bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors and mortality of carbapenem-resistant Klebsiella pneumoniae bloodstream infection in a tertiary-care hospital in China: an eight-year retrospective study
Authors: Chen Jie , Ma Hua , Huang Xiaoming , Cui Yanhui , Peng Wenzhong , Zhu Fei , Ma Shiyang , Rao Minjun , Zhang Peipei , Yang Hang , Su Longxiang , Niu Ruichao , Pan Pinhua
Published: December 2022

Background

The prevalence of carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) is increasing worldwide. CRKP-BSI is associated with high rates of morbidity and mortality due to limited antibiotic choices. Here, we aim to identify the prevalence and risk factors for infection and mortality of CRKP BSI.

Methods

This was a retrospective study of the past data from January 1st, 2012 to December 31st, 2019 of adult patients with KP-BSI in Xiangya Hospital, China.

Results

Among the 706 incidences included in this study, 27.4% of them (212/753) being CR-KP strains. The occurrence of CRKP-BSI was increased from 20.69 to 37.40% from 2012 to 2019. Hematologic malignancies and ICU acquired infection were identified to be substantial risk factors of carbapenem resistance. The overall 28-day mortality rates of CRKP-BSI patients was significantly higher than that of CSKP-BSI (P < 0.001). Logistic regression analysis identified severe sepsis or septic shock incidents, inadequate empirical antimicrobial therapy and corticosteroids use preceding infection onset as the independent predictors of 28-day mortality of CRKP-BSI patients. However, high dose carbapenem combination therapy was identified as anticipated factors of low 28-day mortality.

Conclusion

The occurrence of CRKP-BSI was significantly increased during the study period. Hematologic malignancies and ICU acquired infection were associated with the development of CRKP BSI. Severe sepsis or septic shock incidents, inadequate empirical antimicrobial therapy and corticosteroids use preceding infection onset caused significant increase of mortality rates in CRKP-BSI patients. High dose carbapenem combination therapy was associated with better outcome.
Improved quantification of catechin and epicatechin in red rice (Oryza sativa L.) using stable isotope dilution liquid chromatography-mass spectrometry
Authors: Kim Tae Jin , Kim Ye Jin , Seo Woo Duck , Park Sang Un , Kim Jae Kwang
Published: December 2022

Epimerization can change the catechin content and composition of samples during extraction and analytical analyses. To control the effect of epimerization, we developed a novel and stable isotope dilution liquid chromatography-mass spectrometry (LC–MS) method using catechin-2,3,4-13C3 and epicatechin-2,3,4-13C3 as stable-isotope-labeled internal standards (SIL-ISs). When the SIL-ISs were used, the catechin and epicatechin contents were stable (104–109% and 100–109% of the initial concentration, respectively) despite long storage times. In contrast, when L-2-chlorophenylalanine was used as an internal standard, catechin and epicatechin concentrations of 88–97% and 164–277% of the initial concentration, respectively, were obtained after long storage times. Furthermore, the least significant epimerization effect and highest extractability were observed when extraction was performed at 70 ℃ for 30 min. The recoveries for red rice using the developed isotope dilution LC–MS method at two different concentrations were between 100.72 and 118.67%, with relative standard deviations less than 3.67%.
Experimental and Numerical Investigations on Crack Intersection and Propagation of Concrete Structures
Authors: Wang Siyao , Zhuang Mei-Ling , Xue Xiang
Published: December 2022

This study presents experimental and numerical methods to reveal concrete structures’ crack propagation and intersection laws under static and dynamic loads. Firstly, a numerical simulation method was established using the user-defined material subroutines to solve the free crack surface contact problem of concrete structures. Secondly, three-point bending tests of concrete beams containing double cracks of different approaching angles were carried out based on the digital image correlation (DIC) technology to study the intersection and propagation of cracks. Finally, the fracture processes of double-crack concrete beams and concrete gravity dams with and without a longitudinal crack were simulated and analyzed under static and dynamic loads. The numerical results were compared with the test results to verify the effectiveness and accuracy of the proposed method in simulating crack intersection and propagation in concrete structures. Results indicate that the crack intersection affects the fracture path of concrete structures, weakens their bearing capacity, and accelerates the failure of the structures. The proposed simulation method provides an effective technical approach for crack propagation prediction and safety evaluation of engineering structures.
The impact of COVID-19 on the treatment of opioid use disorder in carceral facilities: a cross-sectional study
Authors: Saunders Elizabeth C. , Satcher Milan F. , Monico Laura B. , McDonald Ryan D. , Springer Sandra A. , Farabee David , Gryczynski Jan , Nyaku Amesika , Reeves Donald , Kunkel Lynn E. , Schultheis Alysse M. , Schwartz Robert P. , Lee Joshua D. , Marsch Lisa A. , Waddell Elizabeth Needham
Published: December 2022

