bluuebunny/crossref_metadata_2025 huggingface dataset:
Current understanding of antibiotic-associated dysbiosis and approaches for its management
Authors: Kesavelu Dhanasekhar , Jog Pramod
Published: February 2023

Increased exposure to antibiotics during early childhood increases the risk of antibiotic-associated dysbiosis, which is associated with reduced diversity of gut microbial species and abundance of certain taxa, disruption of host immunity, and the emergence of antibiotic-resistant microbes. The disruption of gut microbiota and host immunity in early life is linked to the development of immune-related and metabolic disorders later in life. Antibiotic administration in populations predisposed to gut microbiota dysbiosis, such as newborns, obese children, and children with allergic rhinitis and recurrent infections; changes microbial composition and diversity; exacerbating dysbiosis and resulting in negative health outcomes. Antibiotic-associated diarrhea (AAD), Clostridiodes difficile-associated diarrhea (CDAD), and Helicobacter pylori infection are all short-term consequences of antibiotic treatment that persist from a few weeks to months. Changes in gut microbiota, which persist even 2 years after antibiotic exposure, and the development of obesity, allergies, and asthma are among the long-term consequences. Probiotic bacteria and dietary supplements can potentially prevent or reverse antibiotic-associated gut microbiota dysbiosis. Probiotics have been demonstrated in clinical studies to help prevent AAD and, to a lesser extent, CDAD, as well as to improve H pylori eradication rates. In the Indian setting, probiotics ( Saccharomyces boulardii and Bacillus clausii) have been shown to reduce the duration and frequency of acute diarrhea in children. Antibiotics may exaggerate the consequences of gut microbiota dysbiosis in vulnerable populations already affected by the condition. Therefore, prudent use of antibiotics among neonates and young children is critical to prevent the detrimental effects on gut health.
Biventricular Repair for Aortic Atresia, Ventricular Septal Defect, and Type C Interrupted Aortic Arch
Authors: Wang Yi-Chia , Chou Heng-Wen , Chen Yih-Sharng , Huang Shu-Chien
Published: February 2023

Interrupted aortic arch is a rare congenital heart defect. Among patients with interrupted aortic arch, an interruption between the innominate artery and left common carotid artery (type C) is the rarest. Herein, we report the case of a neonate with aortic atresia, ventricular septal defect, type C interrupted aortic arch, and aberrant right subclavian artery who underwent Norwood stage I operation and staged biventricular repair. Due to aortic atresia, coronary artery perfusion was retrograde from the right common carotid artery. The surgical technique and special considerations for cardiopulmonary bypass are presented.
Adolescents and Adults With Congenital Heart Disease: Why Are They Lost to Follow-Up?
Authors: Liu Tianwei , Jackson Alun C. , Menahem Samuel
Published: February 2023

Almost 90% of infants with congenital heart disease (CHD) now reach adulthood but require long-term surveillance to recognize and manage residual and/or evolving lesions. Yet many are lost to follow-up. A scoping review identified four specific domains that pose barriers to consistent follow-up. There are multiple issues associated with transition from pediatric to adult care which included—the lack of a seamless transfer, the establishment of a new trusting relationship, promoting the right balance of patient autonomy and addressing knowledge gaps. Additional issues related to logistic problems of time, distance, cost, and the availability of specialized care, are further compounded by the psychosocial factors and the heterogeneity of the cardiac abnormality affecting our patients. Further study of all these issues is warranted to improve ongoing engagement.
Common Inflammatory Markers and Outcome After Pediatric Cardiac Surgery With High Thoracic Epidural Anesthesia: A Randomized Controlled Study
Authors: Kumar Alok , Ghotra Gurpinder Singh , Dwivedi Deepak , Bhargava D. V. , Joshi Ankur , Tiwari Nikhil , Ramamurthy H. R.
Published: February 2023

Background: High thoracic epidural analgesia (HTEA) plays a pivotal role in reducing stress and neuroendocrine response in cardiac surgeries. Aim: The primary objective is to assess the effect of HTEA, in pediatric cardiac surgery, on inflammatory markers (interleukin [IL]-6, IL-8, and tumor necrosis factor-α). The secondary objectives are to assess its effect on various organ systems, that is, pulmonary (PaO2, P/F ratio), renal (Creatinine clearance, somatic near infrared spectroscopy [NIRS], serum neutrophil gelatinase–associated lipocalin values), cardiac (cardiac index, serum Trop-I, and lactate levels), mechanical ventilation duration, and length of stay in hospital (LOS). Methods: The study included 188 pediatric patients, who underwent, on-pump cardiac surgery randomized into the Epidural Group (n = 92) and Non-Epidural Group (n = 96). After general anesthesia, a 23 G epidural catheter was placed at the T4-5 level with a Bupivacaine infusion while the Non-epidural Group received fentanyl infusion. Blood samples were collected at four-time points, T0(preop), T1(4 h), and on the first and second postoperative days (T2 and T3). Results: The inflammatory markers were reduced, while the outcomes variables of mechanical ventilation (MV) duration had lower values in the epidural group (19.5 h vs 47.3 h, P = .002). LOS was shorter (10.1 days vs 13.3 days, P = .016). pO2, PF ratio, and renal NIRS values were better in the Epidural Gp, while other parameters were comparable. Non-epidural Gp had more complications esp. Acute kidney injury requires RRT. Conclusion: HTEA use in pediatric, on-pump cardiac surgery offers a favorable profile in terms of reduction in the inflammatory markers and positive effect on the organ systems with lesser MV duration and the LOS.
Chinese EFL Teachers’ Use of Digital Resources in Doing Research: Its Current Status and Influential Factors
Authors: Wang Qi , Zhang Ning , Ma Wulin
Published: February 2023

