bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk-Averse Importance Sampling of Tree Attributes in High-Risk Forested Areas
Authors: Roesch Francis A , Schroeder Todd A , McCollum Joseph M
Published: April 2023

This study develops the theory of risk-averse importance sampling and explains its potential application to forest inventory estimation through the use of a heuristic simulation. When the risk-producing elements of the landscape are known, a risk-averse sampling strategy can be created that results in fewer samples in high-risk areas. Our simulation shows that for certain high-risk populations, risk-averse importance sampling can be highly effective at reducing both risk to field crew members (requiring only 10% of the plot visits in the riskiest category) and sample variance relative to simple random sampling. The method is shown to be especially helpful when a population of values of interest decreases with increasing risk, with a reduction in mean square error (MSE) of 84% to 99% in these cases. The simulation also showed the opposite effect on MSE can be expected when values of interest increase with increasing risk. By increasing field crew safety, risk-averse importance sampling should also improve the frequency and accuracy of field observations, potentially leading to even bigger gains in estimate precision. We recommend risk-averse importance sampling any time hazardous conditions can result in a high number of missing observations and reasonably accurate characterizations of landscape risks can be developed.
Identification of immune cell infiltration landscape for predicting prognosis of colorectal cancer
Authors: Wu Xueqian , Li Jianxia , Zhang Yuanzhe , Cheng Yi , Wu Zehua , Zhan Weixiang , Deng Yanhong
Published: April 2023

Background

The tumor microenvironment plays an essential role in the therapeutic response to immunotherapy. It is necessary to identify immune cell infiltration (ICI) subtypes for evaluating prognosis and therapeutic benefits. This study aimed to evaluate the ICI score as an effective prognostic biomarker for immune response.

Methods

The cell-type identification by estimating relative subsets of RNA transcripts and the estimation of stromal and immune cells in malignant tumors using expression methods were used to analyse ICI landscapes in 161 colorectal cancer (CRC) samples with patients’ clinical and prognostic data, RNA sequencing data, and whole-exome sequencing data from the Sixth Affiliated Hospital, Sun Yat-sen University (Guangzhou, China). Statistical analysis and data processing were conducted to calculate ICI scores, and to analyse the prognosis of CRC patients with different ICI scores and other features. A similar analysis with RNA sequencing and clinical data of colon adenocarcinoma (COAD) samples from The Cancer Genome Atlas (TCGA) database was conducted to confirm the correctness of the findings.

Results

The high-ICI score group with a better prognosis (hazard ratio [HR], 2.19; 95% confidence interval [CI], 1.03–4.64; log-rank test, P = 0.036) was characterized by the increased tumor mutational burden and interleukin-17 (IL-17) signaling pathway. Significant differences in the prognosis and the expression levels of immune checkpoints and chemokine marker genes were found between the two ICI score groups. For COAD samples from TCGA, the results also showed a significant difference in patients’ prognosis between the two ICI score groups (HR, 1.72; 95% CI, 1.00–2.96; log-rank test, P = 0.047).

Conclusions

Tumor heterogeneity induced differences in identifying ICI subtypes of CRC patients. The ICI score may serve as an effective biomarker for predicting prognosis, help identify new therapeutic markers for CRC, and develop novel effective immune checkpoint blockade therapies.
Siegel Zeros, Twin Primes, Goldbach’s Conjecture, and Primes in Short Intervals
Authors: Matomäki Kaisa , Merikoski Jori
Published: April 2023

We study the distribution of prime numbers under the unlikely assumption that Siegel zeros exist. In particular, we prove for $$ \begin{align*} & \sum_{n \leq X} \Lambda(n) \Lambda(\pm n+h) \end{align*}$$an asymptotic formula that holds uniformly for $h = O(X)$. Such an asymptotic formula has been previously obtained only for fixed $h$ in which case our result quantitatively improves those of Heath-Brown (1983) and Tao and Teräväinen (2021). Since our main theorems work also for large $h$, we can derive new results concerning connections between Siegel zeros and the Goldbach conjecture and between Siegel zeros and primes in almost all very short intervals.
Impact of long-term care insurance on health inequality in older adults in China based on the concentration index approach
Authors: Tian Yong , Fan Lijun , Zhou Menghan , Du Wei
Published: April 2023

Background

Several studies have shown that social security would reduce health inequalities. However, little was known about the relationship between long-term care insurance and health inequality. We aimed to evaluate the impact of long-term care insurance on health status and health inequality in older adults using a nationally representative cohort.

Methods

Based on four waves of data from the China Health and Retirement Longitudinal Study (CHARLS 2011, 2013, 2015 and 2018), we used the staggered difference in difference (DID) design with the order probit regression models and the concentration index approach as well as decomposition analysis to assess the contribution of long-term care insurance towards residents’ health status and health inequality in older adults aged ≥65 y. We further used the semi-parametric DID model for robustness testing.

Results

Long-term care insurance demonstrated its role, improving self-assessed health in the study population (βcoefficient: 0.090, 95% CI 0.087 to 0.092, p<0.001). The estimation results of the semi-parametric DID were consistent with those of the staggered DID. The income-related health concentration index was 0.0005, having a contribution rate of 1.639% to health inequality in older adults. Decomposition analysis revealed that different policies and residential areas were more influential on the observed health inequalities.

