bluuebunny/crossref_metadata_2025 huggingface dataset:
The association of intraleucocytic malaria pigment and disease severity in Papua New Guinean children with severe P. falciparum malaria
Authors: Lufele Elvin , Manning Laurens , Lorry Lina , Warrel Jonathan , Aipit Susan , Robinson Leanne J , Laman Moses
Published: June 2023

Background

Plasmodium falciparum pigment-containing leucocytes (PCLs) are associated with adverse clinical manifestations of severe malaria in African children. However, limited data exist on the association of PCLs in settings outside of Africa.

Methods

Thin films on peripheral blood slides obtained from children ages 6 months–10 y with severe malaria were examined for PCLs. The intraleucocytic pigment data were correlated with clinical phenotypic data such as severe anaemia, metabolic acidosis and coma to determine the association of PCLs with clinical phenotypes of severe malaria and outcome.

Results

Of the 169 children with severe P. falciparum malaria confirmed by microscopy, 76% (129/169) had PCLs. Compared with children without PCLs, the presence (adjusted odds ratio [AOR] 3.2 [95% confidence interval {CI} 1.5 to 6.9], p≤0.01) and quantity (AOR 1.0 [95% CI 1.0 to 1.1], p=0.04) of pigment-containing monocytes (PCMs) was significantly associated with severe anaemia, while the quantity of both PCMs (AOR 1.0 [95% CI 1.0 to 1.1], p≤0.01) and pigment-containing neutrophils (AOR 1.0 [95% CI 1.0 to 1.1], p=0.01) was significantly associated with metabolic acidosis. Plasma P. falciparum histidine-rich protein-2 level negatively correlated with the platelet count (r=−0.5, p≤0.01) in patients with PCLs and no PCLs.

Conclusions

In Papua New Guinean children with severe P. falciparum malaria, the presence and quantity of PCLs are predictors of disease severity, severe anaemia and metabolic acidosis.
Environmental sustainability in the operating room
Authors: Gonzalez-Pizarro Patricio , Koch Susanne , Muret Jane , Trinks Alexandra , Brazzi Luca , Reinoso-Barbero Francisco , Diez Sebastian Jesus , MRF Struys Michel
Published: June 2023

BACKGROUND

The healthcare industry carbon footprint is 5.2% of total CO2 equivalent emissions worldwide. The operating rooms are the most resource demanding areas in hospital care and the higher energy demands, lack of effective waste management, and inhaled anaesthetic use, lead to a high carbon footprint. There is wide variation in the carbon footprint of inhaled gases, with desflurane ranking 40 times higher than sevoflurane. Other inhaled agents, including N2O and isoflurane, have additional ozone-depleting properties.

OBJECTIVE

To describe what factors influence the implementation of sustainable anaesthetic strategies.

DESIGN

An international survey.

SETTING

Anaesthesia clinicians worldwide between April 2021 and April 2022.

PARTICIPANTS

One thousand two hundred and thirty-seven anaesthesia clinicians from 75 countries.

MAIN OUTCOME MEASURES

The primary outcome was a determination of the most used anaesthetic plans among anaesthesia practitioners. Secondary outcomes included an assessment of the influence of various socioeconomic variables on anaesthetic decision-making, and on the level of the practitioners’ awareness of peri-operative environmental sustainability.

RESULTS

Sixty-four percent of respondents use inhaled anaesthetics on a daily basis, with 83% preferring sevoflurane, and only 5% using N2O regularly. Forty-five percent do not know which halogen gas has the highest carbon footprint. Fifty-one percent do not use low flow anaesthesia regimes (<1.0 l min-1) due to concerns about CO2 rebreathing (30%), hypoxia (25%), compound A related renal failure (12%) or CO generation (10%). Only 15% use minimal flow anaesthesia (<0.5 l min-1). There is a correlation between higher income countries and implementation of more sustainable strategies, probably due to better access to updated technology and sustainability education programmes. Desflurane is used in 6 to 12% of the cases regardless of the GDP index.

CONCLUSIONS

Halogen gases are the most frequently used anaesthetic drugs worldwide. The majority of respondents are unaware of their global warming impact, or are not influenced in their anaesthetic choices by environmental concerns. More sustainable alternatives of anaesthesia are under-implemented, and vary significantly among countries depending on their GDP index. Further education and training in sustainability is needed.
Targeting temperature-sensitive transient receptor potential channels in hypertension: far beyond the perception of hot and cold
Authors: Jesus Rafael Leonne C. , Araujo Fênix A. , Alves Quiara L. , Dourado Keina C. , Silva Darizy F.
Published: June 2023

Transient receptor potential (TRP) channels are nonselective cation channels and participate in various physiological roles. Thus, changes in TRP channel function or expression have been linked to several disorders. Among the many TRP channel subtypes, the TRP ankyrin type 1 (TRPA1), TRP melastatin type 8 (TRPM8), and TRP vanilloid type 1 (TRPV1) channels are temperature-sensitive and recognized as thermo-TRPs, which are expressed in the primary afferent nerve. Thermal stimuli are converted into neuronal activity. Several studies have described the expression of TRPA1, TRPM8, and TRPV1 in the cardiovascular system, where these channels can modulate physiological and pathological conditions, including hypertension. This review provides a complete understanding of the functional role of the opposing thermo-receptors TRPA1/TRPM8/TRPV1 in hypertension and a more comprehensive appreciation of TRPA1/TRPM8/TRPV1-dependent mechanisms involved in hypertension. These channels varied activation and inactivation have revealed a signaling pathway that may lead to innovative future treatment options for hypertension and correlated vascular diseases.
Validation of the C-DU(KE) Calculator as a Predictor of Outcomes in Patients Enrolled in Steroids for Corneal Ulcer and Mycotic Ulcer Treatment Trials
Authors: Arboleda Alejandro , Prajna N. Venkatesh , Lalitha Prajna , Srinivasan Muthiah , Rajaraman Revathi , Krishnan Tiruvengada , Mousa Hazem M. , Feghali James , Acharya Nisha R. , Lietman Thomas M. , Perez Victor L. , Rose-Nussbaumer Jennifer
Published: June 2023