This paper is designed to explore the current status of Chinese EFL teachers’ use of digital resources in doing research and its influential factors. It classifies digital resources into six types aligned to the research process and uses the revised TAM to find out and explain its influential factors. A total of 180 teachers were investigated via the online questionnaire. The results show the Chinese EFL teachers’ use of six-type resources is at an intermediate low level. Among them, the type of resources for getting data analysis software is most frequently used; The type of resources for managing literature is least frequently used. However, teachers’ intention to use the resources is relatively high. Frequency of doing research, facilitating condition (FC), and perceived ease of use of resources (PEOU) are the direct predictive factors for EFL teachers’ actual use of digital resources (AU). Self-efficacy in using resources, ICT skill, and FC are significant direct predictors of PEOU, and they are indirect predictors of AU.
“They Don’t Really Care about my Results, they Prefer Selling my Life Story.” Inspirational Paralympians and Sponsorship
Authors: Beldame Yann , Joncheray Helene , Duquesne Valentine , Richard Rémi
Published: February 2023

This article intends to analyze the links that Paralympic athletes and their staff members establish between the Paralympic athletes’ self-presentation as cyborgs or supercrips and their access to sponsors. Based on an interview survey of 15 Paralympic athletes and 42 members of their staffs, we will show that not all Paralympic athletes can be associated with inspirational cyborg or supercrip figures. Indeed, according to the Paralympic athletes and staff members interviewed, some discriminating criteria prevail for sponsors in their attribution of sponsorship contracts. Some Paralympic athletes report numerous situations in which they are perceived and presented in a miserabilist perspective of pity remote from any sponsorship perspective. We will then analyze the ableist dimension of the intelligibility frameworks through which Paralympic athletes claim to be recognized by sponsors. Finally, we will show how this type of recognizability continues to exclude and invisibilize Paralympic athletes who are the least inspiring for non-disabled people. Therefore, it appears that there are inequalities between Paralympic athletes in their access to sponsors according to the inspiration they arouse in non-disabled people.
Impact of the COVID-19 Pandemic on Injury Incidence in Japanese Male Professional Soccer Players
Authors: Matsunaga Ryo , Nagao Masashi , Akagi Ryuichiro , Fukai Atsushi , Sando Takashi , Ikeda Hiroshi , Taketomi Shuji
Published: February 2023

Background:

The outbreak of the 2019 novel coronavirus disease (COVID-19) led to an enforced quarantine period and limited training and match activities for athletes.

Purpose:

To report the influence of the COVID-19 pandemic on the occurrence of injury in Japanese male professional soccer players.

Study Design:

Descriptive epidemiology study.

Methods:

In total, 21 clubs in the 2019 season and 28 clubs in the 2020 season from the Japan Professional Football League were prospectively followed, and 16 clubs in 2019 and 24 clubs in 2020 were analyzed in this study. Individual training, match exposure, and time-loss injuries were recorded using an electronic data capture system. The influence of COVID-19–related suspension during the 2020 season was retrospectively investigated via comparisons with the 2019 season.

Results:

Total activity time included 114,001 hours in training and 16,339 hours in matches in 2019 and 170,798 hours in training and 25,411 hours in matches in 2020. The mean training interruption period caused by COVID-19 in 2020 was 39.9 days (range, 3-65 days), and the mean game-interruption period was 70.1 days (range, 58-79 days). The total number of injuries was 1495 in 2019 and 1701 in 2020. The overall injury incidence per 1000 hours of exposure was 5.7 in 2019 and 5.8 in 2020. The overall injury burden per 1000 hours of exposure was 155.5 days in 2019 and 130.2 days in 2020. The muscle injury incidence was highest in May 2020, immediately after the suspension period.

Conclusion:

The overall injury incidence did not differ between 2019 and 2020. However, muscle injury incidence notably increased in the 2 months after the COVID-19 pandemic suspension period.
Balancing exploration and exploitation across boundaries: Evidence from new product development
Authors: Fernandes Rodrigues Alves Marlon , Pacheco Larissa Marchiori , Galina Simone Vasconcelos Ribeiro
Published: February 2023

Exploration and exploitation have opposite natures; therefore, balancing the two presents a key challenge for firms. Recent studies have argued that firms can combine exploration (exploitation) capabilities with exploitation (exploration) partnerships to surmount this obstacle. However, little is known about how accumulated capabilities for exploring and exploiting activities shape the ways in which firms select partnerships. We examine this question by leveraging a unique data set on new product development in the Brazilian manufacturing sector that has 19,081 observations over a 14-year span. Contrary to the expectation of complementarity, in which the greater capability of one type (e.g., exploitation) is associated with selecting a partnership of another type (e.g., exploration), our findings suggest that increases in capabilities of any type are associated with exploration partnerships. We provide alternative explanations for our findings, highlight implications for theory and practice, and discuss potential avenues for future research.

