bluuebunny/crossref_metadata_2025 huggingface dataset:
Rickettsiales in the WHO European Region: an update from a One Health perspective
Authors: Guccione Cristoforo , Colomba Claudia , Iaria Chiara , Cascio Antonio
Published: January 2023

Background

The availability of molecular techniques has significantly increased our understanding of bacteria of the order Rickettsiales, allowing the identification of distinct species in both vector and host arthropods. However, the literature lacks studies that comprehensively summarize the vast amount of knowledge generated on this topic in recent years. The purpose of this study was to conduct a comprehensive analysis of the distribution of Rickettsiales in arthropod vectors, animals and humans in the WHO European Region in order to provide useful information to predict the emergence of certain diseases in specific geographical areas and to formulate hypotheses regarding the possible pathogenetic role of some rickettsial species in the etiology of human pathological conditions.

Methods

A systematic review of the literature in the PubMed and EMBASE databases was conducted following the PRISMA methodology using the search terms “Spotted fever” OR “rickettsiosis” OR “ricketts*” AND all the countries of the WHO European Region, from 1 January 2013 to 12 February 2022. Only studies that identified rickettsiae in human, animal or arthropod samples using molecular techniques were included in the review.

Results

A total of 467 articles considering 61 different species of Rickettsiales with confirmed or suspected human pathogenicity were analyzed in the review. More than 566 identifications of Rickettsiales DNA in human samples were described, of which 89 cases were assessed as importation cases. A total of 55 species of ticks, 17 species of fleas, 10 species of mite and four species of lice were found infected. Twenty-three species of Rickettsiales were detected in wild and domestic animal samples.

Conclusion

The routine use of molecular methods to search for Rickettsiales DNA in questing ticks and other blood-sucking arthropods that commonly bite humans should be encouraged. Molecular methods specific for Rickettsiales should be used routinely in the diagnostics of fever of unknown origin and in all cases of human diseases secondary to an arthropod bite or animal contact.

Graphical Abstract
Non-altered incretin secretion in women with impaired fasting plasma glucose in the early stage of pregnancy: a case control study
Authors: Krystynik Ondrej , Karasek David , Kahle Michal , Kubickova Veronika , Macakova Dominika , Cibickova Lubica , Mraz Milos , Haluzik Martin
Published: January 2023

Backgrounds

Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) may be involved in pathogenesis of gestational diabetes mellitus (GDM). The aim was to compare GLP-1 and GIP production in fasting state and during 3 h mixed meal tolerance test (MMTT) measured by mean area under the curve (AUC) between pregnant women with normal and impaired fasting glucose in an early phase of pregnancy, and healthy non-pregnant controls.

Methods

This study was undertaken as a case–control study. Repeated measurement of fasting plasma glucose ≥ 5.1 mmol/L and < 7.0 mmol/L during the first trimester of pregnancy and exclusion of overt diabetes according to IADSPG criteria was used to find women with impaired fasting glucose (n = 22). Age-matched controls consisted of healthy pregnant (n = 25) and non-pregnant (n = 24) women. In addition to incretins, anthropometric parameters and markers of insulin resistance and beta-cell function were assessed. Variables were summarized as median (interquartile range).

Results

Fasting GLP-1 and GIP concentration or their AUC during MMTT did not significantly differ between pregnant women with impaired fasting plasma glucose [GLP-1AUC19.0 (53.1) and GIPAUC302 (100) pg/mL/min] and healthy pregnant women [GLP-1AUC16.7 (22.3) and GIPAUC297 (142) pg/mL/min] or non-pregnant controls [GLP-1AUC16.8 (9.8) and for GIPAUC313 (98) pg/mL/min]. Although women with impaired fasting glucose were more obese and showed decreased beta-cell function, there were not significant correlations between incretin production and parameters of insulin secretion, insulin resistance, or obesity.

Conclusions

Women with impaired fasting plasma glucose did not show altered incretin production in the first trimester of pregnancy. In contrast to type 2 diabetes, impaired incretin secretion does not seem to play a major role in the early development of GDM.
Mental status is significantly associated with low back pain: a survey-based cross-sectional study among Japanese women
Authors: Watanabe Mayumi , Tomiyama Chikako , Nikaido Takuya , Takeda Tokimasa , Mandai Nozomu
Published: January 2023

Objective

Low back pain (LBP) is a highly prevalent condition that poses significant patient burden. This cross-sectional study identified factors associated with LBP occurrence and developed a strategy to identify, prevent, and reduce LBP-related burden on patient health. A web-based questionnaire-answering system was used to assess the potential effects of LBP on mental health, assessing five domains (physical features, demographics, lifestyle, diet, and mental status) conceptually associated with hie, a common disease state traditionally described in the Japanese culture as a chilly sensation.