While the COVID-19 pandemic disrupted healthcare delivery everywhere, persons with carceral system involvement and opioid use disorder (OUD) were disproportionately impacted and vulnerable to severe COVID-associated illness. Carceral settings and community treatment programs (CTPs) rapidly developed protocols to sustain healthcare delivery while reducing risk of COVID-19 transmission. This survey study assessed changes to OUD treatment, telemedicine use, and re-entry support services among carceral and CTPs participating in the National Institute on Drug Abuse (NIDA)-funded study, Long-Acting Buprenorphine vs. Naltrexone Opioid Treatments in Criminal Justice System-Involved Adults (EXIT-CJS) study. In December 2020, carceral sites (n = 6; median pre-COVID 2020 monthly census = 3468 people) and CTPs (n = 7; median pre-COVID 2020 monthly census = 550 patients) participating in EXIT-CJS completed a cross-sectional web-based survey. The survey assessed changes pre- (January–March 2020) and post- (April–September 2020) COVID-19 in OUD treatment, telemedicine use, re-entry supports and referral practices. Compared to January–March 2020, half of carceral sites (n = 3) increased the total number of persons initiating medication for opioid use disorder (MOUD) from April–September 2020, while a third (n = 2) decreased the number of persons initiated. Most CTPs (n = 4) reported a decrease in the number of new admissions from April–September 2020, with two programs stopping or pausing MOUD programs due to COVID-19. All carceral sites with pre-COVID telemedicine use (n = 5) increased or maintained telemedicine use, and all CTPs providing MOUD (n = 6) increased telemedicine use. While expansion of telemedicine services supported MOUD service delivery, the majority of sites experienced challenges providing community support post-release, including referrals to housing, employment, and transportation services. During the COVID-19 pandemic, this small sample of carceral and CTP sites innovated to continue delivery of treatment for OUD. Expansion of telemedicine services was critical to support MOUD service delivery. Despite these innovations, sites experienced challenges providing reintegration supports for persons in the community. Pre-COVID strategies for identifying and engaging individuals while incarcerated may be less effective since the pandemic. In addition to expanding research on the most effective telemedicine practices for carceral settings, research exploring strategies to expand housing and employment support during reintegration are critical.
Variations in the TAS2R38 gene among college students in Hubei
Authors: Wang Xiaojun , Wang Lin , Xia Mengwei , Teng Feng , Chen Xuejiao , Huang Rufeng , Zhou Jiahao , Xiao Juan , Zhai Lihong
Published: December 2022

Background

The bitter taste receptor gene TAS2R38 is a member of the human TAS2R gene family. Polymorphisms in TAS2R38 affect the ability to taste the bitterness of phenylthiourea (PTC) compounds, thus affecting an individual’s food preference and health status.

Methods

We investigated polymorphisms in the TAS2R38 gene and the sensitivity to PTC bitterness among healthy Chinese college students in Hubei province. The association of TAS2R38 polymorphisms and PTC sensitivity with body mass index (BMI), food preference, and health status was also analyzed. A total of 320 healthy college students were enrolled (male: 133, female: 187; aged 18–23 years). The threshold value method was used to measure the perception of PTC bitterness, and a questionnaire was used to analyze dietary preferences and health status. Polymerase chain reaction (PCR) was used to analyze polymorphisms at three common TAS2R38 loci (rs713598, rs1726866, and rs10246939).

Results

In our study population, 65.00% of individuals had medium sensitivity to the bitterness of PTC; in contrast, 20.94% were highly sensitive to PTC bitterness, and 14.06% were not sensitive. For the TAS2R38 gene, the PAV/PAV and PAV/AAI diplotypes were the most common (42.19% and 40.63%, respectively), followed by the homozygous AVI/AVI (8.75%) and PAV/AVI (5.00%) diplotypes.

Conclusion

There was a significant correlation between the sensitivity to PTC bitterness and sex, but there was no correlation between the common diplotypes of TAS2R38 and gender. Polymorphisms in the TAS2R38 gene were associated with the preference for tea, but not with one’s native place, BMI, health status, or other dietary preferences. There was no significant correlation between the perception of PTC bitterness and one’s native place, BMI, dietary preference, or health status. We hope to find out the relationship between PTC sensitivity and TAS2R38 gene polymorphisms and dietary preference and health status of Chinese population through this study, providing relevant guidance and suggestions for dietary guidance and prevention of some chronic diseases in Chinese population.
The digitalisation in chartering business: special reference to the role of e-bill of lading in the bulk and liner markets
Authors: Plomaritou Evi , Jeropoulos Sotiris
Published: December 2022

Previous research offering a comprehensive overview of digitalisation in maritime transport is limited. In this paper, the authors use several cases to examine digitalisation’s role in the chartering business. The applications of innovative digitalisation to enhance efficiency in the shipping business are presented analytically. Special emphasis is given to the role of the e-bill of lading in the bulk and liner markets. The advantages, disadvantages and legal barriers of the e-bill of lading are examined thoroughly for both markets (bulk and liner markets). The research follows a qualitative case study approach. It shows that although digital technologies offer important advantages in the chartering business, many legal barriers still need to be overcome. The findings fill the gap in the literature and assist maritime professionals and shipping companies in understanding the necessity of digitalisation in chartering business.
The perceived affordances of simulation-based learning: online student teachers’ perspectives
Authors: Dittrich Lynn , Aagaard Toril , Hjukse Hjørdis
Published: December 2022

In this study, we explore the perceived affordances of simulation-based learning (SBL) among online student teachers in Norway. We investigated how simulations mediate professional learning when coupled with educator-led debriefings and peer-led focus groups. Using an exploratory qualitative design, we examined 21 pre-service teachers’ perspectives on their experiences of this SBL intervention. We analysed peer-led focus group data, as well as written reflection logs. Our findings reveal that despite experienced technical challenges, the overall intervention afforded work-life relevant practice, prompting collaborative reflection. In addition to expert feedback, the peer-led focus group discussions are found to be a key component of the SBL design, as these enabled collaborative reflection over a shared practice teaching experience. The findings imply that SBL can be used to bridge the theory-practice gap, a recurring challenge in the field. Consequently, SBL has transformative potential in teacher education.
First report of preimplantation genetic diagnosis of mucopolysaccharidoses IVA and HLA typing for hematopoietic stem cell transplantation
Authors: Khordadpoor Deilamani Faravareh , Akbari Mohammad Taghi
Published: December 2022

Background

Mucopolysaccharidoses IVA is an autosomal recessive lysosomal storage disease resulting in skeletal and cartilage dysplasia. Hematopoietic stem cell transplantation is a good therapeutic option for MPS IV. Here we report the first application of PGD test for MPS IVA and HLA with the purpose of HSCT for the affected son in a family with consanguineous marriage. Haplotype analysis of linked STR markers in GALNS gene and HLA loci as well as variant detection by cycle sequencing were included in our PGD test.