Purpose:

The aim of this study was to validate the C-DU(KE) calculator as a predictor of treatment outcomes on a data set derived from patients with culture-positive ulcers.

Methods:

C-DU(KE) criteria were compiled from a data set consisting of 1063 cases of infectious keratitis from the Steroids for Corneal Ulcer Trial (SCUT) and Mycotic Ulcer Treatment Trial (MUTT) studies. These criteria include corticosteroid use after symptoms, visual acuity, ulcer area, fungal etiology, and elapsed time to organism-sensitive therapy. Univariate analysis was performed followed by multivariable logistic regressions on culture-exclusive and culture-inclusive models to assess for associations between the variables and outcome. The predictive probability of treatment failure, defined as the need for surgical intervention, was calculated for each study participant. Discrimination was assessed using the area under the curve for each model.

Results:

Overall, 17.9% of SCUT/MUTT participants required surgical intervention. Univariate analysis showed that decreased visual acuity, larger ulcer area, and fungal etiology had a significant association with failed medical management. The other 2 criteria did not. In the culture-exclusive model, 2 of 3 criteria, decreased vision [odds ratio (OR) = 3.13, P < 0.001] and increased ulcer area (OR = 1.03, P < 0.001), affected outcomes. In the culture-inclusive model, 3 of 5 criteria, decreased vision (OR = 4.9, P < 0.001), ulcer area (OR = 1.02, P < 0.001), and fungal etiology (OR = 9.8, P < 0.001), affected results. The area under the curves were 0.784 for the culture-exclusive model and 0.846 for the culture-inclusive model which were comparable to the original study.

Conclusions:

The C-DU(KE) calculator is generalizable to a study population from large international studies primarily taking place in India. These results support its use as a risk stratification tool assisting ophthalmologists in patient management.
Characterization of Extended-Release Lorazepam
Authors: Mathew Sanjay J. , Jean-Lys Shedly , Phull Rupinder , Yarasani Rama
Published: June 2023

Purpose/Background

Once-daily extended-release (ER) lorazepam was developed to reduce fluctuations in plasma levels compared with lorazepam immediate-release (IR) for short-term anxiety relief. Here we report a series of phase 1 randomized, open-label, multiperiod crossover studies characterizing ER lorazepam pharmacokinetics and safety in healthy adults.

Methods/Procedures

These phase 1 studies assessed the pharmacokinetics of ER lorazepam administered: (study 1) 3 mg once daily versus IR lorazepam 1 mg 3 times a day (TID; every 8 hours), (study 2) with or without food, and (study 3) intact versus sprinkled onto food. Study 3 further evaluated the proportionality of 1 × 4- versus 4 × 1-mg doses. Safety was also monitored.

Findings/Results

There were 43, 27, and 29 subjects who completed studies 1, 2, and 3, respectively. The 90% confidence intervals for C
max,SS, C
min, and AUCTAU,SS of once-daily ER lorazepam compared with IR given TID were within 80% to 125% limits establishing steady-state bioequivalence. Maximum mean lorazepam concentrations were achieved at 11 hours compared with 1 hour after dosing for ER versus IR lorazepam, respectively. Pharmacokinetic parameters (C
max, AUClast or AUC0–t
, AUCinf or AUC0–inf) of ER lorazepam were bioequivalent whether taken with or without food, administered intact or sprinkled onto food, or administered as intact 1 × 4- versus 4 × 1-mg capsules. No serious safety concerns were found.

Implications/Conclusions

Once-daily ER lorazepam provided a pharmacokinetic profile bioequivalent to IR lorazepam given TID and was well tolerated in healthy adults across all phase 1 studies. These data suggest that ER lorazepam could be an alternative for patients currently treated with IR lorazepam.
The nicotine and tobacco epidemic among adolescents: new products are addicting our youth
Authors: Heinly Allison , Walley Susan
Published: June 2023

Purpose of review

New nicotine and tobacco products such as electronic cigarettes and oral nicotine products have increased in use and threaten to addict a new generation of youth. This review summarizes current literature on nicotine and tobacco products used by youth, epidemiology, health effects, prevention and treatment of nicotine dependence, and current policies and regulations.

Recent findings

Electronic cigarettes and oral nicotine products are popular among youth, attracting adolescents through exposure to deceptive marketing and fruit, candy and dessert flavors. Electronic cigarettes and oral nicotine product use can lead to nicotine addiction and is associated with respiratory, cardiovascular, and oral health problems, although long-term health effects are not fully known. The Food and Drug Administration (FDA) has authority to regulate nicotine and tobacco products; however, thousands of unregulated and unauthorized products remain on the market.