JEL CLASSIFICATION: O31, M13, L14
Barriers and Facilitators Affecting the Uptake of COVID-19 Vaccines: A Qualitative Perspective of Frontline Nurses in Namibia
Authors: Ashipala Daniel Opotamutale , Tomas Nestor , Costa Tenete Godwin
Published: February 2023

Aim

Vaccinations remain one of the most effective measures to prevent and control the spread of COVID-19, while also reducing hospitalizations and deaths, yet many are unwilling to be vaccinated. This study explores the barriers and facilitators affecting the uptake of COVID-19 vaccines among frontline nurses.

Design

A qualitative, explorative, descriptive, and contextual research strategy was employed.

Methods

A sample of 15 nurses were selected via purposeful sampling to the point of data saturation. The participants were nurses at the COVID-19 vaccinations Centre in Rundu, Namibia. Data were collected using semistructured interviews and analyzed thematically.

Results

Three themes and 11 subthemes were identified, namely: (a) barriers, (b) facilitators, and (c) measures to increase the COVID-19 vaccine uptake. Barriers included living in deep rural areas, unavailability of vaccines, and misinformation, whereas scared of death, availability of COVID-19 vaccines, and family influence and peer pressure emerged as facilitators to the uptake of COVID-19 vaccines. Adoption of vaccination passport as a requirement to work premises and as an international travel requirement were the measures proposed to increase the COVID-19 vaccine uptake.

Conclusion

The study found several facilitators and barriers to COVID-19 vaccine uptake among frontline nurses. The identified barriers cover the individual, health system, and social factors hindering the COVID-19 vaccine uptake among frontline nurses. Whereas fear of COVID-19 deaths, family influence, and availability of vaccines were found to promote COVID-19 uptake. This study recommends targeted interventions to improve the uptake of COVID-19 vaccines.
SBAR Shift Report Training Program and its Effect on Nurses’ Knowledge and Practice and Their Perception of Shift Handoff Communication
Authors: Ghonem Nadia M. El-Sayed , El-Husany Wafaa A.
Published: February 2023

Introduction: Handover is a key factor in the continuity of care and is the most vital communication means among nurses. Using an identical method for this can enhance the quality of the handover. Objective: To evaluate the effect of a shift reporting training program using the Situation, Background, Assessment, Recommendation tool on nurses’ knowledge and practice and their perception of shift handoff communication in noncritical departments. Methods: A quasiexperimental research design. The study was held in noncritical departments on 83 staff nurses. Researcher used a knowledge questionnaire, an observation checklist, and two perception scales were used to collect data. Statistical data analysis was performed with SPSS using descriptive, chi-square or Fisher exact tests, correlation coefficient, multiple linear regression model. Results: Nurses varied in age from 22 to 45 years old, with 85.5% of them being female. After the intervention, their knowledge rose from 4.8% to 92.8% ( p < .001), the adequate practice reached 100%, and their perception of the process had significant improvement ( p < .001). Using multivariate analysis, the study involvement was the main significant independent positive predictor of nurses’ knowledge and scores, and these latter were positive predictors of their perception. Conclusion: Using the shift work reporting method had a significant effect among the study participants using Situation, Background, Assessment, and Recommendation tool and improved their knowledge, practice and perception of shift handoff communication.
Risk Factors Associated With Worse Clinical Outcomes of Ankle Fractures Involving the Posterior Malleolus
Authors: Rajan Lavan , Eble Stephanie , Kim Jaeyoung , Kukadia Saanchi , Kumar Prashanth , Day Jonathan , Cho David , Drakos Mark , Ellis Scott
Published: February 2023

Background:

Ankle fractures involving the posterior malleolus (PM) tend to result in inferior clinical outcomes compared to other ankle fractures. However, it is unclear which specific risk factors and fracture characteristics are associated with negative outcomes in these fractures. The aim of this study was to identify risk factors for poor postoperative patient-reported outcomes in patients with fractures involving the PM.

Methods:

This retrospective cohort study included patients who sustained ankle fractures involving the PM between March 2016 and July 2020 and had preoperative computed tomography (CT) scans. In total, 122 patients were included for analysis. One patient (0.8%) had an isolated PM fracture, 19 (15.6%) had bimalleolar ankle fractures involving the PM, and 102 (83.6%) had trimalleolar fractures. Fracture characteristics including the Lauge-Hansen (LH) and Haraguchi classifications and posterior malleolar fragment size were collected from preoperative CT scans. Patient Reported Outcome Measurement Information System (PROMIS) scores were collected preoperatively and at a minimum of 1 year postoperatively. The association between various demographic and fracture characteristics with postoperative PROMIS scores was assessed.

Results:

Involvement of more malleoli was associated with worse PROMIS Physical Function ( P = .04), Global Physical Health ( P = .04), and Global Mental Health ( P < .001), and Depression scores ( P = .001). Elevated BMI was also associated with worse PROMIS Physical Function ( P = .0025), Pain Interference ( P = .0013), and Global Physical Health ( P = .012) scores. Time to surgery, fragment size, Haraguchi classification, and LH classification were not associated with PROMIS scores.