Results

Two out of nine embryos were transferrable. The second embryo transfer was successful and resulted in the pregnancy of one healthy and HLA matched girl.

Conclusions

Preimplantation genetic diagnosis could be considered as a noninvasive clinical option for families with a mucopolysaccharidoses IVA patient to have a healthy child that is HLA-matched with the patient in need of hematopoietic stem cell transplantation. In lack of an appropriate hematopoietic stem cell donor the importance of preimplantation genetic diagnosis is much more significant too.
Long-term recovery of Mexican spotted owl nesting habitat after fire in the Lincoln National Forest, New Mexico
Authors: Durboraw Tara D. , Boal Clint W. , Fleck Mary S. , Gill Nathan S.
Published: December 2022

Background

Dry mixed-conifer forests of the southwestern United States are experiencing rapid, anthropogenically driven fire regime change. Prior to the Euro-American settlement, most of these forests experienced frequent surface fires but are now vulnerable to uncharacteristically large, high-severity fires. Fire directly influences the structure and composition of these forests and, in turn, the wildlife that inhabit them. Changing fire regimes result in a certain decline of some species and uncertain consequences for others. The Mexican spotted owl (Strix occidentalis lucida) is a federally listed threatened species of particular note in southwestern mixed-conifer forests. High-severity fire is cited as the owl’s primary threat in the revised species recovery plan, but uncertainties surround the impacts of high-severity fire on the habitat of the threatened owl, particularly across a timeframe longer than a few years. Our objective was to explore the long-term (100-year) effects of fire severity on elements of forest structure vital for Mexican spotted owl nesting. We quantified structural attributes for nest/roost habitat across mixed-conifer forests that burned at varying severity levels and time periods in the last century. We then examined the drivers of structural attributes by detecting statistical differences between severity classes and time periods through permutational multivariate analysis of variance.

Results

High-severity fire has the strongest deleterious impact on elements of forest structure (total basal area, percent medium tree basal area, percent large tree basal area, large tree density, and canopy cover) vital to Mexican spotted owl nesting, and although the structural differences between severity classes diminish with time, it took ≥ 80–100 years to reach the structural conditions desired for Mexican spotted owl nesting after stand-replacing fires. The most important attribute measured, canopy cover, required 90–100 years after high-severity fires to reach levels most suitable for Mexican spotted owls in the Lincoln National Forest.

Conclusions

As fires increase in frequency, severity, and size compared to the last century, the Lincoln National Forest is projected to face an overall decrease in the structural conditions needed for Mexican spotted owl nesting habitat in this region. Short intervals between uncharacteristically high-severity fires in particular pose an imminent threat to nesting habitat.
Survey on computational 3D visual optical art design
Authors: Wu Kang , Fu Xiao-Ming , Chen Renjie , Liu Ligang
Published: December 2022

Visual arts refer to art experienced primarily through vision. 3D visual optical art is one of them. Artists use their rich imagination and experience to combine light and objects to give viewers an unforgettable visual experience. However, the design process involves much trial and error; therefore, it is often very time-consuming. This has prompted many researchers to focus on proposing various algorithms to simplify the complicated design processes and help artists quickly realize the arts in their minds. To help computer graphics researchers interested in creating 3D visual optical art, we first classify and review relevant studies, then extract a general framework for solving 3D visual optical art design problems, and finally propose possible directions for future research.
Recycling of aluminum dross for producing calcinated alumina by microwave plasma
Authors: Lin Wen-Chang , Tsai Cheng-Hsien , Zhang Da-Nian , Syu Sheng-Syong , Kuo Yi-Ming
Published: December 2022

Due to the excellent engineering property, aluminum has become an important material for processing industries. As the demand of aluminum increased, a large amount of waste aluminum dross has been generated during the aluminum smelting process. The aluminum dross contained aluminum nitride and would cause odor while being disposed in landfill, making the aluminum dross disposal a tough issue. Therefore, the aluminum dross was mostly stored in the original plants. The objective of this study is to develop an economically-feasible and environmentally-friendly technology to recover aluminum dross.

