. A high order finite-difference code OpenCFD developed by the authors is used for the simulation, and grid convergence test shows that the transition locations are grid-convergence. DNS results show that transition occurs in central area of the lower surface and the concaved region of the upper surface, and the transition regions are also the streamline convergence regions. The transition mechanisms in different regions are investigated by using the spectrum and POD analysis.
The utility of the standardized uptake value, metabolic tumor volume and total lesion glycolysis as predictive markers of recurrent breast cancer
Authors: Fathinul Fikri A. S. , Chong E. Y. , Syafrina A. H.
Published: October 2021

Background

Breast cancer is the second leading cancer killer of women globally. An early measure utilizing a noninvasive molecular marker for predicting cancer aggressiveness is important to better manage the patient and to avert early disease progression. We aimed to determine whether metabolic tumor volume (MTV) and total lesion glycolysis (TLG) are able to predict risk in high TNM tumor staging and the need for the appropriate treatment in breast cancer patients. This is a retrospective study of confirmed breast cancer patients who underwent neoadjuvant, local and adjuvant treatment and follow-up. The 18F-FDG PET/CT study for initial staging was performed, and metabolic parameters (MTV, TLG, SUVmax mean) were analyzed. Spearman correlation was used to assess correlations between metabolic parameters and clinicopathological factors with TNM staging and treatment intention. SUVmean, wbMTV and wbTLG were analyzed to predict the dichotomization of patient endpoint for low (stage I and II) and high (stage III and IV) TNM stage.

Results

Twenty-six patients (4 low stage, 22 high stage) with a mean age of 51.8 ± 11.8 years with confirmed breast cancer underwent 18FFDG PET/CT. The MTV and TLG parameters in the tumor (T) were significantly correlated with the TNM stage (P < 0.050); the SUVmax mean (4.18 ± 1.68 g/dl), wbMTV mean (404.68 ± 558.02 cm3) and wbTLG (1756.55 ± 2432.11 g) differed significantly in the high versus low TNM staging with the best predictive cut-off value of SUVmax mean (3.55 g/ml, p < 0.05), wbMTV (20 cm3, p < 0.05) and wbTLG (130 g, p < 0.05) when these values were exceeded. Only wbTLG (130 g, p < 0.05) showed significance difference in treatment intention.

Conclusions

In this study, the metabolic parameters SUVmax mean, MTV and TLG showed potential good relationships with TNM staging. TLG was the only marker that influenced the treatment intention in predicting breast cancer aggressiveness.
COVITALE 2020 from eastern Indian population: imageologists perspective, a learning curve
Authors: Kumar Sen Kamal , Dubey Roopak , Goyal Mayank , Sethi Humsheer , Sharawat Ajay , Arora Rohit
Published: October 2021

Background

High-resolution computed tomography (HRCT) chest becomes a valuable diagnostic tool for identifying patients infected with Coronavirus Disease 2019 (COVID-19) in the early stage, where patients may be asymptomatic or with non-specific pulmonary symptoms. An early diagnosis of COVID-19 is of utmost importance, so that patients can be isolated and treated in time, eventually preventing spread of the disease, improving the prognosis and reducing the mortality. In this paper, we have highlighted our radiological experience of dealing with the pandemic crisis of 2020 through the study of HRCT thorax, lung ultrasonography, chest X-rays and artificial intelligence (AI).

Results

Results of CT thorax analysis have been given in detail. We had also compared CT severity score (CTSS) with clinical and laboratory parameters. Correlation of CTSS with SpO2 values and comorbidities was also studied. We also analysed manual CTSS with the CTSS scored calculated by the AI software.

Conclusions

CTSS and use of COVID-19 Reporting and Data System (CORADS) result in accuracy and uniform percolation of information among the clinicians. Bed-side X-rays and ultrasonography have played a role where the patients could not be shifted for CT scan. The possibility of predicting impending or progression of hypoxia was not possible when SpO2 mapping was correlated with the CTSS. AI was alternatively tried with available software (CT pneumonia analysis) which was not so appropriate considering the imaging patterns in the bulk ofatypical category.
Centralized colorectal cancer screening outreach and patient navigation for vulnerable populations in North Carolina: study protocol for the SCORE randomized controlled trial
Authors: Malo Teri L. , Correa Sara Y. , Moore Alexis A. , Ferrari Renée M. , Leeman Jennifer , Brenner Alison T. , Wheeler Stephanie B. , Tan Xianming , Reuland Daniel S. ,   on behalf of the Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE) Study Protocol Consortium, Ratner Shana , Frerichs Leah , Lich Kristen Hassmiller , Crockett Seth , Rohweder Catherine , Farr Deeonna E. , Richardson Claudia , Erhard Cory , Beasley Evan , Hogsed Michelle , Bland Ashley
Published: October 2021

Background

Although colorectal cancer (CRC) screening is effective in reducing CRC mortality, screening rates in vulnerable populations served by community health centers (CHCs) remain below national targets. CHCs in North Carolina are challenged to reach CRC screening targets as they tend to be under-resourced, have limited capacity to implement and sustain population health interventions, and typically operate independently from one another and from regional colonoscopy providers. The Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE) project is designed to address barriers to CRC screening in partnership with CHCs by implementing a multilevel intervention that includes centralized support infrastructure for mailed fecal immunochemical test (FIT) outreach and patient navigation to follow-up colonoscopy. This paper describes protocols for the SCORE implementation trial.