Millions of adolescents continue to use nicotine and tobacco products, which puts them at risk for health problems, including nicotine addiction. Pediatric providers can provide prevention messages, screen youth for tobacco and nicotine use, and offer appropriate treatment options. Regulation of tobacco and nicotine products by the FDA is critical to reverse this public health epidemic of youth nicotine and tobacco use.
Investigating Same-Day Discharge For Postmastectomy Immediate Breast Reconstruction: A National Surgical Quality Improvement Program Study
Authors: Miller Amanda , Jain Nirbhay S. , Wells Michael W. , Da Lio Andrew , Roostaeian Jason , Crisera Christopher , Slack Ginger , Tseng Charles , Delong Michael , Festekjian Jaco H.
Published: June 2023

Background:

Patients undergoing immediate breast reconstruction with tissue expanders are frequently admitted after surgery for monitoring and pain control, which introduces additional costs and risks of nosocomial infection. Same-day discharge could conserve resources, mitigate risk, and return patients home for faster recovery. We used large data sets to investigate the safety of same day discharge after mastectomy with immediate postoperative expander placement.

Methods:

A retrospective review of patients in the National Surgical Quality Improvement Program NSQIP database who underwent tissue expander breast reconstruction between 2005 and 2019 was performed. Patients were grouped based on date of discharge. Demographic information, medical comorbidities, and outcomes were recorded. Statistical analysis was performed to determine efficacy of same-day discharge and identify factors that predict safety.

Results:

Of the 14,387 included patients, 10% were discharged same-day, 70% postoperative day one, and 20% later. Most common complications were infection, reoperation, and readmission and trended upward with length of stay (6.4% v 9.3% v 16.8%), though statistically equivalent between same-day and next-day discharge. The complication rate for later-day discharge was statistically higher. Patients discharged later had significantly more comorbidities than same or next-day discharge counterparts. Predictors of complication included hypertension, smoking, diabetes, and obesity.

Conclusions:

Immediate tissue expander reconstruction patients are usually admitted overnight. However, we demonstrate same-day discharge has equivalent risk of perioperative complications as next-day discharge. For the otherwise healthy patient, going home the day of surgery is a safe and cost-effective option, though the decision should be made in the context of each patient.
Staged Mastopexy Before Nipple-Sparing Mastectomy: Improving Safety and Appearance in Implant-Based and Autologous Breast Reconstruction
Authors: Awaida Cyril J. , Bernier Christina , Bou-Merhi Joseph S. , Trabelsi Nadia O. , Gagnon Alain , El-Khatib Arij , Harris Patrick G. , Odobescu Andrei
Published: June 2023

Background:

Breast reconstruction following nipple sparing mastectomy in patients with large or ptotic breasts remains challenging because of the risk of ischemic complications and the difficulty in managing the redundant skin envelope. Staged mastopexy or breast reduction before the mastectomy/reconstruction has been shown to decrease the risk of complications and improve clinical outcomes.

Methods:

A retrospective analysis was conducted of patients with a genetic predisposition to breast cancer who underwent staged breast reduction/mastopexy before nipple sparing mastectomy and reconstruction in our institution. In patients with in situ disease or invasive cancer, the first stage consisted of lumpectomy and oncoplastic reduction/mastopexy. Breast reconstruction at the second stage was performed with free abdominal flaps or breast implants and acellular dermal matrix. Data regarding the ischemic complications were recorded.

Results:

In total, 47 patients (84 breasts) underwent this staged approach. All patients had a genetic predisposition to breast cancer. The time interval between the two stages was 11.5 months (range, 1.3 to 23.6 months). Twelve breasts (14.3 percent) were reconstructed with free abdominal flaps, 6 (7.1 percent) with tissue expanders and 66 (78.6 percent) with permanent subpectoral implants and acellular dermal matrix. There was one postoperative superficial nipple areolar complex epidermolysis (1.2 percent), and two partial mastectomy skin flap necrosis (2.4 percent). The mean follow-up time after completion of reconstruction was 8.3 months.

Conclusion:

Mastopexy or breast reduction before nipple sparing mastectomy and reconstruction is a safe procedure with a low risk of ischemic complications.
Bilateral Simultaneous LAP Flaps in Breast Reconstruction: Perioperative anesthetic outcomes addressing safety and feasibility
Authors: Haddock Nicholas T. , Ercan Alp , Teotia Sumeet S.
Published: June 2023

Introduction

The lumbar artery perforator flap (LAP flap) has emerged as an excellent option for breast reconstruction, but its steep learning curve makes it less approachable. Furthermore, length of the operation, flap ischemia time, need for composite vascular grafts, complex microsurgery, multiple position changes, and general concern for safety has led experienced surgeons to stage bilateral reconstructions. In our experience, simultaneous bilateral LAP flaps are successfully feasible, but overall peri-operative safety has not been fully explored.

Methods:

Thirty-one patients (62 flaps) underwent simultaneous bilateral LAP flaps and were included in the study (excluding stacked 4-flaps and unilateral flaps). Patients underwent two position changes in the OR: supine to prone and then supine again. A retrospective review of patient demographics, intraoperative details and complications was performed.

Results:

Overall flap success rate was 96.8%. Five flaps were compromised postoperatively. Intra-operative anastomotic revision rate was 24.1% per flap (4.3% per anastomoses). Significant complication rate was 22.6%. The number of sustained hypothermic episodes and hypotensive episodes correlated with intra-operative arterial thrombosis (p<0.05). The number of hypotensive episodes and increased intra-operative fluid correlated with flap compromise (p<0.05). High BMI correlated with overall complications (p<0.05). The presence of diabetes correlated with intra-operative arterial thrombosis (p<0.05).