In this study, the original aluminum dross was collected from the secondary smelting aluminum dross factories with 33.6% Al. The aluminum dross was dissolved with 3 M NaOH at 50 °C for 60 min to form NaAl(OH)4 solution. The NaAl(OH)4 was then transformed to aluminum hydroxide by adding H2SO4. Then, the aluminum hydroxide was filtered, washed, and dried. The thermogravimetric analysis and X-ray powder diffraction analysis result show that the main crystal phase of aluminum hydroxide (intermediate product) is boehmite. The aluminum hydroxide powder was calcined at 700 °C for 5 min by an atmospheric-pressure microwave plasma to produce Al2O3. The result show that this process can reduce environmental pollution and recycle aluminum as recoverable form.
Cognitive functions and behavioural profiles in children with cystinosis treated with cysteamine and correlation with treatment duration
Authors: Atia Fatma M. , Alfaleet Weam Ryad , Shaheen Somaya H. , Soliman Neveen A.
Published: December 2022

Background

Cystinosis is a rare autosomal recessive disease. Children with nephropathic cystinosis (NCTN) have evidence of intellectual dysfunction and behavioural abnormalities which are attributed to renal dysfunction, metabolic disarrangement, and gene mutation. This study aimed to characterize the cognitive functions and behavioural profiles in nephropathic cystinosis patients on cysteamine therapy, and determine its relation to cysteamine treatment duration. In this analytical cohort study, 20 children with nephropathic cystinosis aged 6 years or above were compared to 26 children with chronic kidney disease (CKD) matched in age, sex, and CKD stage. All patients were subjected to full clinical and psychometric assessment using the Child Behaviour Checklist (CBCL) and the Arabic language version of Stanford-Binet test (SB).

Results

There was no significant difference between both groups regarding Stanford-Binet test (SB) and Child Behavioural Checklist (CBCL), apart from delinquent behaviour. Duration of cysteamine treatment was inversely correlated with short-term memory, thought, and sex problems.

Conclusions

Children with cystinosis have a wide range of neurocognitive and behavioural problems that still present after cysteamine treatment and may be related to impact of genetic mutation on brain structure and function. Longer duration of cysteamine treatment could have beneficial effects on some behavioural problems.
Effective suicide prevention strategies in primary healthcare settings: a systematic review
Authors: Azizi Hosein , Esmaeili Elham Davtalab , Khodamoradi Farzad , Sarbazi Ehsan
Published: December 2022

Background

There is a fundamental need for health systems, health managers, and policymakers to identify effective components of suicide prevention strategies (SPS) and programs in primary healthcare (PHC) settings. Accordingly, this systematic review aimed to identify and summarize effective and significant evidence on suicide prevention in PHC setting. We systematically searched the published literature in English from PubMed, Web of Science, Scopus, CINAHL, PsychoINFO, and Embase up to 31 July 2022. The study searched all records reporting effective and significant strategies and programs on suicide prevention in PHC settings. A content analysis approach was carried out to extract major components of suicide prevention strategies in PHC settings.

Results

A total of 10 records (8 original articles and 2 reports) with 1,199,986 samples were included. In all the included articles, SPS decreased suicide rates. The majority of studies were conducted among the general population. The content analysis approach emerged five major components to SPS in PHC setting: (1) training and educating healthcare providers, (2) screening and suicide risk assessment, (3) managing depression symptoms and mental disorders, (4) managing suicide attempters and at-risk cases, and (5) prevention strategies at the general population.

Conclusions

This review provided reliable evidence for health systems to develop SPS in PHC and practitioners who are eager to provide brief and effective contact interventions for suicide risk to well-serve their patients.
Six potential biomarkers for bladder cancer: key proteins in cell-cycle division and apoptosis pathways
Authors: Inal Gültekin Güldal , Timirci Kahraman Özlem , Işbilen Murat , Durmuş Saliha , Çakir Tunahan , Yaylim İlhan , Isbir Turgay
Published: December 2022

Background

The bladder cancer (BC) pathology is caused by both exogenous environmental and endogenous molecular factors. Several genes have been implicated, but the molecular pathogenesis of BC and its subtypes remains debatable. The bioinformatic analysis evaluates high numbers of proteins in a single study, increasing the opportunity to identify possible biomarkers for disorders.

Methods

The aim of this study is to identify biomarkers for the identification of BC using several bioinformatic analytical tools and methods. BC and normal samples were compared for each probeset with T test in GSE13507 and GSE37817 datasets, and statistical probesets were verified with GSE52519 and E-MTAB-1940 datasets. Differential gene expression, hierarchical clustering, gene ontology enrichment analysis, and heuristic online phenotype prediction algorithm methods were utilized. Statistically significant proteins were assessed in the Human Protein Atlas database. GSE13507 (6271 probesets) and GSE37817 (3267 probesets) data were significant after the extraction of probesets without gene annotation information. Common probesets in both datasets (2888) were further narrowed by analyzing the first 100 upregulated and downregulated probesets in BC samples.

Results

Among the total 400 probesets, 68 were significant for both datasets with similar fold-change values (Pearson r: 0.995). Protein-protein interaction networks demonstrated strong interactions between CCNB1, BUB1B, and AURKB. The HPA database revealed similar protein expression levels for CKAP2L, AURKB, APIP, and LGALS3 both for BC and control samples.

Conclusion

This study disclosed six candidate biomarkers for the early diagnosis of BC. It is suggested that these candidate proteins be investigated in a wet lab to identify their functions in BC pathology and possible treatment approaches.
Antimicrobial sensitivity pattern of children with cystic fibrosis in Bangladesh: a lesson from a specialized Sishu (Children) Hospital
Authors: Sarkar Probir Kumar , Akand Nabila , Tahura Sarabon , Kamruzzaman Md , Akter Johora , Zaman Khandakar Ashikur , Farhana Tanzila , Rima Sathi Sultana , Alam Md Jahangir , Hassan Md. Kamrul , Fardous Jannatul
Published: December 2022

Background

Infection control in cystic fibrosis (CF) patients plays a crucial role in improving the survival of patients with CF. Antimicrobial sensitivity patterns in these patient groups in our country are currently lacking. Therefore, the purpose of the study was to evaluate the microbiological cultures and antimicrobial susceptibility pattern of pediatric CF patients.