Conclusion:

In this cohort, we found that trimalleolar ankle fractures were associated with inferior PROMIS outcomes compared with bimalleolar ankle fractures involving the PM in multiple domains.

Level of Evidence:

Level III, retrospective cohort study.
VPS13 Forum Proceedings: XK, XK-Related and VPS13 Proteins in Membrane Lipid Dynamics
Authors: Peikert Kevin , Danek Adrian
Published: February 2023

In 2020, the pandemic interrupted the series of biannual International Neuroacanthocytosis Meetings that brought together clinicians, scientists, and patient groups to share research into a small group of devastating genetic diseases that combine both acanthocytosis (deformed red blood cells) and neurodegeneration with movement disorders. This Meeting Report describes talks at the 5th VPS13 Forum in January 2022, one of a series of online meetings held to fill the gap. The meeting addressed the basic biology of two key proteins implicated in chorea-acanthocytosis (mutations in VPS13A) and McLeod syndrome (mutations in XK). In a remarkable confluence of ideas, the speakers described different aspects of a single functional unit that comprises of VPS13A and XK proteins working together. Conditions caused by VPS13 (A-D) gene family mutations and related genes, such as XK, previously footnote knowledge, seem to turn central for a novel disease paradigm: bulk lipid transfer disorders.
Sampling bias in environmental peacebuilding research
Authors: Ide Tobias
Published: February 2023

Sampling bias poses enormous challenges to research as it can undermine the validity of results, cause significant knowledge gaps, result in research that is driven by convenience rather than need and limit the ability to provide policy advice. In this study, I assess potential sampling biases in the rapidly emerging research field of environmental peacebuilding based on a systematic review of the peer-reviewed literature. The field frequently engages with difficult cases which are hard to access and/or unlikely to confirm theories, hence reducing concerns about sampling by convenience and result validity. By contrast, there are clear knowledge gaps regarding countries highly vulnerable to environmental change, regarding the Pacific region and Latin America, regarding intra-state peacebuilding dynamics in Asia, and regarding countries with weak or isolated civil societies. Voices from the Global South and female scholars are relatively well represented, but further improvements are desirable. Addressing these issues would support environmental peacebuilding in challenging one-sided environment-conflict narratives, adding to the wider peacebuilding literature, and providing policy advice on sustainable peace.
A framework to quantify the effectiveness of earthquake early warning in mitigating seismic risk
Authors: Papadopoulos Athanasios N , Böse Maren , Danciu Laurentiu , Clinton John , Wiemer Stefan
Published: February 2023

Earthquake early warning systems (EEWSs) aim to rapidly detect earthquakes and provide timely alerts, so that users can take protective actions prior to the onset of strong ground shaking. The promise and limitations of EEWSs have both been widely debated. On one hand, an operational EEWS could mitigate earthquake damage by triggering potentially cost- and life-saving actions. These range from automated system responses such as slowing down trains to the actions of individuals that receive the alerts and take protective measures. On the other hand, the effectiveness of an EEWS is conditional on the ability to issue warnings that are sufficiently accurate and timely to facilitate an appropriate action. The refinement of earthquake early warning (EEW) algorithms and the installation of denser and faster seismic networks have improved performance; however, the benefit in risk reduction that an EEWS could achieve remains unquantified. In this study, we leverage upon regional event-based probabilistic seismic risk assessment to devise a quantitative and fully customizable framework for evaluating the effectiveness of EEW in mitigating seismic risk. We demonstrate this framework using Switzerland as a testbed, for which we compute and contrast human loss exceedance curves with and without EEW.
How I treat anemia in older adults
Authors: Oyedeji Charity I. , Artz Andrew S. , Cohen Harvey Jay
Published: February 2023

With the global growing older adult population, clinicians face the common, yet complex challenge of how to evaluate and manage anemia in this population. Older age predisposes to common causes of anemia such as nutritional deficiencies, inflammatory disorders, chronic kidney disease, and hematologic malignancies. Failure to diagnose and appropriately manage anemia may result in decreased quality of life, impaired cognition, impaired mobility, and increased mortality. Anemia diagnosis in older adults presents a diagnostic conundrum because anemia may have a single cause, may be multifactorial, or may have no apparent cause even after an extensive evaluation. We believe a systematic approach to diagnosis ensures appropriate testing and avoids the pitfall of undertreatment and overtreatment. In this article we present our recommended approach through common scenarios for the management of anemia in the older adult.
Prognostic Value of Blood Biomarkers in Steroid-Refractory/Dependent Acute Graft-vs-Host Disease: A REACH2 Analysis
Authors: Socie Gérard , Niederwieser Dietger , von Bubnoff Nikolas , Mohty Mohamad , Szer Jeff , Or Reuven , Garrett James , Prahallad Anirudh Cadapa , Wilke Celine , Zeiser Robert
Published: February 2023