Methods

We will conduct a type 2 hybrid effectiveness-implementation trial that will assess effectiveness at increasing CRC screening and follow-up rates while also assessing implementation outcomes. The planned trial sample will include 4000 CHC patients who are at average CRC risk and due for screening. Participants will be randomized 1:1 to receive either usual care or a multilevel intervention that includes mailed FIT outreach and patient navigation support to follow-up colonoscopy for those with abnormal FIT. The primary effectiveness outcome is completion of any CRC screening test at six months after randomization. We will also conduct a multilevel assessment of implementation outcomes and determinants.

Discussion

This hybrid effectiveness-implementation trial will evaluate the effectiveness and implementation of an intervention that provides centralized infrastructure for mailed FIT screening and patient navigation for CHCs that operate independently of other healthcare facilities. Findings from this research will enhance understanding of the effectiveness of a centralized approach and factors that determine successful implementation in vulnerable patient populations.

Trial registration

The trial was registered on May 28, 2020, at ClinicalTrials.gov (identifier NCT04406714).
Aptitude of endophytic microbes for production of novel biocontrol agents and industrial enzymes towards agro-industrial sustainability
Authors: Falade Ayodeji O. , Adewole Kayode E. , Ekundayo Temitope C.
Published: October 2021

Background

Endophytes have continued to receive increased attention worldwide, probably, due to the enormous biotechnological potentials spanning through various industrial sectors. This paper outlines the biotechnological potentials of endophytes in biocontrol and industrial enzyme production, and the possible contribution towards achieving agro-industrial sustainability using published articles on endophytes in both Web of Science and Scopus (1990–2020).

Main body of the abstract

This review discusses the potential of endophytes to produce novel secondary metabolites with effective biocontrol activity against insect pests and plant pathogens. More so, the aptitude of endophytes for production of a wide range of enzymes with potential applications in agriculture, energy and health is discussed in this review. Furthermore, this review highlights the emerging potentials of endophytes in the production of exopolysaccharide and fatty acids. This paper also advocates the need for bioprospecting endophytes for novel biocontrol agents against termites, which are known for causing significant damage to forest and stored products.

Short conclusion

Exploration of endophytes for biocontrol and production of biomolecules of industrial significance could contribute significantly towards agricultural and industrial sustainability.
Evolution of RNA viruses from SARS to SARS-CoV-2 and diagnostic techniques for COVID-19: a review
Authors: Khan Johra , Asoom Lubna Ibrahim Al , Khan Maryam , Chakrabartty Ishani , Dandoti Sayequa , Rudrapal Mithun , Zothantluanga James H.
Published: October 2021

Background

From the start of the twenty-first century up to the year 2021, RNA viruses are the main causative agents of the majority of the disease outbreaks the world has confronted. Recently published reviews on SARS-CoV-2 have mainly focused on its structure, development of the outbreak, relevant precautions, management trials and available therapies. However, in this review, we aim to explore the history, evolution of all coronaviruses and the associated viral outbreaks along with the diagnostics for COVID-19 in the twenty-first century.

Main body

We have focused on different RNA viruses’ viz. SARS-CoV, MERS-CoV, and SARS-CoV-2, their classification, and the various disease outbreaks caused by them. In the subsequent section, the comparison of different RNA viruses affecting humans has been made based on the viral genome, structure, time of the outbreak, mode of spread, virulence, causative agents, and transmission. Due to the current mayhem caused by the rapidly emerging virus, special attention is given to SARS-CoV-2, its genome updates, and infectivity. Finally, the current diagnostic techniques such as nucleic acid testing (real time-polymerase chain reaction and loop-mediated isothermal amplification), CRISPR-based diagnostics (CRISPR based DETECTR assay, CRISPR based SHERLOCK test, AIOD-CRISPR, FELUDA, CREST), chest radiographs (computed tomography, X-ray), and serological tests (Lateral flow assay, enzyme-linked immunosorbent assay, chemiluminescent immunoassay, neutralization assay, nano-sensors, blood test, viral sequencing) with their pros and cons, and future diagnostic prospective have been described.