Method

A total of 50 respiratory samples were prospectively collected from the period between February 2021 and October 2021. Sputum and oropharyngeal swabs were processed for culture and microbiological testing. Sample collection and evaluation were performed according to the Good Laboratory Practice guidelines (GLP). Informed written consent was ensured before participation. Statistical analysis was performed with SPSS v 26.

Result

The median age of the children was 30 months (6–120) months, with a male predominance (66% vs 34%). Single and two organisms were isolated in 72% (n = 36) and 12% (n = 6) of cases, respectively. During the study period, 36% of the patients harbored Pseudomonas aeruginosa, 18% harbored Klebsiella pneumoniae, and both Staphylococcus aureus and Escherichia coli were detected in 16% of cases. Levofloxacin was found to be the most active antibiotic agent with 100% susceptibility. In contrast, nearly all isolates were resistant to amoxicillin, erythromycin and rifampicin.

Conclusion

Levofloxacin is the most effective agent to treat CF patients. Active surveillance of the resistance pattern should always continue to be promoted.
Binary and ternary inclusion complexation of lapatinib ditosylate with β-cyclodextrin: preparation, evaluation and in vitro anticancer activity
Authors: Mane Preeti Tanaji , Wakure Balaji Sopanrao , Wakte Pravin Shridhar
Published: December 2022

Background

Lapatinib ditosylate, an efficient tyrosine kinase inhibitor for breast cancer, poses pharmacokinetic issues, hence developing its oral delivery system is troublesome. The poor aqueous solubility of this medicament is a key impediment in developing its successful formulation. So, the current study aims to improve water solubility of Lapatinib ditosylate by using complexation technique with β-cyclodextrin and a suitable ternary agent.

Results

Binary and ternary complexes of Lapatinib ditosylate were synthesized by means of kneading and lyophilization using β-cyclodextrin and PVP K30. As a ternary agent, various hydrophilic polymers, as well as organic acids, were assessed, and PVP K30 was chosen for the final formulation based on its stability constant and complexation efficiency. When compared to pure Lapatinib ditosylate, both inclusion complexes demonstrated improved solubility, and drug dissolution. Differential scanning calorimetry (DSC), powder X-ray diffractometry (PXRD), Fourier transform infrared (FTIR), and scanning electron microscopic (SEM) techniques, all validated the complex formation. Docking studies picturized the geometry of Lapatinib ditosylate in β-cyclodextrin cavity. Using MCF-7 cell lines, investigation of anticancer activity of the pure drug and its synthesized complexes was carried out and the results revealed that the complexes had stronger anticancer activity than Lapatinib ditosylate alone.

Conclusions

Overall, it can be concluded that Lapatinib ditosylate complexation increased its aqueous solubility, resulting in its increased dissolution and in vitro anticancer activity in a breast cancer cell line.
Bioactive potential of tropical highland apple (Malus domestica cv. Anna) crude extract: opportunities for food waste revalorization
Authors: Calvo-Castro Laura A. , Lobo-Vázquez Michelle , Gómez-González Julio César , Arnáez-Serrano Elizabeth , Zamora-Fallas Gabriel , Sánchez-Zúñiga Katherine , Centeno-Cerdas Carolina
Published: December 2022

Background

The third most produced fruit crop in the world, apples (Malus domestica Borkh) are one of the most accessible and widely consumed fruits, with known benefits for human health. Although they are a temperate crop, apple cultivation has been successfully implemented in lower latitudes. Tropical highland Costa Rican apples (cv. Anna) have shown high total polyphenol content, and cytotoxic effects against human cancer cell lines. However, most reports originate from purified fractions, obtained using methods which are not easily translatable for commercial applications. In this study, we prepared a polyphenol-rich bioactive extract from Costa Rican Anna apples, using food-grade solvents and simple techniques, aiming towards easy translation of the extraction protocols to small local producers.

Results

The whole apple crude extract (AE) was investigated for its total polyphenol content, general phytochemical profile, cytotoxicity against human breast and lung cancer cells, and regenerative potential in murine skin fibroblast monolayers. The AE showed total polyphenol amounts comparable to that obtained using more refined extractions in previous studies, and exhibited cytotoxic activity against human breast (MCF7) and lung (NCI-H460) cancer cells, and inhibition of cell proliferation in the scratch-wound-healing assay.

Conclusions

Food-grade simple protocols were successful for obtaining a polyphenol-rich bioactive extract from Costa Rican Anna apples. The easy-to-implement extraction protocols and biochemical tests could provide a source of bioactive phytochemicals to be used in circular production systems.
Bilateral congenital lobar emphysema: a rare entity and a therapeutic challenge
Authors: Garge Saurabh , Mahalik Santosh , Jain Pradeep
Published: December 2022

Background

Bilateral congenital lobar emphysema is an extremely rare condition, and detailed workup of these patients is very important. Operative intervention is usually based on radiological, biochemical, and clinical details. Bronchoscopy gives an added advantage in cases with diagnostic dilemmas and makes the treatment more evidence based. We here present three cases and review the literature for this rare entity.

Material and methods

We retrospectively collected data about all the cases of bilateral CLE operated by the authors at various centres over the period of 3 years from January 2016 to December 2018.

Results

We managed three cases of bilateral CLE, and all three had unique details based on which treatment was planned. We operated three cases of this very rare entity and compared our findings with 23 cases from the literature reviewed.