Systemic steroids are the standard first-line treatment for acute graft-vs-host disease (aGVHD), but approximately 50% of patients become steroid refractory or dependent (SR/D). Ruxolitinib is the only FDA and EMA approved therapy for patients with SR/D aGVHD. In the phase 3 REACH2 trial (NCT02913261), ruxolitinib demonstrated superior efficacy to best available therapy (BAT) in treating SR/D aGVHD, with significantly higher overall response rate (ORR) at day 28, durable ORR at day 56, and longer median overall survival. Identifying biomarkers and clinical characteristics associated with increased probability of response could guide treatment decisions. In this exploratory analysis of the REACH2 study, we developed baseline (pretreatment) and Day 14 models to identify patient characteristics and biomarkers (12 aGVHD-associated cytokines/chemokines, 6 immune cell types, and 3 inflammatory proteins) before and during treatment that affected the probability of response at day 28. Treatment with ruxolitinib versus BAT, type of conditioning, skin involvement, and age were strongly associated with increased likelihood of response in ≥1 model. Lower levels of most aGVHD and immune cell markers at baseline were associated with increased probability of response. In the Day 14 model, levels of aGVHD markers at day 14, rather than change from baseline, impacted probability of response. For both models, bias-corrected area under receiver operating characteristic (AUROC) values (baseline, 0.73; Day 14, 0.80) indicated high level of correspondence between fitted and actual outcomes. This first biomarker study in context of a randomized phase 3 aGVHD trial, highlights the potential prognostic value of select biomarkers and patient characteristics.
Gender wage gap in European emerging markets: a meta-analytic perspective
Authors: Iwasaki Ichiro , Satogami Mihoko
Published: February 2023

In this paper, we report the results of a meta-analysis of 670 estimates extracted from 53 previous research works to estimate the gender wage gap in European emerging markets. A meta-synthesis of collected estimates exhibits that the gender differences have a statistically significant and economically meaningful impact on wage levels. Synthesis results also reveal that the gender wage gap in countries with EU membership is lower than that in non-EU member states and, nevertheless, the wage gap between men and women has a tendency to diminish over time in the region as a whole. The meta-regression analysis of literature heterogeneity and test for publication selection bias back up the findings obtained from the meta-synthesis.
Immunoinformatics-aided design of a new multi-epitope vaccine adjuvanted with domain 4 of pneumolysin against Streptococcus pneumoniae strains
Authors: Shafaghi Mona , Bahadori Zohreh , Madanchi Hamid , Ranjbar Mohammad Mehdi , Shabani Ali Akbar , Mousavi Seyed Fazlollah
Published: February 2023

Background

Streptococcus pneumoniae (Pneumococcus) has remained a leading cause of fatal infections such as pneumonia, meningitis, and sepsis. Moreover, this pathogen plays a major role in bacterial co-infection in patients with life-threatening respiratory virus diseases such as influenza and COVID-19. High morbidity and mortality in over one million cases, especially in very young children and the elderly, are the main motivations for pneumococcal vaccine development. Due to the limitations of the currently marketed polysaccharide-based vaccines, non-serotype-specific protein-based vaccines have received wide research interest in recent years. One step further is to identify high antigenic regions within multiple highly-conserved proteins in order to develop peptide vaccines that can affect various stages of pneumococcal infection, providing broader serotype coverage and more effective protection. In this study, immunoinformatics tools were used to design an effective multi-epitope vaccine in order to elicit neutralizing antibodies against multiple strains of pneumococcus.

Results

The B- and T-cell epitopes from highly protective antigens PspA (clades 1–5) and PhtD were predicted and immunodominant peptides were linked to each other with proper linkers. The domain 4 of Ply, as a potential TLR4 agonist adjuvant candidate, was attached to the end of the construct to enhance the immunogenicity of the epitope vaccine. The evaluation of the physicochemical and immunological properties showed that the final construct was stable, soluble, antigenic, and non-allergenic. Furthermore, the protein was found to be acidic and hydrophilic in nature. The protein 3D-structure was built and refined, and the Ramachandran plot, ProSA–web, ERRAT, and Verify3D validated the quality of the final model. Molecular docking analysis showed that the designed construct via Ply domain 4 had a strong interaction with TLR4. The structural stability of the docked complex was confirmed by molecular dynamics. Finally, codon optimization was performed for gene expression in E. coli, followed by in silico cloning in the pET28a(+) vector.

Conclusion

The computational analysis of the construct showed acceptable results, however, the suggested vaccine needs to be experimentally verified in laboratory to ensure its safety and immunogenicity.
Comparative analysis of two kinds of garlic seedings: qualities and transcriptional landscape
Authors: Ai Penghui , Xue Jundong , Zhu Yifei , Tan Wenchao , Wu Yifei , Wang Ying , Li Zhongai , Shi Zhongya , Kang Dongru , Zhang Haoyi , Jiang Liwen , Wang Zicheng
Published: February 2023

Background

Facility cultivation is widely applied to meet the increasing demand for high yield and quality, with light intensity and light quality being major limiting factors. However, how changes in the light environment affect development and quality are unclear in garlic. When garlic seedlings are grown, they can also be exposed to blanching culture conditions of darkness or low-light intensity to ameliorate their appearance and modify their bioactive compounds and flavor.