Results

Of 1000 women, 354 had and 646 did not have LBP. The Chi test identified 21 factors, and subsequent multivariate logistic regression indicated eight factors significantly associated with LBP: age, history of physician consultation regarding anemia, history of analgesic agents, dietary limitations, nocturia, sauna use, hie, and fatigue. Furthermore, women with LBP exhibited a significantly lower body temperature (BT) in the axilla/on the forehead than women without LBP. LBP and hie are subjective and potentially affected by patient mental status. Stress reduces blood circulation, causing hypothermia and possibly worsening LBP. Therefore, mental-health support is important for patients with LBP to reduce physiological stress. Hyperthermia therapy, a traditionally prescribed intervention, is a potential intervention for future studies.
Timing, extent and outcomes of public health measures in the first wave of the COVID-19 pandemic in Israel and a comparative analysis by socioeconomic indices
Authors: Ginzburg Amit , Barasche-Berdah Deborah , Manor Orly , Levine-Schnur Ronit , Paltiel Ora , Levine Hagai
Published: January 2023

Background

Early in the coronavirus disease 2019 (COVID-19) pandemic, governments implemented exceptional public health measures (PHMs) in the face of uncertainty. This study aimed to compare mitigation policies implemented by Israel and their timing in the first wave of the pandemic to those of other countries, and to assess whether country characteristics such as democracy, trust, education, economic strength and healthcare reserve were associated with decision-making.

Methods

PHMs and pre-pandemic characteristics, using internationally accepted indices, of 50 countries were collected from 1/1/2020-30/06/2020; and associations between them were assessed. Time to implementation of these measures was compared among the Organisation for Economic Co-operation (OECD) nations. Log-rank test was used for univariate analysis. Cox regression was performed to assess the independent contribution of pre-pandemic characteristics to time-to-implementation of measures. Correlations between timing of specific measures and COVID-19 mortality at 60 days were assessed.

Results

Israel ranked in the upper third of the OECD in swiftness to implementation of eight of the ten measures compared. In univariate survival analysis, countries with an education level below the OECD median were more likely to implement a lockdown (p-value = 0.043) and to close restaurants and entertainment venues (p-value = 0.007) when compared to countries above the OECD median. In Cox regression models, controlling for geographic location, democracy level above the OECD median was associated with a longer time-to-implementation of a lockdown (HR=0.35, 95% CI=0.14-0.88, p-value=0.025). Similarly, a high level of GDP per capita was inversely associated with closing schools; and a high level of education inversely associated with closure of restaurants and entertainment venues. Earlier initiation of all PHMs was associated with lower mortality at 60 days, controlling for geographic location.

Conclusions

Israel's initial response to the pandemic was relatively quick, and may have been facilitated by its geographic isolation. Countries with lower pre-pandemic socio-economic indices were quicker to initiate forced social distancing. Early initiation of PHMs was associated with reduced mortality in the short run. Timing of initiation of measures relative to the country-specific spread of disease is a significant factor contributing to short-term early local pandemic control, perhaps more than the exact measures implemented. It is important to note that this study is limited to the initial pandemic response. Furthermore, it does not take into account the broader long-term effects of certain PHMs, which should be a focus of further research.
Carrier phase recovery of LDPC-coded systems based on the likelihood difference algorithm
Authors: Imad Rodrigue , Houcke Sebastien
Published: January 2023

The problem of blind phase offset recovery of low density parity-check (LDPC)-coded systems is considered in this paper. We propose a new algorithm of phase offset estimation that involves the computation and maximization of a likelihood difference (LD)-based cost function calculated from the parity-check matrix of the code. We show in this paper that the new cost function has a simplified form compared to another algorithm proposed in the literature and presents similar estimation performance. Mean squared error (MSE) curves show very good performance of the proposed phase offset estimation algorithm, even at low signal-to-noise ratios.
Assessment and management of cardiovascular complications in eating disorders
Authors: Friars Dara , Walsh Orla , McNicholas Fiona
Published: January 2023

Background

Eating disorders (EDs) are serious conditions predominantly affecting adolescents and young adults (AYAs) and pose a considerable threat to their health and wellbeing. Much of this increased morbidity and mortality is linked to medical compromise, especially cardiovascular abnormalities. Rates of presentation to both community and inpatient medical settings have increased in all age groups following the Covid-19 pandemic and subsequent “lockdowns”, with patients presentations being more medically compromised compared to previous years. This has implications for clinicians with regard to the performance of competent cardiovascular assessments and management of findings.

Aims

This paper is a practical resource for clinicians working with AYAs in whom EDs may present. It will provide a brief summary of the physiological context in which cardiovascular complications develop, systematically outline these complications and suggest a pragmatic approach to their clinical evaluation.

Methods

Relevant literature, guidelines and academic texts were critically reviewed. Conclusions were extracted and verified by a Child and Adolescent Psychiatrist and Adolescent Paediatrician, with suitable expertise in this clinical cohort.

Conclusions

The cardiovascular complications in EDs are primarily linked to malnutrition, and patients presenting with Anorexia Nervosa are most often at greatest risk of structural and functional cardiac abnormalities, including aberrations of heart rate and rhythm, haemodynamic changes and peripheral vascular abnormalities. Other cardiovascular abnormalities are secondary to electrolyte imbalances, as seen in patients with Bulimia Nervosa. More recently defined EDs including Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder are also likely associated with distinct cardiovascular complications though further research is required to clarify their nature and severity. Most cardiovascular abnormalities are fully reversible with nutritional restoration, and normalisation of eating behaviours, including the cessation of purging, though rare cases are linked to cardiac deaths. A detailed clinical enquiry accompanied by a thorough physical examination is imperative to ensure the medical safety of AYAs with EDs, and should be supported by an electrocardiogram and laboratory investigations. Consideration of cardiovascular issues, along with effective collaboration with acute medical teams allows community clinicians identify those at highest risk and minimise adverse outcomes in this cohort.
Depression and quality of life among Afghan healthcare workers: A cross-sectional survey study
Authors: Mohammadi Abdul Qadim , Neyazi Ahmad , Rangelova Vanya , Padhi Bijaya Kumar , Odey Goodness Ogeyi , Ogbodum Molly Unoh , Griffiths Mark D.
Published: January 2023

Background

According to the World Health Organization, approximately 280 million individuals worldwide suffer from depression. One occupational group that is more prone to mental health issues is healthcare workers (HCWs). However, very little is known about the mental health of HCWs in Afghanistan. Therefore, the present study examined depression, quality of life (QOL), and related factors among Afghan HCWs.