Conclusions

The findings implied that long-term care insurance has widened the health inequality while improving health status in older adults. Additional investment in more comprehensive insurance coverage and increased accessibility to enhance implementation of long-term care insurance is warranted to close the gap.
Exploring the epidemiology of mcr genes, genetic context and plasmids in Enterobacteriaceae originating from pigs and humans on farms in Thailand
Authors: Leangapichart Thongpan , Stosic Milan S , Hickman Rachel A , Lunha Kamonwan , Jiwakanon Jatesada , Angkititrakul Sunpetch , Magnusson Ulf , Van Boeckel Thomas P , Järhult Josef D , Sunde Marianne
Published: April 2023

Objectives

In veterinary medicine, colistin has been widely used as therapeutic and prophylactic agent, and for growth promotion. However, colistin has been re-introduced into treatment of human MDR bacterial infections. We assessed the characteristics and spread of plasmid-borne colistin resistance among healthy pigs, workers with animal-contact and their household members in Thailand.

Methods

WGS and MIC data of 146 mcr-positive isolates from a cross-sectional One Health study were analysed. Long-read sequencing and conjugation were performed for selected isolates.

Results

mcr-carrying isolates were detected in 38% of pooled-pig samples and 16% of human faecal samples. Of 143 Escherichia coli and three Escherichia fergusonii, mcr-1, mcr-3, and mcr-9 variants were identified in 96 (65.8%), 61 (41.8%) and one (0.7%) isolate, respectively. Twelve E. coli co-harboured two mcr variants (mcr-1 and mcr-3). Clonal transmission was detected in five out of 164 farms. mcr-1 was mostly harboured by epidemic IncX4 and IncHI1 plasmids (89.9%). Conversely, mcr-3 was harboured by a range of different plasmids. Comparative plasmid studies suggested IncP and IncFII plasmids as possible endemic mcr-3 plasmids in Asian countries. Moreover, mcr-3 was associated with different mobile genetic elements including TnAs2, ISKpn40 and IS26/15DI. Detected genetic signatures (DRs) indicated recent mcr-3 transpositions, underlining the mobilizable nature of the mcr-3 cassette.

Conclusions

The epidemiology of mcr and the possible evolution of successful plasmids and transposition modules should be carefully monitored. Of special concern is the growing number of different horizontal gene transferring pathways encompassing various transposable modules the mcr genes can be shared between bacteria.
Using elemental staining and mapping techniques for simultaneous visualization of biological structures in the nucleus by multichannel electron microscopy
Authors: Strickfaden Hilmar , Abate Natnael , Förster Christian , Wuest Frank , Underhill D Alan , Hendzel Michael J
Published: April 2023

Transmission electron microscopy (TEM) has been essential in defining the structural organization of the cell due to its ability to image cell structures at molecular resolution. However, the absence of colour has made it very difficult to compare the distributions and relationships of two or more types of biomolecules simultaneously if they lack clear morphological distinctions. Furthermore, single-channel information limits functional analysis, particularly in the nucleoplasm, where fibrillar material could be chromatin, ribonucleic acid or protein. Where specific stains exist to discriminate among these molecules, they cannot be combined because conventional TEM is a single-channel technology. A potential path around this barrier is through electron spectroscopic imaging (ESI). ESI can map the distributions of chemical elements within an ultrathin section. Here, we present methods to stain specific molecules with elements that ESI can visualize to enable multichannel electron microscopy.
Journal author funding sources and conflict of interest disclosures in travel medicine
Authors: Lim Bryan W W , Flaherty Gerard T
Published: April 2023

Highlight Failure to fully disclose conflicts of interest and funding sources in biomedical and clinical research erodes public confidence in the academic integrity of research publications. This study is the first of its kind to analyse the funding and conflict disclosures in a leading travel medicine journal.
Restoring carboxypeptidase E rescues BDNF maturation and neurogenesis in aged brains
Authors: Liu Hongmei , Jiang Dongfang , Yao Fuwen , Li Tingting , Zhou Bo , Zhao Song , Yang Keyan , Feng Haiping , Shen Jiaqi , Tang Jinglan , Wang Sijia , Zhang Yu-Xin , Wang Yun , Li Qian , Zhao Yongliang , Guo Caixia , Tang Tie-Shan
Published: April 2023

Adult neurogenesis declines with age due to the less functional neural stem cells (NSCs) and niches, but the underlying molecular bases for this impaired condition remain unclear. Here we analyzed >55,000 single-cell transcriptomes from two discrete neurogenic niches across the mouse lifespan, and identified new features and populations in NSCs, new markers, and neurogenic regional-specific alternations during aging. Intercellular communication analysis revealed defects in brain-derived neurotrophic factor (BDNF)-TrkB signaling cascade in old NSCs. Carboxypeptidase E (CPE) was found to be highly enriched in NSCs, and played a crucial role in mature/proBDNF balance and adult neurogenesis. Diminishment of CPE with aging resulted in impaired generation of BDNF, thus limiting the neurogenesis in old neurogenic niches. Restoring CPE expression markedly rescued the adult neurogenesis by increasing the production of mature BDNF, offering an attractive therapeutic strategy for the treatment of certain disorders in regions associated with constitutive neurogenesis.
UV luminosity density results at z > 8 from the first JWST/NIRCam fields: limitations of early data sets and the need for spectroscopy
Authors: Bouwens Rychard , Illingworth Garth , Oesch Pascal , Stefanon Mauro , Naidu Rohan , van Leeuwen Ivana , Magee Dan
Published: April 2023