Conclusion

We propose that bronchoscopy should be an essential component in the management of all cases of CLE. It helps in defining pathology, the severity of the disease, and the decision on which side to be operated first and avoids unnecessary simultaneous lobectomies. We recommend case selection on basis of radiological, biochemical, clinical, and bronchoscopy criteria. Based on this, an approach of sequential lobectomies is less risky and should be advocated in most of the patients.
Multiple cystic lung disease in a smoker
Authors: Panjwani Amit , Salman Mohamed Redha
Published: December 2022

Background

Pulmonary cyst is a rounded lung parenchymal lucency, usually containing air or fluid. Approach to establishing the etiology of lung cyst includes determining their location, number, distribution, and presence or absence of associated computed tomography findings (associated with nodules or ground-glass attenuation). Multiple cysts may be seen in various diseases, and radiological imaging is the usual starting point in detecting lung cysts. Importance of adequate clinical examination accompanied with relevant investigations in securing the etiology of lung cysts cannot be overemphasized. We present a first case of a rare multiple cystic lung disease from the Kingdom of Bahrain that was successfully managed with oral corticosteroids.

Case presentation

A 42-year-old male, chronic smoker presented with progressive dyspnea and productive cough of 1 year duration. He was evaluated and found to have multiple variable sized thin and thick-walled cysts with bizarre shapes in both lungs. A diagnosis of pulmonary Langerhans’ cell histiocytosis was made, and the patient was treated with smoking cessation and oral corticosteroids for 9 months.

Conclusion

Patients with characteristic clinical and radiological features can be diagnosed as pulmonary Langerhans’ cell histiocytosis, without a tissue biopsy. A good response may be seen with smoking cessation and oral corticosteroids in selected group of patients.
Transthoracic sonographic scores in evaluating the success of different scelerosing modalities in patients with malignant pleural effusion
Authors: Agmy Gamal , Adam Mohamed F. , El Sagheir Safaa Ahmed , Mahmoud Manal A.
Published: December 2022

Background

Malignant pleural effusions (MPE) mostly arises from metastases to the pleura from other sites. Management of malignant effusions aims to palliate dyspnea and prevent the reaccumulation of pleural fluid to improve patients’ quality of life. Pleurodesis is the most common palliative treatment for patients with refractory MPE. This study was carried out to evaluate the performance of transthoracic sonographic (TUS) scores (pleural sliding and pleural adherence score) in predicting the success of pleurodesis by different modalities in patients with malignant pleural effusion. One hundred malignant pleural effusion patients were enrolled to an interventional clinical trial from September 2019 to April 2021 for palliative management of dyspnea. Pleurodesis for palliative treatment of dyspnea was done either spontaneously by the intercostal chest tube or by a sclerosing agent such as tetracycline solution or tetracycline poudrage or iodopovidine. Patients were randomly allocated to one of these four groups where each group included 25 patients. Transthoracic ultrasound was performed at baseline, and 1 month after pleurodesis and the lung sliding score and pleural adherence score were evaluated.

Results

Majority of patients (78%) had high baseline lung sliding score (7-8). Post pleurodesis only 11.4% had high scores (p<0.001), also the mean lung sliding score decreased significantly in comparison to the baseline values (p˂ 0.001) in the spontaneous, tetracycline solution, tetracycline poudrage, and iodopovidine groups (7.04 ± 1.02 vs. 4.85 ± 1.60, 7.28± 0.98 vs. 4.48± 1.75, 7.20±0.96 vs. 4.44 ± 1.45, 7.04±0.93 vs. 3.35±1.81, respectively). Iodopovidine pleurodesis group in comparison to the other modalities showed the highest pleural adherence score (12.64 ± 2.98) and absent lung sliding in 72.7% of cases and 70 % success rate. Pleural adherence score at cut off ≥ 12 showed 92.75% sensitivity, 89.47% specificity, 92.1 accuracy, and 0.911 area under the curve (AUC) for predicting successful pleurodesis.

Conclusion

TUS scores is a feasible, bedside, and accurate method to detect the outcome of pleurodesis. Iodopovidone was more effective than tetracycline solution, tetracycline poudrage, and spontaneous pleurodesis.

Trial registration

ClinicalTrials.gov. NCT04074902. Registered on 29 August 2019
Cost-effectiveness of implementing a suicide prediction tool (OxMIS) in severe mental illness: Economic modeling study
Authors: Botchway Stella , Tsiachristas Apostolos , Pollard Jack , Fazel Seena
Published: December 2022

Background

Cost-effectiveness analysis needs to be considered when introducing new tools and treatments to clinical services. The number of new assessment tools in mental health has rapidly expanded, including suicide risk assessment. Such suicide-based assessments, when linked to preventative interventions, are integral to high-quality mental health care for people with severe mental illness (SMI). We examined the cost implications of implementing Oxford Mental Illness and Suicide (OxMIS), an evidence-based, scalable suicide risk assessment tool that provides probabilistic estimates of suicide risk over 12 months for people with SMI in England.

Methods

We developed a decision analytic model using secondary data to estimate the potential cost-effectiveness of incorporating OxMIS into clinical decision-making in secondary care as compared to usual care. Cost-effectiveness was measured in terms of costs per quality-adjusted life years (QALYs) gained. Uncertainty was addressed with deterministic and probabilistic sensitivity analysis.