Methods

A cross-sectional survey was administered in June 2022 among healthcare workers (N = 299) in the Herat province of Afghanistan. The survey examined depression, its risk factors and predictors among HCWs.

Results

Of the 299 participants, 73.6% of them reported depression symptoms. Low monthly income, working in a private hospital, and being a cigarette smoker were some of the main variables associated with depression symptoms among Afghan HCWs. Multiple regression analysis indicated that field of work (aOR = 3.774, p = 0.0048), monthly income (aOR = 0.746, p = 0.0088), job type (aOR = 8.970, p < 0.0001), cigarette smoking (aOR = 2.955, p = 0.0069), a bad event happening during the past month (aOR = 2.433, p = 0.0157), physical domain of quality of life (aOR = 0.966, p = 0.0186), and psychological domain of quality of life (aOR = 0.950, p = 0.0005) were significantly associated with depression symptoms.

Conclusion

The prevalence of depression symptoms is high among healthcare workers in the Herat province of Afghanistan. One of the variables found to have a major impact on the prevalence of depression was their monthly income. Considering its impact on quality of life and the overall quality of healthcare services, the government should implement regular screening for depression, psychological counselling services, and psychiatric treatment for vulnerable healthcare workers.
Trauma-related falls in an urban geriatric population: predictive risk factors for poorer clinical outcomes
Authors: Farrell Alexander , Castro Taylor , Nalubola Shreya , Lakhi Nisha
Published: January 2023

Background

The aim of this study was to elucidate associations between polypharmacy, types of medications, and geriatric comorbidities to identify predictive risk factors for poorer clinical outcomes following trauma-related falls in the geriatric population. Nearly 80% of trauma-related hospital admissions in the older adult population are secondary to falls, accounting for 3 million emergency department visits annually. Numerous studies have demonstrated associations between falls, polypharmacy, and other geriatric comorbidities, but studies outlining predictive risk factors for poor clinical outcomes are lacking.

Methods

A retrospective cohort study of 1087 patients ≥ 65 years old who presented to Level 1 Trauma Center after a trauma-related fall. Comorbidities, current medication, demographic information, and clinical outcomes were identified to ascertain predictive risk factors for poorer clinical outcomes. Variables were assessed for statistical significance on unadjusted analysis. Variables found to be significant were entered into a multivariable logistic regression model to test for adjusted associations, withp < 0.05 as statistically significant, and presented as adjusted odds ratios with 95% confidence intervals.

Results

Polypharmacy ≥ 4 medications (aOR 2.38 (1.10–5.15),p < .028) was an independent predictor of hospital readmission within 30 days. Chronic kidney disease, male gender, and Asian race had an increased association with ICU admission. History of malignancy (aOR 3.65 (1.62–8.19),p < .002) and chronic kidney disease (aOR 2.56 (1.11–5.96),p < .027) were independent predictors of 30-day mortality.

Conclusions

Polypharmacy, chronic renal disease, malignancy history, male gender, and Asian race had an increased association of adverse clinical outcomes after falls in the geriatric population. Critical evaluation of patients with these risk factors may be needed to mitigate risk in this population.
Characterized source model of the M7.3 2016 Kumamoto earthquake by the 3D reciprocity GFs inversion with special reference to the velocity pulse at KMMH16
Authors: Petukhin Anatoly , Kawase Hiroshi , Nagashima Fumiaki , Ito Eri
Published: January 2023

The 2016 Kumamoto earthquakes caused severe damage centering on the Mashiki residential area. The velocity waveforms at station KMMH16 in Mashiki, during the M7.3 mainshock, show large pulses. We found that severe damage in Mashiki may be the result of the strong westward velocity pulse. The question raised is how the near-fault ground motions with strong velocity pulse at KMMH16 were generated during the mainshock. We focus on the characterized source model with Strong Motion Generation Areas (SMGA). Empirical Green’s function (EGF) method is widely used for source modeling in this case. However, in case that the target site is located just near the fault in nodal plane of source mechanism (like KMMH16), mechanism of the EGF event should perfectly fit mechanism of the mainshock, which is a rare case. Therefore, instead of using EGFs, we used theoretical 3D Green’s functions. Our approach is a nonlinear source inversion. This method requires calculation of waveforms and comparison with observations for many source models. To accelerate these calculations, we use pre-calculated GFs by the reciprocity method in the JIVSM velocity structure model. By comparison with aftershock records, we validated this structure for periods as short as 1.5 s. Target sites are limited to sites close to the fault: KMM005, KMM006, KMMH14, and KMMH16. First, we look for an initial SMGA source model by the grid search method applied to relatively long-period (> 3 s) waveforms and coarse grid of source parameters. Then, we tune that source model to fit observed short-period waveforms with the simplex search method. Necessary physical constraints for the range of the source parameters are applied here. The important point in our inversion scheme is to describe the Kostrov-like slip velocity functions inside each SMGAs by using two triangles. The resulting source model agrees well with other inversion results. We found that the observed westward pulse at KMMH16 is the result of the constructive interference of two pulses from SMGA1 and SMGA2, located in Hinagu fault and southwestern segment of Futagawa fault.