We have derived luminosity functions and set constraints on the UV luminosity and SFR density from z ∼ 17 to z ∼ 8, using the three most-studied JWST/NIRCam data sets, the SMACS0723, GLASS Parallel, and CEERS fields. We first used our own selections on two independent reductions of these data sets using the latest calibrations. A total of 18 z ∼ 8, 12 z ∼ 10, 5 z ∼ 13, and 1 z ∼ 17 candidate galaxies are identified over these fields in our primary reductions, with a similar number of candidates in our secondary reductions. We then use these two reductions, applying a quantitative discriminator, to segregate the full set of z ≥ 8 candidates reported over these fields from the literature, into three different samples, ‘robust’, ‘solid’, and ‘possible’. Using all of these samples, we then derive UV LF and luminosity density results at z ≥ 8, finding substantial differences. For example, including the full set of ‘solid’ and ‘possible’ z ≥ 12 candidates from the literature, we find UV luminosity densities, which are ∼7× and ∼20× higher than relying on the ‘robust’ candidates alone. These results indicate the evolution of the UV LF and luminosity densities at z ≥ 8 is still extremely uncertain, emphasizing the need for spectroscopy and deeper NIRCam + optical imaging to obtain reliable results. Nevertheless, even with the very conservative ‘robust’ approach to selections, both from our own and those of other studies, we find the luminosity density from luminous (MUV < −19) galaxies to be ∼2 × larger than is easily achievable using constant star formation efficiency models, similar to what other early JWST results have suggested.
Intrinsic alignment as an RSD contaminant in the DESI survey
Authors: Lamman Claire , Eisenstein Daniel , Aguilar Jessica Nicole , Brooks David , de la Macorra Axel , Doel Peter , Font-Ribera Andreu , Gontcho A Gontcho Satya , Honscheid Klaus , Kehoe Robert , Kisner Theodore , Kremin Anthony , Landriau Martin , Levi Michael , Miquel Ramon , Moustakas John , Palanque-Delabrouille Nathalie , Poppett Claire , Schubnell Michael , Tarlé Gregory
Published: April 2023

We measure the tidal alignment of the major axes of luminous red galaxies (LRGs) from the Legacy Imaging Survey and use it to infer the artificial redshift-space distortion signature that will arise from an orientation-dependent, surface-brightness selection in the Dark Energy Spectroscopic Instrument (DESI) survey. Using photometric redshifts to downweight the shape–density correlations due to weak lensing, we measure the intrinsic tidal alignment of LRGs. Separately, we estimate the net polarization of LRG orientations from DESI’s fibre-magnitude target selection to be of order 10−2 along the line of sight. Using these measurements and a linear tidal model, we forecast a 0.5 per cent fractional decrease on the quadrupole of the two-point correlation function for projected separations of 40–80 h−1 Mpc. We also use a halo catalogue from the Abacussummit cosmological simulation suite to reproduce this false quadrupole.
The role of China in the international financial system
Authors: Gao Haihong
Published: April 2023

China’s interaction with the international financial system is driven by its growing economic importance in the world. However, China’s financial influence has been much under-presented compared with its economic power. This mismatch provides an opportunity for China to promote greater inclusiveness and better balance of power in global financial governance. The accelerated financial opening-up, exchange-rate flexibility, and deepened domestic reform also nourished the ambition of internationalization of the renminbi that would have impact on the global reserve currency system. This paper investigates the motivations behind China’s engagements with the international financial system, the approaches China adopted to achieve its goals, and the key domestic policies required for China to gain more weight in the global financial market.
European monetary regimes after the fall of Bretton Woods: a political economy approach
Authors: Farese Giovanni , Guerrieri Paolo , Padoan Pier Carlo
Published: April 2023

After the fall of the Bretton Woods system, the EU initiated an original path towards monetary integration which led to the establishment of the European monetary system (EMS) in the 1980s and the economic monetary union (EMU) in the 1990s. This path was an alternative to the floating exchange rate regime which many other countries decided to follow. Adopting a political economy approach, in this paper we reconstruct the main phases of this process, from the 1970s up until today, arguing that they cannot be explained only in terms of costs and benefits of alternative exchange rate configuration, but should consider political as well as economic factors—both domestic and international ones—and the interaction between European monetary and real integration. Ultimately, the predominance of political factors led to an underestimation of the economic difficulties generated by the coexistence of irrevocable exchange rates and full capital mobility. We suggest that new policy instruments and institutional changes are needed to make the common currency workable in the long run. The mandatory path should be towards a more deeply integrated Europe. Such integration is essential to enable the European monetary union to confront with future challenges.
Exorbitant privilege and fiscal autonomy
Authors: Subacchi Paola , van den Noord Paul
Published: April 2023