Conclusion:

Simultaneous bilateral LAP flaps can be safely performed with an experienced and trained microsurgical team. Hypothermia and hypotension negatively impact the initial anastomotic success. In this complex operation, a coordinated approach between the anesthesia and nursing team is paramount for patient safety.
“Multiplane L-Scar Augmentation Mastopexy: An Individualized Approach to Muscle, Glandular Tissue and Skin”
Authors: Bark Adel A. , Minikowski Guilherme C. , Mujahed Isaac B. U.
Published: June 2023

Background:

Augmentation mastopexy focus on restoring the youthful appearance of the female breast. Despite those benefits, there is large scarring to be considered, and the reduction of this side effect is the main goal to enhance the aesthetic result. This article aims to describe a variation of the L-shaped mastopexy technique without complex marking and performed in planes, which brings long-term results for patients undergoing this approach.

Methods:

This is a retrospective, observational study, based on a series of cases conducted by the author. The preoperative appointment and the surgical technique are described, and divided into steps according to their components: cutaneous, glandular tissue, and muscular.

Results:

Between January 2016 and July 2021, 632 women underwent surgery. The mean age was 38 years (18-71 years). The mean volume of implants was 285cc (175-550cc). All the implants used were round with a nanotextured surface. The mean tissue resected from each breast was 117g (5-550g). Follow-ups ranged from 12 to 84 months, and photographic documentation was performed from 30 days after surgery. Complications totaled 19.30% and were divided into minor - treated with expectant treatment, non-invasive or with the possibility of correction with local anesthesia, corresponding to 10.44%; and major - in which it was necessary to return to the operating room, corresponding to 8.86%.

Conclusion:

Multiplane L-Scar Mastopexy is a versatile and safe technique with predictable results, which allows the systematic treatment of the most diverse breast types, with complications similar to other already described and solidified techniques.
Primary Urethra Non-Hodgkin Lymphoma in a 46-Year-Old Man on FDG PET/CT
Authors: Zhao Weiwei , Li Peng , Li Yanmei , He Yueming , Yang Jianwei
Published: June 2023

Primary lymphoma of the male urethra is exceptionally rare. A 46-year-old man complained of low back pain, hematuria, and dysuria. Cystourethroscopy revealed a pale, annular thickening of the urethral mucosa. A biopsy revealed that the patient had diffuse large B-cell lymphoma. Before treatment, an 18F-FDG PET/CT was used for staging. The urethra and left inguinal lymph nodes showed increased FDG uptake. The patient was then diagnosed with primary urethral lymphoma that had invaded the left inguinal lymph node.
Extrastriatal Accumulation of 18F-FP-CIT at Cerebral Infarction in a Patient With Suspected Parkinson Disease
Authors: Yoo Jihye , Chun In Kook
Published: June 2023

18F-FP-CIT PET/CT is a useful diagnostic tool for differentiating between idiopathic Parkinson disease and atypical Parkinson syndrome by visualizing the striatum, where the nerve endings of nigrostriatal dopaminergic neurons are located. We present an unusual accumulation of 18F-FP-CIT in the infarct and peri-infarct brain area of an 83-year-old man who was referred for the management of suspected cerebral infarction due to sudden dysarthria and delirium.
A Systematic Review of Microsurgical Pedicle Lengthening in Free Tissue Transfer
Authors: Soto Edgar , Peacock Paxton W. , Clark Ashlynn R. , King Timothy W. , de la Torre Jorge I. , Patcha Prasanth , Fix R. Jobe , Myers René P.
Published: June 2023

Introduction

Traumatic injuries that require free tissue flaps for reconstruction may require vascular pedicle extension between the flap and recipient vessels to form a clear anastomosis. Currently, a variety of techniques are used, each with their own potential benefits and harms. In addition, reports in the literature conflict on the reliability of pedicle extensions of vessels in free flap (FF) surgery. The objective of this study is to systematically assess the available literature about outcomes of pedicle extensions in FF reconstruction.

Methods

A comprehensive search was performed for relevant studies published up to January 2020. Study quality was assessed using the Cochrane Collaboration risk of bias assessment tool and a set of predetermined parameters was extracted by 2 investigators independently for further analysis. The literature review yielded 49 studies investigating pedicled extension of FF. Studies meeting inclusion criteria underwent data extraction focusing on demographics, conduit type, microsurgical technique, and postoperative outcomes.

Results

The search yielded 22 retrospective studies totaling 855 procedures from 2007 to 2018 in which 159 complications (17.1%) were reported in patients aged between 39 and 78 years. Overall heterogeneity of articles included in this study was high. Free flap failure and thrombosis were the 2 most prevalent major complications noted: vein graft extension technique had the highest rate of flap failure (11%) in comparison with the arterial graft (9%) and arteriovenous loops (8%). Arteriovenous loops had a rate of thrombosis of 5% versus 6% in arterial grafts and 8% in venous grafts. Bone flaps maintained the highest overall complication rates per tissue type at 21%. The overall success rate of pedicle extensions in FFs was 91%. Arteriovenous loop extension resulted in a 63% decrease in the odds of vascular thrombosis and a 27% decrease in the odds of FF failure when compared with venous graft extensions (P < 0.05). Arterial graft extension resulted in a 25% decrease in the odds of venous thrombosis and a 19% decrease in the odds of FF failure when compared with venous graft extensions (P < 0.05).