Results

In this study, we determined the quality and transcriptomes of 14-day-old garlic and blanched garlic seedlings (green seedlings and blanched seedlings) to explore the mechanisms by which seedlings integrate light signals. The findings revealed that blanched garlic seedlings were taller and heavier in fresh weight compared to green garlic seedlings. In addition, the contents of allicin, cellulose, and soluble sugars were higher in the green seedlings. We also identified 3,872 differentially expressed genes between green and blanched garlic seedlings. The Kyoto Encyclopedia of Genes and Genomes analysis suggested enrichment for plant-pathogen interactions, phytohormone signaling, mitogen-activated protein kinase signaling, and other metabolic processes. In functional annotations, pathways related to the growth and formation of the main compounds included phytohormone signaling, cell wall metabolism, allicin biosynthesis, secondary metabolism and MAPK signaling. Accordingly, we identified multiple types of transcription factor genes involved in plant-pathogen interactions, plant phytohormone signaling, and biosynthesis of secondary metabolites among the differentially expressed genes between green and blanched garlic seedlings.

Conclusions

Blanching culture is one facility cultivation mode that promotes chlorophyll degradation, thus changing the outward appearance of crops, and improves their flavor. The large number of DEGs identified confirmed the difference of the regulatory machinery under two culture system. This study increases our understanding of the regulatory network integrating light and darkness signals in garlic seedlings and provides a useful resource for the genetic manipulation and cultivation of blanched garlic seedlings.
Similar cortical morphometry trajectories from 5 to 9 years in children with perinatal HIV who started treatment before age 2 years and uninfected controls
Authors: Nwosu Emmanuel C. , Holmes Martha J. , Cotton Mark F. , Dobbels Els , Little Francesca , Laughton Barbara , van der Kouwe Andre , Robertson Frances , Meintjes Ernesta M.
Published: February 2023

Background

Life-long early ART (started before age 2 years), often with periods of treatment interruption, is now the standard of care in pediatric HIV infection. Although cross-sectional studies have investigated HIV-related differences in cortical morphology in the setting of early ART and ART interruption, the long-term impact on cortical developmental trajectories is unclear. This study compares the longitudinal trajectories of cortical thickness and folding (gyrification) from age 5 to 9 years in a subset of children perinatally infected with HIV (CPHIV) from the Children with HIV Early antiRetroviral therapy (CHER) trial to age-matched children without HIV infection.

Methods

75 CHER participants in follow-up care at FAMCRU (Family Centre for Research with Ubuntu), as well as 66 age-matched controls, received magnetic resonance imaging (MRI) on a 3 T Siemens Allegra at ages 5, 7 and/or 9 years. MR images were processed, and cortical surfaces reconstructed using the FreeSurfer longitudinal processing stream. Vertex-wise linear mixed effects (LME) analyses were performed across the whole brain to compare the means and linear rates of change of cortical thickness and gyrification from 5 to 9 years between CPHIV and controls, as well as to examine effects of ART interruption.

Results

Children without HIV demonstrated generalized cortical thinning from 5 to 9 years, with the rate of thinning varying by region, as well as regional age-related gyrification increases. Overall, the means and developmental trajectories of cortical thickness and gyrification were similar in CPHIV. However, at an uncorrected p < 0.005, 6 regions were identified where the cortex of CPHIV was thicker than in uninfected children, namely bilateral insula, left supramarginal, lateral orbitofrontal and superior temporal, and right medial superior frontal regions. Planned ART interruption did not affect development of cortical morphometry.

Conclusions

Although our results suggest that normal development of cortical morphometry between the ages of 5 and 9 years is preserved in CPHIV who started ART early, these findings require further confirmation with longitudinal follow-up through the vulnerable adolescent period.
Statistical models versus machine learning for competing risks: development and validation of prognostic models
Authors: Kantidakis Georgios , Putter Hein , Litière Saskia , Fiocco Marta
Published: February 2023

Background

In health research, several chronic diseases are susceptible to competing risks (CRs). Initially, statistical models (SM) were developed to estimate the cumulative incidence of an event in the presence of CRs. As recently there is a growing interest in applying machine learning (ML) for clinical prediction, these techniques have also been extended to model CRs but literature is limited. Here, our aim is to investigate the potential role of ML versus SM for CRs within non-complex data (small/medium sample size, low dimensional setting).

Methods

A dataset with 3826 retrospectively collected patients with extremity soft-tissue sarcoma (eSTS) and nine predictors is used to evaluate model-predictive performance in terms of discrimination and calibration. Two SM (cause-specific Cox, Fine-Gray) and three ML techniques are compared for CRs in a simple clinical setting. ML models include an original partial logistic artificial neural network for CRs (PLANNCR original), a PLANNCR with novel specifications in terms of architecture (PLANNCR extended), and a random survival forest for CRs (RSFCR). The clinical endpoint is the time in years between surgery and disease progression (event of interest) or death (competing event). Time points of interest are 2, 5, and 10 years.

Results

Based on the original eSTS data, 100 bootstrapped training datasets are drawn. Performance of the final models is assessed on validation data (left out samples) by employing as measures the Brier score and the Area Under the Curve (AUC) with CRs. Miscalibration (absolute accuracy error) is also estimated. Results show that the ML models are able to reach a comparable performance versus the SM at 2, 5, and 10 years regarding both Brier score and AUC (95% confidence intervals overlapped). However, the SM are frequently better calibrated.