Results

Conducting suicide risk assessment with OxMIS was potentially cheaper than clinical risk assessment alone by £250 (95% confidence interval, −786;31) to £599 (−1,321;−156) (in 2020–2021 prices) per person with SMI and associated with a small increase in quality of life (0.01 [−0.03;0.05] to 0.01 QALY, [−0.04;0.07]). The estimated incremental cost-effectiveness ratio of implementing OxMIS was cost saving. Using probabilistic sensitivity analysis, 99.96% of 10,000 simulations remained cost saving.

Conclusion

Cost-effectiveness analysis can be conducted on risk prediction models. Implementing one such model that focuses on suicide risk in a high-risk population can lead to cost savings and improved health outcomes, especially if explicitly linked to preventative treatments.
Therapy for Stage IV Non–Small-Cell Lung Cancer With Driver Alterations: ASCO Living Guideline, Version 2022.2
Authors: Owen Dwight H. , Singh Navneet , Ismaila Nofisat , Blanchard Elizabeth , Celano Paul , Florez Narjust , Jain Dharamvir , Leighl Natasha B. , Mamdani Hirva , Masters Gregory , Moffitt Pamela R. , Naidoo Jarushka , Phillips Tanyanika , Riely Gregory J. , Robinson Andrew G. , Schenk Erin , Schneider Bryan J. , Sequist Lecia , Spigel David R. , Jaiyesimi Ishmael A.
Published: December 2022

Living guidelines are developed for selected topic areas with rapidly evolving evidence that drives frequent change in recommended clinical practice. Living guidelines are updated on a regular schedule by a standing expert panel that systematically reviews the health literature on a continuous basis, as described in the ASCO Guidelines Methodology Manual . ASCO Living Guidelines follow the ASCO Conflict of Interest Policy Implementation for Clinical Practice Guidelines . Living Guidelines and updates are not intended to substitute for independent professional judgment of the treating provider and do not account for individual variation among patients. See Appendix 1 (online only) for disclaimers and other important information. Updates are published regularly and can be found at https://ascopubs.org/nsclc-da-living-guideline .
Longitudinal Profiling of Plasma Cytokines and Its Association With Postoperative Delirium in Elderly Patients Undergoing Major Lower Limb Surgery: A Prospective Observational Study
Authors: Zhang Yu , Hu Jun , Zuo Weiguang , He Pei , Xue Qi , Feng Xiaomei , Zhang Ye , Maze Mervyn
Published: December 2022

BACKGROUND:

Surgery is accompanied by a systemic inflammatory response that may presage delirium in susceptible individuals. Little is known about the trajectory of plasma proinflammatory cytokines and their potential associations with postoperative delirium (POD). The current study longitudinally assessed both pro and anti-inflammatory plasma cytokine response and development of POD in older surgical patients to investigate associations with individual and/or clusters of cytokines that may indicate pathogenic mechanisms.

METHODS:

A prospective longitudinal study sought to enroll patients >60 years old who were scheduled for major lower limb surgery under general anesthesia. Blood was obtained preoperatively and postoperatively from day 1 through postoperative day 4 for measurement of plasma interleukin-1β (IL-1β), IL-2, IL-4, IL-6, soluble IL-6 receptor (sIL-6R), IL-10, and tumor necrosis factor-α (TNF-α). Participants were assessed for POD twice daily for 4 days using the confusion assessment method. Trajectory of postoperative changes in plasma cytokines was determined by a group-based trajectory modeling analysis that was informed by distinct cytokines identified by time-dependent Cox regression model.

RESULTS:

One hundred eighty-eight patients were assessed for eligibility of whom 129 underwent major surgery and 126 had complete datasets for final analysis. POD was diagnosed in 31 of 126 patients (24.6%). Time-dependent Cox regression model identified that higher IL-6 and sIL-6R levels were associated with higher risk of developing POD. A two-cluster model (stable lower and fluctuating higher levels) was considered to be the most statistically appropriate model for IL-6 and sIL-6R trajectory. More participants with fluctuating higher IL-6 were delirious (73.3% vs 18.0%, P = .001) as were those with fluctuating higher sIL-6R (81.3% vs 16.4%, P = .001).

CONCLUSIONS:

As higher IL-6 and sIL-6R levels were significantly associated with higher risk of POD and the combination is required for IL-6 trans-signaling, it is possible that activation of this pathway may be associated with POD. Furthermore, it will be important to determine whether high levels of the combination of IL-6 and sIL-6R can be an early biomarker for the subsequent development of POD.
Role of cardiac imaging in acute chest pain
Authors: Koh Natalie , Nieman Koen
Published: December 2022

Chest pain is the second most common complaint in the emergency department. The need to diagnose the cause of chest pain in a timely manner and appropriately direct care is crucial. This article discusses the role of imaging in acute chest pain, after first differentiating chest pain into cardiac and non-cardiac causes with upfront clinical and biochemical assessment. The role of non-invasive imaging including point-of-care ultrasound, echocardiography, myocardial perfusion imaging, cardiac MRI, coronary computed tomography angiography and novel cardiac CT applications are discussed. Updates in the literature regarding the role of coronary plaque imaging in acute chest pain are reviewed, as are ongoing challenges and future directions. This includes a discussion on the yield of diagnostic testing in low-risk acute chest pain cohorts vs intermediate-high risk cohorts. The incremental value of further testing in the former is low, which is reflected in contemporary guidelines that discourage the use of costly diagnostic tests in these cohorts. In the latter cohort, emerging evidence has shown specifically the role coronary computed tomography angiography could play in reducing the need for invasive coronary angiography in selective patients where the true probability of acute coronary syndrome is thought to be low. Real-world considerations such as accessibility and affordability are also discussed in the paper because while guidelines offer clinicians the flexibility of evidence-based choice, physician decision must necessarily be made in consideration of real-world constraints.
Σταυρικές εγχαράξεις και απολάξευση γλυπτών κατά την Ύστερη Αρχαιότητα. Μία ερμηνευτική προσέγγιση
Authors: ΔΟΥΛΦΗΣ Ανδρέας
Published: December 2022