Graphical Abstract
Construction of the genetic switches in response to mannitol based on artificial MtlR box
Authors: Xiao Fengxu , Zhang Yupeng , Zhang Liang , Ding Zhongyang , Shi Guiyang , Li Youran
Published: January 2023

Synthetic biology has rapidly advanced from the setup of native genetic devices to the design of artificial elements able to provide organisms with highly controllable functions. In particular, genetic switches are crucial for deploying new layers of regulation into the engineered organisms. While the assembly and mutagenesis of native elements have been extensively studied, limited progress has been made in rational design of genetic switches due to a lack of understanding of the molecular mechanism by which a specific transcription factor interacts with its target gene. Here, a reliable workflow is presented for designing two categories of genetic elements, one is the switch element-MtlR box and the other is the transcriptional regulatory element- catabolite control protein A (CcpA) box. The MtlR box was designed for ON/OFF-state selection and is controlled by mannitol. The rational design of MtlR box-based molecular structures can flexibly tuned the selection of both ON and OFF states with different output switchability in response to varied kind effectors. Different types of CcpA boxes made the switches with more markedly inducer sensitivities. Ultimately, the OFF-state value was reduced by 90.69%, and the maximum change range in the presence of two boxes was 15.31-fold. This study presents a specific design of the switch, in a plug-and-play manner, which has great potential for controlling the flow of the metabolic pathway in synthetic biology.

Graphical Abstract
Surgical classification for large macular hole: based on different surgical techniques results: the CLOSE study group
Authors: Rezende Flavio A. , Ferreira Bruna G. , Rampakakis Emmanouil , Steel David H. , Koss Michael J. , Nawrocka Zofia A. , Bacherini Daniela , Rodrigues Eduardo B. , Meyer Carsten H. , Caporossi Tomaso , Mahmoud Tamer H. , Rizzo Stanislao , Johnson Mark W. , Duker Jay S.
Published: January 2023

Background

The CLOSE study group proposes an updated surgical classification for large macular holes based on a systematic review of new treatments. Recently, many new techniques have been introduced to treat large full-thickness macular holes (FTMH); although the indications are not clear. An updated surgical classification is needed to help surgical decision-making.

Methods

We gathered published series by the CLOSE Study Group members and from literature search until June 2021. Techniques included: internal limiting membrane peeling (ILM peeling), ILM flaps, macular hydrodissection (macular hydro), human amniotic membrane graft (hAM), and autologous retinal transplantation (ART). Within each technique, chi-square test assessed association between the minimal linear diameter (MLD) (in µm) and closure rate; the postoperative best-corrected visual acuity (BCVA) gains were compared among groups.

Results

Data extraction included 31 published articles: total of 1135 eyes. Eyes were divided into the following groups: ILM peel (n: 683), ILM Flap (n: 233), macular hydrodissection (n: 64), hAM (n: 59), and ART (n: 96). The initial BCVA and size were heterogenous between the groups. ILM peel showed the best results in large FTMH ≤ 535 µm (closure rate 96.8%); adjusted mean BCVA: 0.49 (LogMAR) with a statistical difference among groups. Large FTMH between 535 and 799 µm: ILM flap technique showed better results (closure rate 99.0%); adjusted mean BCVA: 0.67(LogMAR); also with a statistical difference. For large FTMH ≥ 800 µm more invasive techniques are required. Use of hAM, macular hydrodissection and ART showed higher closure rates for this category (100%, 83.3% and 90.5% respectively), and adjusted mean BCVA varied from 0.76 to 0.89. Although there was no statistical difference between those techniques for this group due to the smaller number of cases.

Conclusions

The CLOSE study group demonstrated the potential usefulness of a new surgical classification for large FTMHs and propose OCT biomarkers for use in clinical practice and future research. This new classification demonstrated that Large (400–550 µm) and X-Large (550–800 µm) holes can be treated highly successfully with ILM peel and ILM flap techniques, respectively. Further studies are necessary for the larger FTMHs (XX-Large and Giant), using the CLOSE classification, in order to determine which technique is better suited for each hole size and characteristics.
Color vision restrictions for medical school admission: a discussion on regulations in ASEAN countries compared to countries across the world
Authors: Tan Ting Fang , Grzybowski Andrzej , Ruamviboonsuk Paisan , Tan Anna C. S.
Published: January 2023

Color vision deficiency impairs one’s ability to perceive and discriminate colors. Color-deficient individuals may face discrimination in various occupations, particularly in medical school admissions. This discussion seeks to compare the existing color vision requirements for entry to medical school in Southeast Asian countries as compared to countries across the world. Following this, we explore the published evidence in this field, to provide recommendations for future guidelines that will maximize the occupational opportunities for color-deficient individuals.
Gendered division of housework and childcare and women’s intention to have a second child in Spain
Authors: Suero Cristina
Published: January 2023