An aspect of the ‘exorbitant privilege’ we examine in this paper is the ability of the reserve currency issuer to run expansionary fiscal policies to stabilize the economy when a negative shock occurs without triggering an adverse reaction of foreign lenders, including, in particular, higher interest rates imposed by global capital markets. To explore this ‘privilege’ we look at the G7, a group of advanced economies that enjoy larger fiscal space than other countries. We estimate a panel regression model to explain the differences in magnitude of fiscal policy responses to common shocks as a function of countries’ reserve currency status. We find that, indeed, the prevalence of this channel is not rejected by the data and that in fact it seems to have become stronger over time, supported by the global build-up of currency reserves.
Control of contextual memory through interneuronal α5-GABAA receptors
Authors: Zhu Mengwen , Abdulzahir Alifayaz , Perkins Mark G , Chu Chan C , Krause Bryan M , Casey Cameron , Lennertz Richard , Ruhl David , Hentschke Harald , Nagarajan Rajasekar , Chapman Edwin R , Rudolph Uwe , Fanselow Michael S , Pearce Robert A
Published: April 2023

γ-Aminobutyric acid type A receptors that incorporate α5 subunits (α5-GABAARs) are highly enriched in the hippocampus and are strongly implicated in control of learning and memory. Receptors located on pyramidal neuron dendrites have long been considered responsible, but here we report that mice in which α5-GABAARs have been eliminated from pyramidal neurons (α5-pyr-KO) continue to form strong spatial engrams and that they remain as sensitive as their pseudo-wild-type (p-WT) littermates to etomidate-induced suppression of place cells and spatial engrams. By contrast, mice with selective knockout in interneurons (α5-i-KO) no longer exhibit etomidate-induced suppression of place cells. In addition, the strength of spatial engrams is lower in α5-i-KO mice than p-WT littermates under control conditions. Consistent with the established role of the hippocampus in contextual fear conditioning, α5-i-KO mice resisted etomidate’s suppression of freezing to context, but so too did α5-pyr-KO mice, supporting a role for extra-hippocampal regions in the development of contextual fear memory. Overall, our results indicate that interneuronal α5-GABAARs serve a physiological role in promoting spatial learning and that they mediate suppression of hippocampus-dependent contextual memory by etomidate.
Mosquito bite prevention through self-assembled cellulose nanocrystals
Authors: Voignac Daniel , Sar-Shalom Evyatar , Paltiel Yossi , Shoseyov Oded , Bohbot Jonathan
Published: April 2023

Mosquitoes are the deadliest of all combined insects and animals affecting millions and killing hundreds or thousands of people each year. Existing protection methods however are limited and include volatile compounds that actively repel mosquitoes such as N,N-Diethyl-meta-toluamide (DEET) or different essential oils such as geraniol and citronella. Most are odorous compounds and require organic solvents for dispersion. This work investigates the barrier properties of cellulose nanocrystals (CNCs). CNCs are known to self-assemble in strong, transparent, chemical barrier films. They are fully bio-based, and their surface chemistry is ideal for aqueous dispersion of many compounds. This work saw a significant 80% decrease in feeding on human skin when a thin CNC coat was applied. The effect was further confirmed by artificial feeding on Aedes aegypti wherein CNC appears to act as a chemical camouflage to the many cues sought by the insects. The combined effect of CNC with indole reduced egg laying post exposure to mammalian blood close to null with 99.4% less eggs as compared to control. The chemical barrier effect was assessed through a simple headspace experiment showing that the same CNC coat blocked the passage of ammonium hydroxide vapor, a commonly used mosquito attractant, when applied on a filter paper membrane.
Association of Remnant-like Particle Cholesterol with Major Adverse Cardiovascular Events in Subjects with Different Levels of Proprotein Convertase Subtilisin/Kexin 9: A 9.5-year Follow-up Study in a Beijing Community Population
Authors: Wang Xiaona , Tie Ruping , Cao Ruihua , Yang Xu , Xiao Wenkai , Sheng Li , Ye Ping
Published: April 2023

Objective:

The purpose of this study was to determine the relationship between remnant-like particle cholesterol (RLP-C) and major adverse cardiovascular events (MACEs) in patients with different levels of proprotein convertase subtilisin/kexin 9 (PCSK9).

Methods:

From September 2007 to January 2009, 1,859 subjects in Pingguoyuan communities in Beijing were initially screened. After excluding those with bedridden status, mental illness, severe systemic diseases, and missing data, 1,680 subjects were recruited for follow up. All recruited subjects were followed up from February 2013 to September 2013 (181 subjects were lost to follow-up) and from June 2017 to September 2018 (174 subjects were lost to follow up). Finally, 1,325 subjects were included in the study. General demographic characteristics, lifestyle and behaviors, disease history and use of medication was collected. Levels of total cholesterol, triglycerides, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, fast blood glucose, RLP-C, low-density lipoprotein triglycerides and PCSK9 were measured. The levels of RLP-C (low: RLP-C ≤ 157 mg/L; high: RLP-C > 157 mg/L) and PCSK9 (low: PCSK9 ≤ 135.87 μg/L; high: PCSK9 > 135.87 μg/L) were represented using quartiles. Subjects were categorized into 4 groups according to their RLP-C and PCSK9 levels: Q4, high levels of RLP-C with high levels of PCSK9; Q3, high levels of RLP-C with low levels of PCSK9; Q2, low levels of RLP-C with high levels of PCSK9; and Q1, low levels of RLP-C with low levels of PCSK9. The association of RLP-C with MACEs in subjects with different PCSK9 levels was evaluated.