Conclusions

This systematic review strongly suggests that pedicle extensions of the FF in a high-risk complex setting are a practical and effective option. There may be a benefit to using arterial versus venous conduits, although further examination is warranted given the small number of reconstructions reported in the literature.
Waitlist and Transplant Outcomes in Organ Donation After Circulatory Death
Authors: Kwon Jennie H. , Blanding Walker M. , Shorbaji Khaled , Scalea Joseph R. , Gibney Barry C. , Baliga Prabhakar K. , Kilic Arman
Published: June 2023

Objectives:

To summarize waitlist and transplant outcomes in kidney, liver, lung, and heart transplantation using organ donation after circulatory death (DCD).

Background:

DCD has expanded the donor pool for solid organ transplantation, most recently for heart transplantation.

Methods:

The United Network for Organ Sharing registry was used to identify adult transplant candidates and recipients in the most recent allocation policy eras for kidney, liver, lung, and heart transplantation. Transplant candidates and recipients were grouped by acceptance criteria for DCD versus brain-dead donors [donation after brain death (DBD)] only and DCD versus DBD transplant, respectively. Propensity matching and competing-risks regression was used to model waitlist outcomes. Survival was modeled using propensity matching and Kaplan-Meier and Cox regression analysis.

Results:

DCD transplant volumes have increased significantly across all organs. Liver candidates listed for DCD organs were more likely to undergo transplantation compared with propensity-matched candidates listed for DBD only, and heart and liver transplant candidates listed for DCD were less likely to experience death or clinical deterioration requiring waitlist inactivation. Propensity-matched DCD recipients demonstrated an increased mortality risk up to 5 years after liver and kidney transplantation and up to 3 years after lung transplantation compared with DBD. There was no difference in 1-year mortality between DCD and DBD heart transplantation.

Conclusions:

DCD continues to expand access to transplantation and improves waitlist outcomes for liver and heart transplant candidates. Despite an increased risk for mortality with DCD kidney, liver, and lung transplantation, survival with DCD transplant remains acceptable.
Patient-reported Adverse Events During Neoadjuvant Therapy in a Phase 2 Borderline Resectable Pancreatic Cancer Clinical Trial (Alliance A021501)
Authors: Snyder Rebecca A. , Dueck Amylou C. , Fruth Briant , Shi Qian , Hubbard Joleen M. , Herman Joseph M. , O’Reilly Eileen M. , Katz Matthew H.G.
Published: June 2023

Objective:

We sought to evaluate symptomatic adverse event (AE) rates among patients with pancreatic cancer receiving neoadjuvant therapy on clinical trial (A021501) using the Patient-Reported Outcomes Common Terminology Criteria for Adverse Events (PRO-CTCAE).

Background:

To date, pancreatic cancer clinical trials have measured AEs using standard physician reporting [Common Terminology Criteria for Adverse Events (CTCAE)]. Patient-reported symptomatic AEs have been incompletely characterized.

Methods:

A021501 (December 31, 2016–January 1, 2019) randomized patients with borderline resectable pancreatic ductal adenocarcinoma to 8 doses of mFOLFIRINOX (Arm 1) or 7 doses of mFOLFIRINOX+hypofractionated radiotherapy (Arm 2), followed by pancreatectomy and adjuvant FOLFOX6. Patients completed PRO-CTCAE assessments at baseline, on day 1 of each chemotherapy cycle, and daily during radiotherapy.

Results:

Of 126 patients, 96 (76%) initiated treatment and completed a baseline plus at least 1 postbaseline PRO-CTCAE assessment. Diarrhea and fatigue were the only symptomatic grade 3 or higher AEs identified in at least 10% of patients using CTCAE. At least 10% of all patients reported an adjusted PRO-CTCAE composite grade 3 AE during neoadjuvant treatment for 10 of 15 items: anxiety (10%), bloating of abdomen (16%), decreased appetite (18%), diarrhea (13%), dry mouth (21%), fatigue (36%), nausea (18%), generalized pain (16%), abdominal pain (21%), and problems tasting (32%). Decreased appetite was higher in Arm 2 than in Arm 1 (P=0.0497); no other differences between study arms were observed.

Conclusion:

Symptomatic AEs during neoadjuvant therapy were common and were reported more frequently by patients using PRO-CTCAE than were recorded by clinicians using standard CTCAE.
Screening, prevention, and management of patients with poststroke depression in a tertiary hospital in China: a best practice implementation project
Authors: Tan Jing , Brancatisano Olivia , Cadilhac Dominique A. , Deng Bo , Wu Yanni , Li Yan , Liu Ning
Published: June 2023

Introduction:

Poststroke depression (PSD) is common but insufficiently addressed by health professionals, and management is not always evidence-based.

Objectives:

This evidence implementation project aimed to improve adherence to evidence-based practice for screening, prevention, and management of patients with PSD in the neurology ward of the Fifth Affiliated Hospital of Zunyi Medical University, China.

Methods:

This project was based on the JBI methodological approach and was conducted in three phases, from January to June 2021: a baseline audit, implementation of strategies, and a follow-up audit. We utilized the JBI Practical Application of Clinical Evidence System software and the Getting Research into Practice tools. Fourteen nurses, 162 stroke patients, and their caregivers participated in this study.