The Gender Revolution Theory forecasts a rise in fertility as gender equality increases and permeates the private sphere. However, empirical evidence across different societies has not always been conclusive, which suggests further research on the relationship between gender equality and fertility is needed. This research aims to assess the impact of the distribution of housework and childcare within the couple on one-child mothers’ fertility intentions in Spain. The educational expansion in recent decades has facilitated women’s mass entry into the workforce in this country. Nevertheless, the distribution of unpaid labour remains quite gendered and public support for families is scarce, making family/work balance challenging, especially for women. Using data from the 2018 Spanish Fertility Survey, the results suggest that when the distribution of housework is highly unbalanced between mothers and fathers, women are less likely to intend to have a second child. In contrast, unequal childcare workload does not substantially impact their intention to have a second child. Furthermore, whereas women’s satisfaction with the distribution of housework and childcare does not seem to moderate the effect of distribution, their education level slightly does. University-educated women are more likely to revise their fertility intentions downwards when the distribution is highly unequal.
Static information, K-neighbor, and self-attention aggregated scheme: a transient stability prediction model with enhanced interpretability
Authors: Chen Liukai , Guan Lin
Published: January 2023

Data-driven preventive scanning for transient stability assessment (DTSA) is a faster and more efficient solution than time-domain simulation (TDS). However, most current methods cannot balance generalization to different topologies and interpretability, with simple output. A model that conforms to the physical mechanism and richer label for transient stability can increase confidence in DTSA. Thus a static-information, k-neighbor, and self-attention aggregated schema (SKETCH) is proposed in this paper. Taking only static measurements as input, SKETCH gives several explanations that are consistent with the physical mechanisms of TSA and provides results for all generator stability while predicting system stability. A module based on the self-attention mechanism is designed to solve the locality problem of a graph neural network (GNN), achieving subgraph equivalence outside the k-order neighborhood. Test results on the IEEE 39-bus system and IEEE 300-bus system indicate the superiority of SKETCH and also demonstrate the rich sample interpretation results.
Bioprospective studies of pigmented ink from Sepioteuthis lessoniana and its molecular identification using CO1 gene
Authors: Sumi M. S. , Thazeem B. , Sunish K. S.
Published: January 2023

Abstract5

Background

The present-day world is teeming with numerous diseases due to the changing environment. The enormous growth of population has overburdened the prevailing resources of drugs; hence, drug manufacturers are in the lookout to develop effective and safe drugs in the pharmaceutical field. Marine environment is well known for its secondary metabolites, having a high potential in the research world of medicines. Several successful researches have explored the bioactivities of the marine organisms. In this regard, this study highlights the bioprospective activities of squid ink and identification of the organism using CO1 gene marker.

Results

In the present study, anti-inflammatory activity evaluated by human red blood cell (HRBC) membrane stabilization assay revealed protection of human blood cells in hypotonic solution confirming ant-inflammatory property of squid ink extract. Bovine serum protein denaturation method for investigating in vitro anti-arthritic activity proved that the ink extract has appreciable inhibitory effect on denatured proteins. The in vitro antioxidative property of the squid ink disclosed remarkable free radical scavenging activity. The squid ink exhibited potent antibacterial activity against three microbial pathogens such as Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. From the molecular study using CO1 gene sequencing, it was found that the given species of squid showed 100% similarity with a species in NCBI GenBank and it was identified to be Sepioteuthis lessoniana.

Conclusions

It is evident from the study that squid ink extract is a good source of anti-inflammatory, antioxidative, anti-arthritic and antimicrobial agents which would replace the existing cost of effective investigations intending to purify these active compounds and its identification of new molecular skeleton can give idea to the development of either the base or a new drug itself in the future.
Bone wax causing a middle trunk plexopathy following vertebral artery injury: a neuroradiological pitfall
Authors: Nagi Sonia , Rekik Arwa , Drissi Cyrine , Zammel Ihsen
Published: January 2023

Background

Bone wax is a hemostatic agent widely used in surgery. Since it is neither absorbed nor metabolized, its use remains risky and a potential cause of complications. Even though its MRI radiological characteristics are distinguishable, it is generally misinterpreted as postoperative hematoma or trapped air. We report the first case in literature of brachial plexopathy due to the compressive mass effect of bone wax and the main clues that led us to establish this diagnosis prior to its surgical resection.

Case presentation

A 20-year-old male, victim of stabbing presented with an open wound of the right latero-cervical region with a vascular injury of the V2 segment of the right vertebral artery on CT angiography. He was first admitted for bleeding from the neck uncontrollable with external pressure. The patient underwent an emergency surgical vertebral artery ligation. Forty-eight hours later, he reported a feeling of paresthesia of right arm with right-sided weakness. Neurologic examination revealed a motor deficit of the right triceps and wrist extensor muscles and absence of the triceps reflex. A postoperative compression of the C7 cervical root or the middle trunk of brachial plexus was initially suspected. A cervical MRI demonstrated a T1- and T2-weighted images well-defined right mass located laterally to the spinal cord in the epidural space at the level of C6–C7 vertebrae with a signal-intensity void on both sequences. T2*-weighted images showed no signal attenuation. It did not enhance after contrast administration. An epidural hematoma was less probable since acute hematoma is typically hypointense on T2*-weighted images. Computed tomography helped rule out residual postoperative air trapped in the epidural space based on the density study of the mass compared to air. Finally, a residual surgical foreign material used for packing during the procedure was suspected. The massive use of bone wax was ultimately confirmed by the surgeon and surgically removed with complete immediate postoperative recovery.