Results:

After a median follow-up of 9.5 years, 1,325 subjects were included in the study and a total of 191 MACEs had occurred. The incidence of MACEs was higher in the RLP-C > 157 mg/L group than the RLP-C ≤ 157 mg/L group (18.40% vs. 10.42%). Cox proportional hazards regression model analysis showed that increased RLP-C levels were associated with an increased risk of MACEs (hazard ratio: 1.405; 95% confidence interval: 1.005–1.964; P < 0.005). The incidence of MACEs was higher in the high RLP-C/PCSK9 group vs. the low RLP-C/PCSK9 group (20.68% vs. 8.76%). Cox proportional hazards regression model analysis showed that RLP-C was associated with an increased risk of MACEs in subjects with high PCSK9 levels independent of traditional risk factors (hazard ratio: 1.791; 95% confidence interval: 1.168–2.825; P = 0.001), but not in those with low PCSK9 levels.

Conclusions:

RLP-C was identified as a risk factor for MACEs, particularly in subjects with high PCSK9 levels. Lowering PCSK9 levels may reduce residual risk in subjects with elevated plasma RLP-C levels.
Role of Biomarkers to Assess the Use of Alcohol
Authors: Shetty Akshay , De La Torre Sergio , Ibrahim Brittney , Hong Andrew , Meza Julio , Saab Sammy
Published: April 2023

Alcohol-associated liver disease has seen a significant rise in the last 2 decades, with an associated rise in the need for accurate alcohol use assessment. Alcohol use has been associated with poor outcomes in both the pre-liver transplant and post-liver transplant patients. Patients with alcohol use disorder often under-report their alcohol consumption because of varying factors, highlighting the need for objective assessment of alcohol use. Aside from the available self-report questionnaires, multiple serologic biomarkers are currently available to assist clinicians to assess recent alcohol consumption among patients with chronic liver disease, liver transplant candidates, and recipients. In this review, we will assess some of these alcohol biomarkers, discuss their strengths and weakness, and review-available data to discuss their role in pre-liver transplant and post-liver transplant population.
The impact of epidural analgesia for acute pancreatitis on maternal and fetal outcome: a cohort study
Authors: Khan Salman , Rizwan Umer Muhammad , Ali Zubair , Khan Muhammad A. , Raza Amna , Nadeem Amjad , Hassan Muddasir Reyaz , Mumtaz Hassan
Published: April 2023

Introduction:

It is anticipated that between 1 in 10, 000 and 1 in 30, 000 pregnancies will be affected by acute pancreatitis (AP). The authors wanted to evaluate the impact of epidural analgesia on maternal and fetal outcomes and its effectiveness in the pain treatment of obstetric patients with AP.

Methodology:

The period for this cohort research was from January 2022 to September 2022. Fifty pregnant women with AP symptoms were enrolled in the study. Conservative medical management was done using intravenous (i.v.) analgesics, including fentanyl and tramadol. Fentanyl was infused i.v. at a rate of 1 µg/kg every hour, while tramadol was bolused i.v. at 100 mg/kg every 8 h. Boluses of 10–15 ml of 0.1% ropivacaine were injected into the L1–L2 interspace at 2–3-h intervals to provide high lumbar epidural analgesia.

Results:

In this study, 10 patients were given an i.v. infusion of fentanyl, and 20 patients were given tramadol boluses. Epidural analgesia showed the most promising results decreasing the visual analog scale score from 9 to 2 in half of the patients. Most fetal complications were noticed in the tramadol group, including prematurity, respiratory distress, and babies requiring noninvasive ventilation.

Conclusion:

Patients with AP during pregnancy may benefit from a new technique for simultaneous analgesia during labor and cesarean section administered via a single catheter. When AP is detected and treated during pregnancy, the mother and child benefit from pain control and recovery.
Hypokalemia as a responsible factor related with the severity of hepatic encephalopathy: a wide multination cross-sectional study
Authors: Ullah Himayat , Shabana Hossam , Rady Mohamed Akl , Abdelsameea Eman , Youssef Mohamed I. , Helmy Housam Ahmed , Mustafa Ghulam , Elghafar Tamer Samir Abd , Almarshad Feras , Alshahrani Abdulrahman , Abdel-Samiee Mohamed , Alwadai Abdulmajeed Ahmed , Zedan Hendawy Abdel-moety , khalil Farag , Ahmed Mahmoud Osama , Kassem Arafat , Omar Marwa M. , Kamel Shimaa Y. , El Deen Mohamed El sheref Saad , Hassan Mohamed Hassan Attia , AboShabaan Hind S. , Elgendy Wagih , Zaghloul Amr M. , Mohamed Ibrahim Ghoniem Ramadan , Zayed Esam , Abdelghaffar Amir , Aboufarrag Galal Abdelhameed , Seif A.S. , Elmahdy Hussein Ahmed , Said Ashraf , Farahat Ali , El-Sayed Lashin Hesham , Elmahdi Essam , Abuamer Ahmed
Published: April 2023