Results:

The results of the baseline audit showed that compliance with evidence-based practice was poor, with 3/6 criteria showing 0% adherence and the other three audit criteria showing 5.7, 10.3, and 49.4% adherence, respectively. Through feedback to nurses regarding the baseline audit results, the project team identified five barriers and adopted a battery of strategies to overcome these barriers. The follow-up audit revealed significantly enhanced outcomes across all the best practice criteria, and the compliance of each criterion reached at least 80%.

Conclusion:

The implementation program designed to screen, prevent, and manage PSD in a tertiary hospital in China improved nurses’ knowledge and compliance with evidence-based management of PSD. Further testing of this program in more hospitals is needed.
A grand unified theory for the unification of physics, life, information and cognition (mind)
Authors: Swenson Rod
Published: June 2023

The modern scientific world view was built on the incommensurability between cognition (mind) and physics (matter) and later life and physics (the autonomy of biology). Fuelled by Boltzmann's view of the second law of thermodynamics as a ‘law of disorder’, the idea of ‘two opposing rivers’, the river of physics ‘flowing down’ to disorder and the river of life and mind ‘flowing up’ to higher states of order became a cornerstone of contemporary thinking. The deleterious result of this paradigmatic separation of physics, life and mind has been to considerably incapacitate each by bracketing many of the deepest problems of science, including the very nature of life itself and its cognitive capabilities, outside the theoretical reach of contemporary science. An expanded view of physics, notably the addition of the fourth law of thermodynamics (LMEP), or the law of maximum entropy production, coupled with first law time-translation symmetry, and the self-referencing circularity of the relational ontology of autocatakinetic systems, provides the basis for a grand unified theory unifying physics, life, information and cognition (mind). This dissolves the dysfunctional myth of the two rivers, and solves the previously insoluble problems at the foundations of modern science associated with it.

This article is part of the theme issue ‘Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)’.
Philosophy of thermodynamics
Authors: Annila Arto
Published: June 2023

Thermodynamics is regarded as a universal but not foundational theory because its laws for macroscopic quantities have not been derived from microscopic entities. Thus, to root thermodynamics into the fundamental substance, atomism is revived, thinking that the light quantum is the indivisible and permanent element. Assuming the same basic building blocks constitute everything, the state of any system can be quantified by entropy, the logarithmic probability measure multiplied by Boltzmann’s constant. Then, the change in entropy expresses the system’s evolution toward thermodynamic balance with its surroundings. These natural processes consuming free energy in the least time accumulate sigmoidally, resulting in skewed distributions found throughout nature. In this way, thermodynamics makes sense of phenomena across disciplines and provides a holistic worldview to address questions such as what the world is, how we know about it, what is the meaning of life and how we should live.

This article is part of the theme issue ‘’Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)’.
The principle underlying all evolution, biological, geophysical, social and technological
Authors: Bejan Adrian
Published: June 2023

This article addresses the main research areas identified in the call for contributions to this special issue. With examples from published articles and books, the present article shows that all the identified areas are already covered by the universal principle underlying all evolution: the constructal law (1996), i.e. the physics law of design evolution in nature (free morphing, flowing, moving systems). The universal principle of evolution belongs in thermodynamics because thermodynamics is a universal science and evolution is a universal phenomenon. The principle unites the natural sciences with the social sciences, and the living with the non-living. It unifies the world of science and its languages (energy, economy, evolution, sustainability, etc.), and brings together the natural and artificial flow architectures, the human made and the not human made. The principle establishes firmly in physics the reality that humans are part of nature. With the principle, physics extends its coverage over phenomena that were previously considered out of reach: social organization, economics and human perceptions. Such phenomena are physical, i.e. facts. The entire world depends on the science of useful things, and benefits greatly from a physics discipline with freedom, life, wealth, time, beauty and future.

This article is part of the theme issue 'Thermodynamics 2.0: bridging the natural and social sciences (Part 1)'.
Coherent decision making stimulated within the social laser: open quantum systems framework
Authors: Khrennikov Andrei
Published: June 2023

We start with a brief review on social laser theory which is newly framed with the notion of an
infon
–social energy quantum carrying coarse-grained information content. Infons are the excitations of the
quantum social-information field.
Humans are analogues of atoms—social atoms absorbing and emitting infons. Another new development is coupling of the social laser with the
decision making model
based on open quantum systems. The role of the environment for social atoms is played by the strong coherent social-information field—the output of social lasing. We analyse a simple quantum master equation generating decision jumps towards the coherent decision directed by the social laser beam. As an illustrative example, we analyse the possibility to create a societal benefit laser, i.e. directed for societal benefit.

This article is part of the theme issue ‘Thermodynamics 2.0: Bridging the natural and social sciences (Part 1)’.
Epidemiology and urological pathogenic potential of Aerococcus species in greater Glasgow and Clyde (Descriptive study of Aerococcus urinae in blood culture and urinary samples: clinical importance and potential marker of urinary tract pathology)
Authors: Htwe Su Su , Inkster Teresa
Published: June 2023

Introduction.

Aerococcus

species in particular

A. urinae

are increasingly reported as causative agents of bacteraemia, urinary tract infection, sepsis, and endocarditis. We sought to establish the epidemiology of

A. urinae

in Glasgow hospitals and whether the presence of the organism in clinical isolates could be an indicator of undiagnosed urinary tract pathology.