Conclusions

This case highlights the importance of a nuanced critical approach of neurosurgeons and neuroradiologists when interpreting postoperative neuroimaging scans of the spine. It is crucial to always consider foreign body-related complications and to review the per-operative procedure in details.
Barriers to learning for sustainability: a teacher perspective
Authors: Parry Sally , Metzger Ellen
Published: January 2023

We collectively face a constellation of complex and interconnected problems that threaten human and planetary wellbeing now and into the future. Holistic, multidisciplinary education that integrates the social, environmental and economic pillars of sustainability and enables learners to contribute to more sustainable societies are widely expected to play a crucial role in addressing these challenges. However, transformative learning to foster more sustainable ways of living cannot take place without teachers, who serve as role models for students and are widely acknowledged as key agents of social change. Teachers are called upon to translate international policies for sustainability education into classroom practice, but research shows that many practicing educators feel unprepared to help learners develop the competencies needed to forge more sustainable paths forward. In this commentary, the reflections of a British science teacher provide a first-hand account of the disconnect between international policy on sustainability education and the lived experiences of a classroom teacher and serve as a launch point for comparison with other teachers’ perspectives on teaching and learning for sustainability as documented in the literature. Despite significant context-based differences in how sustainability education is implemented, teachers’ voices from across the world reveal several common obstacles to multidisciplinary, learner-centered education for sustainability, including disciplinary silos, a focus on high stakes assessments, and inadequate professional learning opportunities for future and practicing educators. These hurdles persist despite repeated calls from policy-makers and researchers to better prepare and support educators as the facilitators of learning for sustainability, underscoring the need to more closely connect top-down Education for Sustainable Development policy to teachers’ needs and classroom experiences.
Self-assembled surfactant-based nanoparticles as a platform for solubilization and enhancement of the photothermal activity of sepia melanin
Authors: El Ghoubary Nayera Mohamed , Fadel Maha , Fadeel Doaa Ahmed Abdel
Published: January 2023

Background

Sepia melanin (SM) is a natural photothermal biopolymer. Its biomedical applications are limited due to its poor solubility and bioavailability. This study aims to prepare a soluble formulation of sepia melanin to enhance its solubility, in turn, its bioavailability, and its use in photothermal therapy of cancer. SM was extracted from a sepia ink sac and prepared as insoluble powdered (SM) which is identified by FTIR, 1H-NMR, thermogravimetric analysis (TGA), and scanning electron microscope. SM was self-assembled using tween 80 into dispersed nanoparticles (SM-NP-Tw). The prepared SM-NP-Tw were fully characterized. The photothermal performance of SM-NP-Tw was assessed. Dark and photocytotoxicity of SM-NP-Tw was studied on HepG2 cells using two wavelengths (660 nm and 820 nm).

Results

The insoluble powdered (SM) exhibited a spherical nanoparticle-like shape as revealed by scanning electron microscope and was soluble only in an alkaline aqueous solution. TGA of SM showed high resistance to thermal degradation indicating good thermal stability. The prepared SM-NP-Tw exhibited a spherical shape with mean sizes of 308 ± 86 nm and a zeta potential of − 25 mv. The cell viability decreased significantly upon increasing the concentration and upon radiation at 820 nm. The results of UV–Vis spectroscopy and the photothermal performance revealed that melanin can absorb light in a wide range of wavelengths including near the IR region; thus, it can emit sufficient heat to kill cells through the photoheat conversion effects.

Conclusion

Sepia melanin nanoparticles self-assembled into tween-based nanostructures could be a promising natural platform for photothermal cancer therapy.
Examining the relationship between maternal mental health-related hospital admissions and childhood developmental vulnerability at school entry in Canada and Australia
Authors: Bell Megan F. , Glauert Rebecca , Roos Leslie L. , Wall-Wieler Elizabeth
Published: January 2023

Background

It is well established that maternal mental illness is associated with an increased risk of poor development for children. However, inconsistencies in findings regarding the nature of the difficulties children experience may be explained by methodological or geographical differences.

Aims

We used a common methodological approach to compare developmental vulnerability for children whose mothers did and did not have a psychiatric hospital admission between conception and school entry in Manitoba, Canada, and Western Australia, Australia. We aimed to determine if there are common patterns to the type and timing of developmental difficulties across the two settings.

Method

Participants included children who were assessed with the Early Development Instrument in Manitoba, Canada (n= 69 785), and Western Australia, Australia (n= 19 529). We examined any maternal psychiatric hospital admission (obtained from administrative data) between conception and child's school entry, as well as at specific time points (pregnancy and each year until school entry).

Results

Log-binomial regressions modelled the risk of children of mothers with psychiatric hospital admissions being developmentally vulnerable. In both Manitoba and Western Australia, an increased risk of developmental vulnerability on all domains was found. Children had an increased risk of developmental vulnerability regardless of their age at the time their mother was admitted to hospital.