Conclusions

Overall, ML techniques are less practical as they require substantial implementation time (data preprocessing, hyperparameter tuning, computational intensity), whereas regression methods can perform well without the additional workload of model training. As such, for non-complex real life survival data, these techniques should only be applied complementary to SM as exploratory tools of model’s performance. More attention to model calibration is urgently needed.
The relationship between the use of metformin and the risk of pancreatic cancer in patients with diabetes: a systematic review and meta-analysis
Authors: Hu Jian , Fan Hong-Dan , Gong Jian-Ping , Mao Qing-Song
Published: February 2023

Objective

We aim to evaluate the relationship between the use of metformin and the risk of pancreatic cancer in type 2 diabetes patients.

Method

We systematically searched the observational studies on PubMed, Embase, Web of Science, Cochrane Library, clinicalrials.gov, and CNKI databases, extracted relevant data, combined the OR value and 95% CI using the random effect model, and conducted a sensitivity analysis, subgroup analysis, and meta-regression to evaluate the size and stability of this relationship.

Result

Twenty-nine studies from twenty-four articles met our inclusion criteria, including more than 2 million subjects. Overall analysis showed that compared with no use of metformin, the use of metformin could reduce the risk of pancreatic cancer in patients with type 2 diabetes (OR = 0.82, 95% CI (0.69, 0.98)). Subgroup analysis showed that compared with the use of hypoglycemic drugs, the use of metformin could reduce the risk of pancreatic cancer in patients with type 2 diabetes (OR = 0.79, 95% CI (0.66, 0.94)). However, compared with no drugs or only diet therapy, metformin users might increase the risk of pancreatic cancer (OR = 2.19, 95% CI (1.08, 4.44)). Sensitivity analysis confirmed the stability of the study, and there was no significant publication bias.

Conclusion

Compared with the no-use of metformin, metformin users with diabetes can reduce the risk of pancreatic cancer. More research is needed to prove it works.
Isolated cryptococcal osteomyelitis of the sacrum in an immunocompetent patient: a case report and literature review
Authors: Zhong Yanchun , Huang Yuxi , Zhang Di , Chen Zhaoyuan , Liu Zhenxing , Ye Yongjun
Published: February 2023

Background

Cryptococcus neoformans, an opportunistic fungal pathogen, seldom causes infection in immunocompetent people. Cryptococcal osteomyelitis is an uncommon condition in which Cryptococcus invades the bone. It usually occurs as part of a disseminated infection and rarely in isolation. The spine has been reported as the most common site of cryptococcal osteomyelitis; however, isolated case of sacrum involvement in immunocompetent patients has never been reported.

Case presentation

We report the case of a 37-year-old man without underlying disease who presented with progressive low back and sacrococcygeal pain. The patient was initially diagnosed with sacral tumour by a local doctor, and subsequently, after admission, was diagnosed with sacral tuberculosis. He was empirically treated with antitubercular drugs. The patient failed to respond to antitubercular drugs and complained of worsening low back pain. Additionally, he developed persistent radiating pain and numbness in his legs. For further diagnosis, we performed a computed tomography-guided puncture biopsy of the sacrum, which revealed granulomatous inflammation with massive macrophage infiltration and special staining revealed a fungal infection. We performed sacral debridement and drainage and obtained purulent specimens for pathological examination and microbial culture. Microbial identification and drug susceptibility tests revealed a Cryptococcus neoformans infection sensitive to fluconazole. Postoperatively, the persistent radiating pain and numbness in the legs resolved. After 12 consecutive weeks of antifungal therapy, all his symptoms resolved. The patient remained without any signs of recurrence at the 8-month follow-up.

Conclusion

We reported a rare case of isolated sacrum cryptococcal osteomyelitis in an immunocompetent patient. Furthermore, we identified and reviewed 18 published cases of spine cryptococcal osteomyelitis. Immunocompetent individuals are also at risk for cryptococcal osteomyelitis. Clinical manifestation and imaging are insufficient to diagnose cryptococcal osteomyelitis of the spine, and invasive examinations, such as puncture biopsy and fungal examinations, are needed. Antifungal therapy yields satisfactory results for the treatment of cryptococcal osteomyelitis of the spine, however, if the infective lesion is large, especially when it compresses the spinal cord and nerves, a regimen combining aggressive surgery with antifungal therapy is indispensable.
The association of maternal food quality score (FQS) with breast milk nutrient content and antioxidant content of infant urine: a cross-sectional study
Authors: Karbasi Samira , Mohamadian Malihe , Naseri Mohsen , Yahya Hanafi-Bojd Mohammad , Khorasanchi Zahra , Morovatdar Negar , Zarban Asghar , Bahrami Afsane , Ferns Gordon A.
Published: February 2023

Background

Breast milk (BM) is a complex fluid with a variable composition within women over time and between women in the population. The BM compositional differences are likely to be partly due to maternal dietary patterns. This study aimed to evaluate food quality score (FQS) in lactating mothers and its association with quality indicators of BM and antioxidant content of infant urine.

Methods

This cross-sectional study was undertaken in 350 lactating women aged 20 to 35 years. Data on dietary intake was collected using a validated food frequency questionnaire (FFQ) containing 65 food items. The FQS was calculated by integrating the scores obtained from healthy and unhealthy food groups. Subjects were categorized according to FQS adherence, with the greatest adherence being allocated to the third tertile and those with the lowest FQS in the first tertile. Antioxidant activity of the BM and infant urine samples was assessed using the Ferric reducing antioxidant power (FRAP), 2, 2′-diphenyl-1-picrylhydrazyl (DPPH), thiobarbituric acid reactive substances (TBARs), and Ellman’s assay. The total content of BM protein, calcium, and triglyceride was measured using standard biochemical kits.