Hypothesis/Gap statement. The knowledge gap among clinical staffs on

Aerococcus

species as emerging pathogens can be filled by understanding its epidemiology and clinical importance.

Aim. Describe the epidemiology and clinical importance of

Aerococcus urinae

.

Methodology. We reviewed positive blood cultures with

Aerococcus

species (2017–2021) and urinary isolates (2021) in Glasgow hospitals. Data were collected from clinical and laboratory database systems.

Results. All 22 positive blood cultures were

A. urinae

and sensitive to amoxicillin, vancomycin, and ciprofloxacin. The median age was 80.5; the majority was male (18). In total, 15/22 (68 %) were diagnosed with urinary tract infection. Thirteen were treated with amoxicillin. No cases of infective endocarditis were noted. One patient was subsequently diagnosed with bladder carcinoma. All 83 positive urinary isolates in 72 patients were

A. urinae

. One was resistant to amoxicillin; two to ciprofloxacin; all sensitive to nitrofurantoin and vancomycin. The majority was female (43/83), the median age was 80. The commonest risk factors were underlying malignancy including bladder cancer (5/18), chronic kidney disease (17) and diabetes (16). Clinical data was unavailable in 24 episodes. Of these, 41/59 (69.5 %) were diagnosed with urinary tract infection. One patient was subsequently diagnosed with metastatic renal cancer while bladder wall lesions were identified in three patients, two of whom were waiting for an urology review at the time of study. Thirteen patients (18 %) had 1 year recurrent bacteriuria and three were not treated on initial episode.

Conclusion.

A. urinae

are emerging pathogens and are likely to become more common due to advances in laboratory technologies and an ageing population. Clinical teams should be aware of their urological pathogenic potential and not dismiss them as contaminants. Whether

Aerococcus

infection is a potential indicator for undiagnosed urinary tract malignancy warrants further studies.
EFFECT OF DIETARY CALCIUM ON INCIDENCE OF CALCIUM STONES AND URINARY PARAMETERS: A SYSTEMATIC REVIEW
Authors: Desai Dev , Sahni Tanvi , Andharia Dev Umangbhai , Raval Dwija
Published: June 2023

Introduction

Renal stone is a fairly common presentation and the pain is unbearable. Some patients have tendency that stones are frequently formed and management of that s necessary as removal of stone is nt always that simple and can lead to many complications.

Aims and Objectives

To perform a systematic review and meta-analysis to investigate the effect of dietary calcium on the prevention of calcium stones.

Methodology

PubMed, google scholar and Cochrane Library databases were searched for studies. The search strategy and study selection process was conducted by following the PRISMA statement. 16 articles were identified after meeting the inclusion criteria.

Results

Our results showed that with high calcium advice, occurrence of stone formation decreases (RR=0.82, CI95=0.37-1.82, p=0.63). Comparing levels of Urinary caclium with advice of high calcium diet showed increased excretion (SMD=1.99), but decreased excretion with low calcium diet (SMD = -0.43) and Normal calcium diet (SMD = -1.35). An almost no difference can be seen in Urinary oxalate with high calcium (SMD = 0.00), low calcium (SMD = 0.02), Normal Calcium (SMD = -0.052). Results showed that Urinary Urate levels decreased with all types of diet mainly with High calcium diet (SMD = -0.33), then Low calcium diet (SMD = -0.28)and then normal calcium (SMD = -0.22). Urinary Volume was increased with all dietary advice, the most with low calcium diet(SMD = 216.37), then normal calcium diet (SMD = 206.81) and last high calcium diet (SMD = 20.00).

Conclusion

ur study shows high calcium diet decreases the occurrence of stones compared to normal calcium and low calcium diet.
The public health impact of Paxlovid COVID-19 treatment in the United States
Authors: Bai Yuan , Du Zhanwei , Wang Lin , Lau Eric H. Y. , Fung Isaac Chun-Hai , Holme Petter , Cowling Benjamin J. , Galvani Alison P. , Krug Robert M. , Meyers Lauren Ancel
Published: June 2023

The antiviral drug Paxlovid has been shown to rapidly reduce viral load. Coupled with vaccination, timely administration of safe and effective antivirals could provide a path towards managing COVID-19 without restrictive non-pharmaceutical measures. Here, we estimate the population-level impacts of expanding treatment with Paxlovid in the US using a multi-scale mathematical model of SARS-CoV-2 transmission that incorporates the within-host viral load dynamics of the Omicron variant. We find that, under a low transmission scenario (Re∼ 1.2) treating 20% of symptomatic cases would be life and cost saving, leading to an estimated 0.26 (95% CrI: 0.03, 0.59) million hospitalizations averted, 30.61 (95% CrI: 1.69, 71.15) thousand deaths averted, and US$52.16 (95% CrI: 2.62, 122.63) billion reduction in health- and treatment-related costs. Rapid and broad use of the antiviral Paxlovid could substantially reduce COVID-19 morbidity and mortality, while averting socioeconomic hardship.