Background:

Several precipitating factors of hepatic encephalopathy have been recognized and studied. Hepatic encephalopathy which is a frequent and grave complication of liver failure, is associated with multiple biochemical changes like high serum ammonia, mercaptan and phenol levels, low albumin levels and derangements in electrolytes. It is characterized by a range of neuronal and psychological aberrations mainly due to the inability of liver to metabolize different neurotoxic chemicals produced in the body. Hypokalemia is one of the most important findings in hepatic encephalopathy and postulated as a precipitating factor of the condition. The authors aimed to know the frequency of hypokalemia and its relation to the severity of hepatic encephalopathy.

Methods:

After taking approval from the hospital ethical review committee, a total of 5000 patients with hepatic encephalopathy were recruited by consecutive sampling. They were interviewed, examined and investigated for serum potassium levels and other precipitating factors of hepatic encephalopathy.

Results:

Total of 5000 patients including 3070 (61.4%) males and 1930 (38.6%) females, aging 13 years and above were studied. The frequency of hypokalemia was 78% (3900 patients). Relating the serum potassium level with the severity of hepatic encephalopathy, 1200 (60%) out of 2000 patients with serum potassium below 2.5 mEq/l were in grade 4 (40%) and 800 out of 2000 were in grade 3 encephalopathy. On the other hand, only 700 patients (6.4%) out 1100 with serum potassium above 3.4 mEq/l were in grade 4 encephalopathy.

Conclusion:

Hypokalemia is a frequent finding in patients with hepatic encephalopathy and found to be directly related to its severity.
Sigmoid mesocolon internal hernia: a case report
Authors: Lukman Kiki , Sulthana Bambang Am Am Setya , Andreas Rio , Nugraha Prapanca
Published: April 2023

Introduction and importance:

Primary internal hernias are rare in adults. Internal hernias present clinically as a sign of small intestinal obstruction. If left untreated, internal hernias might lead to high morbidity and mortality due to strangulation. Internal hernias are usually diagnosed intraoperatively. Here, we present an internal hernia diagnosed with an abdominal computed tomography (CT) scan. The importance of preoperative diagnosis for internal hernias leads to early surgery and keeps the patient from suffering intestinal strangulation.

Case presentation:

We report here the case of a 67-year-old male who presented with acute intestinal obstruction and underwent an abdominal CT scan. The patient was diagnosed with an internal hernia from the imaging of the abdominal CT scan and scheduled for an exploratory laparotomy. An internal hernia was found in the mesocolon of the sigmoid colon; one loop of jejunum was trapped in the hernia defect. After reduction, the hernial defect was closed; no resections were done, and the patient was discharged after 5 days without complication.

Clinical discussion:

Our finding represents a transmesosigmoid hernia, a rare variant of sigmoid mesocolon hernias. The clinical sign and the judgment of the surgeon for the diagnosis of an internal hernia became important factors related to the patient’s outcome.

Conclusion:

The proper adjunct imaging, correct diagnosis, and timing of surgery for internal hernias save the patient from morbidity or intestinal death.
Vertebromedullary hydatidosis: a case report
Authors: Haouas Mohammed Y. , Jihri Abdelhamid , Makhchoune Marouane , Limi Jihane , Lakhdar Abdelhakim
Published: April 2023

Introduction and importance:

The contamination of humans with the larval form of the tapeworm Echinococcus granulosus results in the parasitic disease known as hypatidosis. Even though hydatid disease is widespread in Maghreb nations, bone hydatidosis is still uncommon.

Case presentation:

This article presents the case of a 12-year-old child with no particular pathological antecedent, who presents a spinal cord compression syndrome evolving gradually for 2 weeks whose objective clinical examination found a 2/5 paraparesis with a sharp pyramidal syndrome and subxiphoid sensory level. Medullary MRI has objectified an aspect of hydatid cysts at the level of D8 D9 and D10 compressing the spinal cord.

Clinical discussion:

Management was surgical by decompression by laminectomy of stage D8, D9, and D10 under general anesthesia and put on albendazole, the diagnosis was confirmed by histopathological examination, the evolution was marked by a partial recovery of deficit.

Conclusions:

Clinical symptomatology is vague with a gradually inescapable movement towards spinal or root pressure.
Wernicke encephalopathy revealed by areflexic flaccid tetraparesis associated with gravidarum hyperemesis
Authors: Ben Chaib Rajae , Mekkaoui Ikram , Chetouani Zaima , kaba Ousmane , Markaoui Ikam , Elmezzeoui Sanae , Bkiyar Houssam , Housni Brahim
Published: April 2023

Introduction:

Wernicke’s encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality. The diagnosis of Wernicke’s encephalopathy is based on the clinical manifestations and rapid reversal of symptoms with thiamine.

Case presentation:

The authors present the case of a 25-year-old female patient at the 19th week of gestation (Gravid 1 para 0) with an unremarkable medical history who was admitted to the hospital for an areflexic flaccid tetraparesis with ataxia after persistent vomiting. The brain and spinal MRIs did not reveal any abnormalities, and the evolution was marked by an important improvement after supplementation with thiamine.