Conclusions

This cross-national comparison provides further evidence of an increased risk of developmental vulnerability for children whose mothers experience severe mental health difficulties. Provision of preventative services during early childhood to children whose mothers experience mental ill health may help to mitigate developmental difficulties at school entry.
Benchmarking Outcomes for Molecularly Characterized Synchronous Oligometastatic Non–Small-Cell Lung Cancer Reveals EGFR Mutations to Be Associated With Longer Overall Survival
Authors: De Brian , Farooqi Ahsan S. , Mitchell Kyle G. , Ludmir Ethan B. , Lewis Jeff , Rinsurongkawong Waree , Rinsurongkawong Vadeerat , Lee J. Jack , Swisher Stephen G. , Gibbons Don L. , Zhang Jianjun , Le Xiuning , Elamin Yasir Y. , Gomez Daniel R. , Ning Matthew S. , Lin Steven H. , Liao Zhongxing , Chang Joe Y. , Vaporciyan Ara A. , Heymach John V. , Antonoff Mara B. , Gandhi Saumil J.
Published: January 2023

PURPOSE

Local consolidative therapy (LCT) for patients with synchronous oligometastatic non–small-cell lung cancer is an evolving treatment strategy, but outcomes following LCT stratified by genetic mutations have not been reported. We sought to identify genomic associations with overall survival (OS) and progression-free survival (PFS) for these patients.

METHODS

We identified all patients presenting between 2000 and 2017 with stage IV non–small-cell lung cancer and ≤ 3 synchronous metastatic sites. Patients were grouped according to mutational statuses. Primary outcomes included OS and PFS following initial diagnosis.

RESULTS

Of 194 included patients, 121 received comprehensive LCT to all sites of disease with either surgery or radiation. TP53 mutations were identified in 40 of 78 (55%), KRAS in 32 of 95 (34%), EGFR in 24 of 109 (22%), and STK11 in nine of 77 (12%). At median follow-up of 96 months, median OS and PFS were 26 (95% CI, 23 to 31) months and 11 (95% CI, 9 to 13) months, respectively. On multivariable analysis, patients with EGFR mutations had lower mortality risk (hazard ratio [HR], 0.53; 95% CI, 0.29 to 0.98; P = .044) compared with wild-type patients, and patients with STK11 mutations had higher risk of progression or mortality (HR, 2.32; 95% CI, 1.12 to 4.79; P = .023) compared with wild-type patients. TP53 and KRAS mutations were not associated with OS or PFS. Among 71 patients with known EGFR mutational status who received comprehensive LCT, EGFR mutations were associated with lower mortality compared with wild-type (HR, 0.45; 95% CI, 0.22 to 0.94; P = .032).

CONCLUSION

When compared with wild-type patients, those with EGFR and STK11 mutations had longer OS and shorter PFS, respectively. EGFR mutations were associated with longer OS among oligometastatic patients treated with comprehensive LCT in addition to systemic therapy.
Experimental observation of spontaneous temperature fluctuations in turbulent flows
Authors: Prabhudesai G. , Perrard S. , Pétrélis F. , Fauve S.
Published: January 2023

Even in the absence of externally applied temperature gradients, spontaneously generated temperature fluctuations arise in turbulent flows. We experimentally study these fluctuations in a closed von Kármán swirling flow of air at Mach number of order

, whose boundaries are maintained at a constant temperature. We observe intermittent peaks of low temperature correlated with pressure drops within the flow and show that they are caused by vorticity filaments. The measured ratio of temperature-to-pressure fluctuation agrees with the prediction based on adiabatic cooling within vortex cores. This experimental study shows that although the Mach number of the flow is small, there exist regions within the flow where compressible effects cannot be discarded in the equation for temperature and locally dominate the effect of viscous dissipation.
Racial/Ethnic Inequities in Use of Diabetes Technologies Among Medicare Advantage Beneficiaries With Type 1 Diabetes
Authors: Kommareddi Mallika , Wherry Kael , Vigersky Robert A
Published: January 2023

Context

Racial/ethnic inequities have been observed in diabetes care.

Objective

To measure changes in prevalence of continuous glucose monitoring (CGM) and insulin pump therapy among Medicare Advantage beneficiaries with type 1 diabetes by race/ethnicity and to determine the impact of socioeconomic factors on racial/ethnic inequities.

Design

The prevalence of CGM and pump use was assessed by race/ethnicity for Medicare Advantage beneficiaries annually from 2017 through 2020. Models predicting technology use by year, race/ethnicity, age, sex, endocrinology visits, and measures of socioeconomic status were fit.

Setting

Community.

Patients or Other Participants

Beneficiaries with type 1 diabetes and 2 or more claims with a diabetes diagnosis in the coverage year.

Intervention(s)

Insulin pump or CGM therapy.

Main Outcome Measure(s)

Use of diabetes technology by racial/ethnic group.

Results

Technology use increased from 2017 through 2020 in all racial/ethnic groups. The absolute difference in use between White and Black beneficiaries from 2017 to 2020 remained stable for insulin pumps (10.7% to 10.8%) and increased for CGM (2.6% to 11.1%). The differences in pump use from 2017 to 2020 narrowed between White and Hispanic beneficiaries (12.3% to 11.4%) and White and Asian beneficiaries (9.7% to 6.6%), whereas the opposite occurred for CGM use (3.0% to 15.5% for White vs Hispanic beneficiaries; 1.5% to 8.0% for White vs Asian beneficiaries). Racial/ethnic inequities persisted (P < .0001) after adjusting for other characteristics.