Article Summary Line

Mass treatment of symptomatic COVID-19 cases with antivirals that rapidly arrest SARS-CoV-2 replication would substantially reduce the spread and burden of the pandemic.
Neurometabolite changes in response to antidepressant medication: a systematic review of1H-MRS findings
Authors: Boucherie Daphne E. , Reneman Liesbeth , Ruhé Henricus G. , Schrantee Anouk
Published: June 2023

Selective serotonin reuptake inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors (SNRIs), and (es-)ketamine are used to treat major depressive disorder (MDD). These different types of medication may involve common neural pathways related to glutamatergic and GABAergic neurotransmitter systems, both of which have been implicated in MDD pathology. We conducted a systematic review of pharmacological1H-MRS studies in healthy volunteers and MDD patients to explore the potential impact of these medications on glutamatergic and GABAergic systems. Studies on SSRIs and SNRIs were highly variable, generally underpowered, and yielded no consistent findings across brain regions or specific populations. Although studies on (es-)ketamine were also highly variable, some demonstrated an increase in glutamate levels in the anterior cingulate cortex in a time-dependent manner after administration. Our findings highlight the need for standardized study and acquisition protocols. Additionally, measuring metabolites dynamically over time or combining1H-MRS with whole brain functional imaging techniques could provide valuable insights into the effects of these medications on glutamate and GABAergic neurometabolism.
Multiple imputation of missing data under missing at random: including a collider as an auxiliary variable in the imputation model can induce bias
Authors: Curnow Elinor , Tilling Kate , Heron Jon E , Cornish Rosie P , Carpenter James R
Published: June 2023

Epidemiological studies often have missing data, which are commonly handled by multiple imputation (MI). In MI, in addition to those required for the substantive analysis, imputation models often include other variables (“auxiliary variables”). Auxiliary variables that predict the partially observed variables can reduce the standard error (SE) of the MI estimator and, if they also predict the probability that data are missing, reduce bias due to data being missing not at random. However, guidance for choosing auxiliary variables is lacking. We examine the consequences of a poorly-chosen auxiliary variable: if it shares a common cause with the partially observed variableandthe probability that it is missing (i.e. it is a “collider”), its inclusion can induce bias in the MI estimator and may increase SE. We quantify, both algebraically and by simulation, the magnitude of bias and SE when either the exposure or outcome are incomplete. When the substantive analysis outcome is partially observed, the bias can be substantial, relative to the magnitude of the exposure coefficient. In settings in which complete records analysis is valid, the bias is smaller when the exposure is partially observed. However, bias can be larger if the outcome also causes missingness in the exposure. When using MI, it is important to examine, through a combination of data exploration and considering plausible casual diagrams and missingness mechanisms, whether potential auxiliary variables are colliders.

Contribution to the field statement

In multiple imputation (MI), in addition to those required for the substantive analysis, imputation models often include other variables (“auxiliary variables”). Auxiliary variables that predict the partially observed variables can reduce the standard error (SE) of the MI estimator and, if they also predict the probability that data are missing, reduce bias due to data being missing not at random. We examine the consequences of a poorly-chosen auxiliary variable: if it shares a common cause with the partially observed variableandthe probability that it is missing (i.e. it is a “collider”), its inclusion can induce bias in the MI estimator and may increase SE. We demonstrate that when the substantive analysis outcome is partially observed, the bias can be substantial, relative to the magnitude of the exposure coefficient. In settings in which complete records analysis is valid, the bias is smaller when the exposure is partially observed. However, bias can be larger if the outcome also causes missingness in the exposure. We recommmend a combination of data exploration and consideration of plausible casual diagrams and missingness mechanisms to examine whether potential auxiliary variables are colliders.
Large language models are universal biomedical simulators
Authors: Schaefer Moritz , Reichl Stephan , ter Horst Rob , Nicolas Adele M. , Krausgruber Thomas , Piras Francesco , Stepper Peter , Bock Christoph , Samwald Matthias
Published: June 2023

Computational simulation of biological processes can be a valuable tool in accelerating biomedical research, but usually requires extensive domain knowledge and manual adaptation. Recently, large language models (LLMs) such as GPT-4 have proven surprisingly successful for a wide range of tasks by generating human language at a very large scale. Here we explore the potential of leveraging LLMs as simulators of biological systems. We establish proof-of-concept of a text-based simulator, SimulateGPT, that uses LLM reasoning. We demonstrate good prediction performance for various biomedical applications, without requiring explicit domain knowledge or manual tuning. LLMs thus enable a new class of versatile and broadly applicable biological simulators. This text-based simulation paradigm is well-suited for modeling and understanding complex living systems that are difficult to describe with physics-based first-principles simulation, but for which extensive knowledge and context is available as written text.
Diffusion model of delipidation in biological sample clearing
Authors: Han Jinglu , Liu Xinyi , Hou Xiaoxiao , Zhong Yuejia , Chen Zhiqiang , Yang Zhenyi , Jiang Tianzi
Published: June 2023

Biological sample clearing techniques are a potent tool for three-dimensional biological imaging, among which delipidation is an essential step in achieving high-quality biological sample transparency. Detergents and organic solvents can both be used for lipids removal. The former has been extensively investigated in biological sample clearing, while the delipidation process based on organic solvents remains to be further elucidated. Recently, organic solvents also served as a delipidation reagent in aqueous-based clearing methods and exhibited very fast clearing speed. To explain the high efficiency of organic solvents, we described the delipidation process of both detergents and organic solvents with a simple diffusion model, we proposed a possible mechanism of the delipidation process of water-miscible polar organic solvents based on the clearing results of brain samples. Both our results and model revealed that polar or non-polar organic solvents with a certain molecular structure could achieve a much faster clearing speed than detergents which could be a guide for establishing a rapid clearing protocol for biological samples with large volumes.