Conclusion:

Gayet Wernicke encephalopathy is a medical emergency. Clinical symptoms are inconstant and varied. MRI is the reference examination to confirm the diagnosis, but in 40% of cases it is strictly normal. Early thiamine administration can prevent morbidity and mortality in pregnant women.
Patients with appendicitis during COVID-19 pandemic: a retrospective cohort study
Authors: Ricard Elizabeth , Marceau Alexandre , Larouche Gabrielle , Dorval Heidi , Malo François-Charles
Published: April 2023

Background:

The Coronavirus Disease 19 (COVID-19) pandemic greatly affected the Quebec healthcare system from spring 2020 onward; the consultation delays that were generated may have delayed the management of urgent intra-abdominal pathologies. Our objective was to evaluate the impact of the pandemic on the length of stay and complications within 30 days of treatment of patients consulting for acute appendicitis (AA) at theCentres intégrés universitaires de santé et de services sociaux(CIUSSS)de l’Estrie-Centre hospitalier universitaire de Sherbrooke(Estrie-CHUS), Quebec, Canada.

Methods:

The authors conducted a single-center retrospective cohort study on the charts of all patients diagnosed with AA at the CIUSSS de l’Estrie-CHUS between March 13 and June 22, 2019 (control group) and between March 13 and June 22, 2020 (pandemic group). This corresponds to the first wave of COVID-19 in Quebec. Patients included were those with a radiologically confirmed diagnosis of AA. There was no exclusion criteria. Outcomes assessed were length of hospital stay and 30-day complications.

Results:

The authors analyzed the charts of 209 patients with AA (117 patients in the control group and 92 patients in the pandemic group). No statistically significant difference was observed for the length of stay or the complications between the groups. The only significant difference was the presence of hemodynamic instability on admission (22.2 vs. 41.3%,P=0.004) as well as a trend that did not reach statistical significance regarding the proportions of reoperation before 30 days (0.9 vs. 5.4%,P=0.060).

Conclusion:

In conclusion, the pandemic did not affect the length of stay of AA managed at the CIUSSS de l’Estrie-CHUS. It is not possible to conclude whether the first wave of the pandemic influenced complications related to AA.
Caring Spiritually
Authors: Viftrup Dorte Toudal , Rosenbæk Frederik , Damgaard Hanne Højsager , Hemdrup Mette , Nielsen Marianne , Nissen Ricko Damberg
Published: April 2023

Spiritual care can improve patients' physical and emotional well-being, but patients at the end of life often experience their spiritual needs are not being sufficiently met by the health care professionals. This is caused by barriers among health care professionals that stem from inadequate education on spiritual care and lack of self-reflection on spiritual topics. By participating in spiritual care training, health care professionals seem to gain the knowledge, confidence, and skills they need to care spiritually for patients. The aim of this study was to evaluate the effect and experiences of a training course in spiritual care for 30 nurses working at a Danish hospice. This was done by means of both a before-and-after questionnaire and focus group interviews. The course focused primarily on the nurses and their personal and collegial reflections on spiritual care, whereas increased spiritual care for patients seemed to be a secondary outcome of the course. There was a significant statistical correlation between the nurses' values and spirituality, and their confidence in being able to exercise spiritual care for patients. The training course facilitated spiritual empowerment, collegial spiritual care, and spiritual language among the nurses, which led to increased spiritual care for patients.
A Random Forest Model Using Flow Cytometry Data Identifies Pulmonary Infection after Thoracic Injury
Authors: Gelbard Rondi B. , Hensman Hannah , Schobel Seth , Stempora Linda , Gann Eric , Moris Dimitrios , Dente Christopher J. , Buchman Timothy , Kirk Allan , Elster Eric
Published: April 2023

Background

Thoracic injury can cause impairment of lung function leading to respiratory complications such as pneumonia. There is increasing evidence that central memory T cells of the adaptive immune system play a key role in pulmonary immunity. We sought to explore whether assessment of cell phenotypes using flow cytometry (FCM) could be used to identify pulmonary infection after thoracic trauma.

Methods

We prospectively studied trauma patients with thoracic injuries who survived >48 h at a Level 1 trauma center from 2014-2020. Clinical and FCM data from serum samples collected within 24 h of admission were considered as potential variables. Random forest (RF) and logistic regression (LR) models were developed to estimate the risk of hospital-acquired and ventilator-associated pneumonia (PNA). Variables were selected using backwards elimination and models were internally validated with leave-one-out.

Results

Seventy patients with thoracic injuries were included (median age 35y (IQR: 25.25 - 51) 62.9% (44/70) male, 61.4% (42/70) blunt trauma). The most common injuries included rib fractures (52/70, 74.3%) and pulmonary contusions (26/70, 37%). The incidence of PNA was 14/70 (20%). Median ISS was similar for patients with and without PNA (30.5 (IQR 22.6 - 39.3) vs 26.5 (IQR 21.6 - 33.3). The final RF model selected three variables (APACHE score, highest pulse rate in first 24 h, and frequency of CD4+ central memory (CM) cells) that identified PNA with an AUC of 0.93, sensitivity of 0.91, and specificity of 0.88. A logistic regression with the same features had an AUC of 0.86, sensitivity of 0.76, and specificity of 0.85.