Conclusions

The present gloomy scenario mandates clinical manifestations, contact tracing, and laboratory tests as important parameters that need to be taken into consideration to make the final diagnosis.
Interplay between the genetics of personality traits, severe psychiatric disorders and COVID-19 host genetics in the susceptibility to SARS-CoV-2 infection
Authors: Heilbronner Urs , Streit Fabian , Vogl Thomas , Senner Fanny , Schaupp Sabrina K. , Reich-Erkelenz Daniela , Papiol Sergi , Oraki Kohshour Mojtaba , Klöhn-Saghatolislam Farahnaz , Kalman Janos L. , Heilbronner Maria , Gade Katrin , Comes Ashley L. , Budde Monika , Andlauer Till F. M. , Anderson-Schmidt Heike , Adorjan Kristina , Stürmer Til , Loerbroks Adrian , Amelang Manfred , Poisel Eric , Foo Jerome , Heilmann-Heimbach Stefanie , Forstner Andreas J. , Degenhardt Franziska , Zimmermann Jörg , Wiltfang Jens , von Hagen Martin , Spitzer Carsten , Schmauss Max , Reininghaus Eva , Reimer Jens , Konrad Carsten , Juckel Georg , Lang Fabian U. , Jäger Markus , Figge Christian , Fallgatter Andreas J. , Dietrich Detlef E. , Dannlowski Udo , Baune Bernhardt T. , Arolt Volker , Anghelescu Ion-George , Nöthen Markus M. , Witt Stephanie H. , Andreassen Ole A. , Chen Chi-Hua , Falkai Peter , Rietschel Marcella , Schulze Thomas G. , Schulte Eva C.
Published: October 2021

Background

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, with its impact on our way of life, is affecting our experiences and mental health. Notably, individuals with mental disorders have been reported to have a higher risk of contracting SARS-CoV-2. Personality traits could represent an important determinant of preventative health behaviour and, therefore, the risk of contracting the virus.

Aims

We examined overlapping genetic underpinnings between major psychiatric disorders, personality traits and susceptibility to SARS-CoV-2 infection.

Method

Linkage disequilibrium score regression was used to explore the genetic correlations of coronavirus disease 2019 (COVID-19) susceptibility with psychiatric disorders and personality traits based on data from the largest available respective genome-wide association studies (GWAS). In two cohorts (the PsyCourse (n = 1346) and the HeiDE (n = 3266) study), polygenic risk scores were used to analyse if a genetic association between, psychiatric disorders, personality traits and COVID-19 susceptibility exists in individual-level data.

Results

We observed no significant genetic correlations of COVID-19 susceptibility with psychiatric disorders. For personality traits, there was a significant genetic correlation for COVID-19 susceptibility with extraversion (P = 1.47 × 10−5; genetic correlation 0.284). Yet, this was not reflected in individual-level data from the PsyCourse and HeiDE studies.

Conclusions

We identified no significant correlation between genetic risk factors for severe psychiatric disorders and genetic risk for COVID-19 susceptibility. Among the personality traits, extraversion showed evidence for a positive genetic association with COVID-19 susceptibility, in one but not in another setting. Overall, these findings highlight a complex contribution of genetic and non-genetic components in the interaction between COVID-19 susceptibility and personality traits or mental disorders.
Effectiveness of Sofosbuvir and Daclatasvir in treatment of Hepatitis-C: An experience of tertiary care hospital in Karachi
Authors: Butt Nazish , Saleem Anoshia , Khan Muhammad Ali , Akbar Ali
Published: October 2021

Objective: To assess the effectiveness of Sofosbuvir (SOF) and Daclatasvir (DCV) in patients with chronic hepatitis C (CHC), compensated cirrhosis (CC) and decompensated cirrhosis (DCLD) either treatment naïve or experienced.

Methods: This was a prospective, observational study, conducted from January 2017 to December 2018 at Jinnah Postgraduate Medical Centre, Karachi. All patients above 12 years of age with detectable HCV RNA PCR were included. Patients were divided into three groups: CHC, CC and DCLD. SOF and DCV for 12 or 24 weeks were given. Ribavirin (RBV) was given to treatment experienced and cirrhotic patients. Primary outcome was End of Treatment Response (ETR) and secondary outcome was Sustained Virological Response (SVR) at post treatment week 12 or 24.

Results: Total 300 patients with mean age of 40.49 ± 13.86 were enrolled. Majority were females 174 (58%). CHC were 200 (66.6%) while cirrhotic were 100 (33.4%). Treatment naïve patients were 267 (89%) and 33 (11%) patients were experienced. Most common genotype was 3 (83%). ETR was achieved in 292 (97.33%) and SVR in 265 (88.33%) patients respectively.

Conclusion: SOF plus DCV with or without RBV is a highly effective treatment for chronic HCV and is still used in many centers of Pakistan. This regimen has excellent results for GT-3. The outcomes are mainly influenced by the presence or absence of cirrhosis.

doi: https://doi.org/10.12669/pjms.37.7.4627

How to cite this:Butt N, Anoshia, Khan MA, Akbar A. Effectiveness of Sofosbuvir and Daclatasvir in treatment of Hepatitis-C: An experience of tertiary care hospital in Karachi. Pak J Med Sci. 2021;37(7):2014-2019. doi: https://doi.org/10.12669/pjms.37.7.4627

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.