Conclusions

Differences in diabetes technology use between racial/ethnic groups often persisted from 2017 through 2020 and could not be explained by demographics, socioeconomic status, or endocrinology visits.
Polygenic Risk of Prediabetes, Undiagnosed Diabetes, and Incident Type 2 Diabetes Stratified by Diabetes Risk Factors
Authors: Liu Xiaonan , Collister Jennifer A , Clifton Lei , Hunter David J , Littlejohns Thomas J
Published: January 2023

Context

Early diagnosis of type 2 diabetes is crucial to reduce severe comorbidities and complications. Current screening recommendations for type 2 diabetes include traditional risk factors, primarily body mass index (BMI) and family history, however genetics also plays a key role in type 2 diabetes risk. It is important to understand whether genetic predisposition to type 2 diabetes modifies the effect of these traditional factors on type 2 diabetes risk.

Objective

This work aimed to investigate whether genetic risk of type 2 diabetes modifies associations between BMI and first-degree family history of diabetes with 1) prevalent prediabetes or undiagnosed diabetes; and 2) incident confirmed type 2 diabetes.

Methods

We included 431 658 individuals aged 40 to 69 years at baseline of multiethnic ancestry from the UK Biobank. We used a multiethnic polygenic risk score for type 2 diabetes (PRST2D) developed by Genomics PLC. Prediabetes or undiagnosed diabetes was defined as baseline glycated hemoglobin greater than or equal to 42 mmol/mol (6.0%), and incident type 2 diabetes was derived from medical records.

Results

At baseline, 43 472 participants had prediabetes or undiagnosed diabetes, and 17 259 developed type 2 diabetes over 15 years follow-up. Dose-response associations were observed for PRST2D with each outcome in each category of BMI or first-degree family history of diabetes. Those in the highest quintile of PRST2D with a normal BMI were at a similar risk as those in the middle quintile who were overweight. Participants who were in the highest quintile of PRST2D and did not have a first-degree family history of diabetes were at a similar risk as those with a family history who were in the middle category of PRST2D.

Conclusion

Genetic risk of type 2 diabetes remains strongly associated with risk of prediabetes, undiagnosed diabetes, and future type 2 diabetes within categories of nongenetic risk factors. This could have important implications for identifying individuals at risk of type 2 diabetes for prevention and early diagnosis programs.
Associations Between Systemic and Cerebral Inflammation in an Ovine Model of Cardiopulmonary Bypass
Authors: Elsaafien Khalid , Sloan Jasmine M. , Evans Roger G. , Cochrane Andrew D. , Marino Bruno , McCall Peter R. , Hood Sally G. , Yao Song T. , Korim Willian S. , Bailey Simon R. , Jufar Alemayehu H. , Peiris Rachel M. , Bellomo Rinaldo , Miles Lachlan F. , May Clive N. , Lankadeva Yugeesh R.
Published: January 2023

BACKGROUND:

Intraoperative inflammation may contribute to postoperative neurocognitive disorders after cardiac surgery requiring cardiopulmonary bypass (CPB). However, the relative contributions of general anesthesia (GA), surgical site injury, and CPB are unclear.

METHODS:

In adult female sheep, we investigated (1) the temporal profile of proinflammatory and anti-inflammatory cytokines and (2) the extent of microglia activation across major cerebral cortical regions during GA and surgical trauma with and without CPB (N = 5/group). Sheep were studied while conscious, during GA and surgical trauma, with and without CPB.

RESULTS:

Plasma tumor necrosis factor-alpha (mean [95% confidence intervals], 3.7 [2.5–4.9] vs 1.6 [0.8–2.3] ng/mL; P = .0004) and interleukin-6 levels (4.4 [3.0–5.8] vs 1.6 [0.8–2.3] ng/mL; P = .029) were significantly higher at 1.5 hours, with a further increase in interleukin-6 at 3 hours (7.0 [3.7–10.3] vs 1.8 [1.1–2.6] ng/mL; P < .0001) in animals undergoing CPB compared with those that did not. Although cerebral oxygen saturation was preserved throughout CPB, there was pronounced neuroinflammation as characterized by greater microglia circularity within the frontal cortex of sheep that underwent CPB compared with those that did not (0.34 [0.32–0.37] vs 0.30 [0.29–0.32]; P = .029). Moreover, microglia had fewer branches within the parietal (7.7 [6.5–8.9] vs 10.9 [9.4–12.5]; P = .001) and temporal (7.8 [7.2–8.3] vs 9.9 [8.2–11.7]; P = .020) cortices in sheep that underwent CPB compared with those that did not.

CONCLUSIONS:

CPB enhanced the release of proinflammatory cytokines beyond that initiated by GA and surgical trauma. This systemic inflammation was associated with microglial activation across 3 major cerebral cortical regions, with a phagocytic microglia phenotype within the frontal cortex, and an inflammatory microglia phenotype within the parietal and temporal cortices. These data provide direct histopathological evidence of CPB-induced neuroinflammation in a large animal model and provide further mechanistic data on how CPB-induced cerebral inflammation might drive postoperative neurocognitive disorders in humans.