Results

BM from mothers from the third tertile of FQS contained significantly higher DPPH, thiol, calcium, and protein levels compared to BM from those in the lowest tertile (p˂0.05). Infant urinary DPPH and FRAP was also significantly higher in the highest tertile vs. the lowest tertile (p˂0.05).

Conclusion

High maternal adherence to the FQS was associated with a high BM quality and antioxidant content of infant urine.
A novel preoperative inflammation score system established for postoperative prognosis predicting of intrahepatic cholangiocarcinoma
Authors: Fu Jun , Chen Qinjunjie , Lai Zisen , Lin Kongying , Fang Guoxu , Ding Zongren , Gao Yuzhen , Zeng Yongyi
Published: February 2023

Background

Inflammation is implicated in tumorigenesis and has been reported as an important prognostic factor in cancers. In this study, we aimed to develop and validate a novel inflammation score (IFS) system based on 12 inflammatory markers and explore its impact on intrahepatic cholangiocarcinoma (ICC) survival after hepatectomy.

Methods

Clinical data of 446 ICC patients undergoing surgical treatment were collected from the Primary Liver Cancer Big Data, and then served as a training cohort to establish the IFS. Furthermore, an internal validation cohort including 175 patients was used as internal validation cohort of the IFS. A survival tree analysis was used to divide ICC patients into three groups (low-, median-, and high- IFS-score groups) according to different IFS values. Kaplan-Meier (KM) curves were used to compare the overall survival (OS) and recurrence-free survival (RFS) rates among three different groups. Cox regression analyses were applied to explore the independent risk factors influencing OS and RFS.

Results

In the training cohort, 149 patients were in the low-IFS-score group, 187 in the median-IFS-score group, and 110 in the high-IFS-score group. KM curves showed that the high-IFS-score group had worse OS and RFS rates than those of the low- and median-IFS-score groups (P < 0.001) in both the training and validation cohorts. Moreover, multivariable Cox analyses identified high IFS as an independent risk factor for OS and RFS in the training cohort. The area under the curve values for OS prediction of IFS were 0.703 and 0.664 in the training and validation cohorts, respectively, which were higher than those of the American Joint Committee on Cancer (AJCC) 7th edition TNM stage, AJCC 8th edition TNM stage, and the Child-Pugh score.

Conclusion

Our results revealed the IFS was an independent risk factor for OS and RFS in patients with ICC after hepatectomy and could serve as an effective prognostic prediction system in daily clinical practice.
Postoperative complications after successful primary rhegmatogenous retinal detachment repair
Authors: Motta Lorenzo , Frisina Rino , Ripa Matteo , Gius Irene , Greggio Angelo , Tozzi Luigi , De Salvo Gabriella , Meduri Alessandro
Published: February 2023

Background

To evaluate the incidence and risk factors for cystoid macular edema (CME) and epiretinal membrane (ERM) development after surgery for primary rhegmatogenous retinal detachment (RRD).

Methods

Retrospective observational cohort study involving 62 consecutive patients with primary RRD who underwent RRD repair with either scleral buckling (SB) or pars plana vitrectomy (PPV). SB was used in young phakic patients without posterior vitreous detachment (PVD), high myopic patients, and RRD associated with either anterior or inferior retinal tears. PPV was preferred over SB in pseudophakic patients or those with media opacity and posterior breaks that precluded the SB approach. After surgery, the macular changes, including CME and ERM development, were evaluated 3 and 6 months postoperatively. Phacoemulsification and intraocular lens (IOL) implantation were performed in phakic patients where media opacity or lens bulging did not allow the surgeon to perform surgical maneuvers. The inner limiting membrane (ILM) peeling was randomly performed in the macula-off and the macula-on RRD “pending foveal detachment” subgroup.

Results

Sixty-two eyes affected by RRD who underwent SB or PPV were enrolled. CME occurred in 33.3% of the PPV group regardless of the ERM formation. No CME cases were found in the SB group. Macula-off RRD increased the risk of CME by odds ratio (OR) = 4.3 times compared to macula-on RRD regardless of the surgical procedure (p = 0.04). Macula-off status increased the risk of CME of OR = 1.73 times compared to macula-on in the PPV subgroup (p = 0.4). Combined cataract surgery and PPV increased the risk of CME by OR = 3.3 times (p = 0.16) compared to PPV alone, and ILM peeling increased the risk of postoperative CME by OR = 1.8 times (p = 0.37). ERM occurred in 28% of patients who did not undergo ILM peeling, and 29.42% of those who underwent ILM peeling developed ERM (p = 0.6).

Conclusions

The risk of postoperative CME was higher in patients with macula-off than in macula-on RRD and in those with macula-off RRD who underwent PPV. The SB would be advisable in patients with RRD sparing the macula. Furthermore, despite having several advantages, the combined phacoemulsification plus IOL implantation and PPV highly increased the risk of postoperative CME.