Conclusion

Clinical and FCM data have diagnostic utility in the early identification of patients at risk of nosocomial pneumonia following thoracic injury. Signs of physiologic stress and lower frequency of CM cells appear to be associated with higher rates of pneumonia after thoracic trauma.

Level of Evidence

Diagnostic test/criteria, IV
Fasting increases investment in soma upon refeeding at the cost of gamete quality in zebrafish
Authors: Ivimey-Cook Edward R. , Murray David S. , de Coriolis Jean-Charles , Edden Nathan , Immler Simone , Maklakov Alexei A.
Published: April 2023

Fasting increases lifespan in invertebrates, improves biomarkers of health in vertebrates and is increasingly proposed as a promising route to improve human health. Nevertheless, little is known about how fasted animals use resources upon refeeding, and how such decisions affect putative trade-offs between somatic growth and repair, reproduction and gamete quality. Such fasting-induced trade-offs are based on strong theoretical foundations and have been recently discovered in invertebrates, but the data on vertebrates are lacking. Here, we report that fasted female zebrafish,
Danio rerio
, increase investment in soma upon refeeding, but it comes at a cost of egg quality. Specifically, an increase in fin regrowth was accompanied by a reduction in 24 h post-fertilization offspring survival. Refed males showed a reduction in sperm velocity and impaired 24 h post-fertilization offspring survival. These findings underscore the necessity of considering the impact on reproduction when assessing evolutionary and biomedical implications of lifespan-extending treatments in females and males and call for careful evaluation of the effects of intermittent fasting on fertilization.
Mistaking opposition for autonomy: psychophysical studies on detecting choice bias
Authors: Kummen Åshild , Haggard Patrick , Williams Gwydion , Charles Lucie
Published: April 2023

Do people know when they act freely and autonomously versus when their actions are influenced? While the human aspiration to freedom is widespread, little research has investigated how people perceive whether their choices are biased. Here, we explored how actions congruent or incongruent with suggestions are perceived as influenced or free. Across three experiments, participants saw directional stimuli cueing left or right manual responses. They were instructed to follow the cue's suggestion, oppose it or ignore it entirely to make a ‘free’ choice. We found that we could bias participants' ‘free responses’ towards adherence or opposition, by making one instruction more frequent than the other. Strikingly, participants consistently reported feeling less influenced by cues to which they responded incongruently, even when response habits effectively biased them towards such opposition behaviour. This effect was so compelling that cues that were frequently presented with theOpposeinstruction became systematically judged as having less influence on behaviour, artificially increasing the sense of freedom of choice. Taken together, these findings demonstrate that acting contrarian distorts the perception of autonomy. Crucially, we demonstrate the existence of a novel illusion of freedom evoked by trained opposition. Our results have important implications for understanding mechanisms of persuasion.
The Impact Of COVID-19 on Health Financing in Kenya
Authors: Kairu Angela , Orangi Stacey , Mbuthia Boniface , Arwah Brian , Guleid Fatuma , Keru Janet , Vilcu Ileana , Musuva Anne , Ravishankar Nirmala , Barasa Edwine
Published: April 2023

Background

Sudden shocks to health systems, such as the COVID-19 pandemic may disrupt health system functions. Health system functions may also influence the health system’s ability to deliver in the face of sudden shocks such as the COVID-19 pandemic. We examined the impact of COVID-19 on the health financing function in Kenya, and how specific health financing arrangements influenced the health systems capacity to deliver services during the COVID-19 pandemic.

Methods

We conducted a cross-sectional study in three purposively selected counties in Kenya using a qualitative approach. We collected data using in-depth interviews (n = 56) and relevant document reviews. We interviewed national level health financing stakeholders, county department of health managers, health facility managers and COVID-19 healthcare workers. We analysed data using a framework approach.

Results

Purchasing arrangements: COVID-19 services were partially subsidized by the national government, exposing individuals to out-of-pocket costs given the high costs of these services. The National Health Insurance Fund (NHIF) adapted its enhanced scheme’s benefit package targeting formal sector groups to include COVID-19 services but did not make any adaptations to its general scheme targeting the less well-off in society. This had potential equity implications. Public Finance Management (PFM) systems: Nationally, PFM processes were adaptable and partly flexible allowing shorter timelines for budget and procurement processes. At county level, PFM systems were partially flexible with some resource reallocation but maintained centralized purchasing arrangements. The flow of funds to counties and health facilities was delayed and the procurement processes were lengthy. Reproductive and child health services: Domestic and donor funds were reallocated towards the pandemic response resulting in postponement of program activities and affected family planning service delivery. Universal Health Coverage (UHC) plans: Prioritization of UHC related activities was negatively impacted due the shift of focus to the pandemic response. Contrarily the strategic investments in the health sector were found to be a beneficial approach in strengthening the health system.

Conclusions

Strengthening health systems to improve their resilience to cope with public health emergencies requires substantial investment of financial and non-financial resources. Health financing arrangements are integral in determining the extent of adaptability, flexibility, and responsiveness of health system to COVID-19 and future pandemics.