Η σύγχρονη έρευνα υποδεικνύει μία περίπλοκη και - τουλάχιστον φαινομενικά - αντιφατική εικόνα ως προς τη στάση των Χριστιανών έναντι των μη χριστιανικών γλυπτών κατά την Ύστερη Αρχαιότητα. Σε ορισμένες περιπτώσεις, η ποιότητα της παρέμβασης υποδηλώνει καταστροφική πρόθεση για το αρχικό μήνυμα του γλυπτού καθώς και για την καλλιτεχνική του αξία. Σε άλλες περιπτώσεις, οι παρεμβάσεις γίνονται με προσοχή και προκαλούν μικρότερη ζημιά στην αρχική εικόνα. Το κύριο ερώτημα είναι: ποιοι είναι οι λόγοι για την εμφάνιση διαφορετικών πρακτικών; Ποιοι είναι οι λόγοι για την εκ νέου ερμηνεία των χριστιανικών αγαλμάτων σε χριστιανικό πλαίσιο σε μια σειρά υποθέσεων; Αντίθετα, ποιοι είναι οι λόγοι πίσω από τις περιπτώσεις όπου η καταστροφική πρόθεση εναντίον των γλυπτών είναι σαφής; Για να απαντηθεί πληρέστερα αυτή η ερώτηση  επιχειρείται μια νέα ερμηνεία, σχετικά με την παράλληλη εμφάνιση αυτών των δύο διαφορετικών πρακτικών.
Byzantine Textual Sources for Climatic and Environmental Developments
Authors: TELELIS Ioannis
Published: December 2022

ΒΥΖΑΝΤΙΝΕΣ ΚΕΙΜΕΝΙΚΕΣ ΠΗΓΕΣ ΣΧΕΤΙΚΑ ΜΕ ΤΙΣ ΚΛΙΜΑΤΟΛΟΓΙΚΕΣ ΚΑΙ ΤΙΣ ΠΕΡΙΒΑΛΛΟΝΤΟΛΟΓΙΚΕΣ ΑΛΛΑΓΕΣΤο παρόν άρθρο πραγματεύεται την πρόοδο που έχει πραγματοποιηθεί στη διερεύνηση των βυζαντινών κειμενικών πηγών από ιστορική και παλαιοκλιματολογική άποψη. Αναλύει γενικές έννοιες που επηρεάζουν την ιδεολογική προοπτική των αναφορών στον καιρό, το κλίμα και τις σχετικές καταστροφές, στο πλαίσιο των ειδών των βυζαντινών κειμενικών πηγών που τις περιλαμβάνουν. Στη συνέχεια, παρουσιάζει επισκόπηση των τεκμηριωμένων παλαιοκλιματικών στοιχείων που συναντώνται για το Βυζάντιο, δίνοντας έμφαση στις κατηγορίες των φαινομένων που αναφέρονται στις πηγές. Τέλος, συζητά προβλήματα που σχετίζονται με την ανάλυση και την ερμηνεία των στοιχείων με όρους ιστορικής κλιματολογίας του Βυζαντίου και, τελικά, βυζαντινής περιβαλλοντικής ιστορίας.
Βιβλιοκρισία: M. Horn, Adam- und-Eva-Erzählungen im Bildprogramm kretischer Kirchen: Eine ikonographische und kulturhistorische Objekt- und Bildfindungsanalyse [Byzanz zwischen Orient und Okzident 16], Mainz 2020.
Authors: ΦΩΣΚΟΛΟΥ Βασιλική Α.
Published: December 2022

Βιβλιοκρισία: Martina Horn, Adam-und-Eva-Erzählungen im Bildprogramm kretischer Kirchen: Eine ikonographische und kulturhistorische Objekt- und Bildfindungsanalyse [Byzanz zwischen Orient und Okzident 16], Mainz (Verlag des Römisch-Germanischen Zentralmuseums) 2020.
Βιβλιογραφικό σημείωμα¨: Λόγιοι καὶ Λογιοσύνη στὸ Βυζάντιο. Ἐπιστ. συμπόσιο πρὸς τιμὴν τοῦ Καθηγητῆ Κ. Ν. Κωνσταντινίδη (Παν. Ἰωαννίνων, 26 -10- 2016). Ἐπιστ. ἐπιμ. Π. Γ. Αντωνόπουλος – Η. Α. Γιαρένης – Δ. Κ. Αγορίτσας, Θεσσαλονίκη 2019
Authors: ΛΑΜΠΑΚΗΣ Στυλιανός
Published: December 2022

Βιβλιογραφικό σημείωμα: Λόγιοι καὶ Λογιοσύνη στὸ Βυζάντιο. Ἐπιστημονικὸ συμπόσιο πρὸς τιμὴν τοῦ Καθηγητῆ Κώστα Ν. Κωνσταντινίδη (Πανεπιστήμιο Ἰωαννίνων, 26 Ὀκτωβρίου 2016). Ἐπιστημονικὴ ἐπιμέλεια Π. Γ. Αντωνόπουλος – Η. Α. Γιαρένης – Δ. Κ. Αγορίτσας, University Studio Press, Θεσσαλονίκη 2019