bluuebunny/crossref_metadata_2025 huggingface dataset:
Involutions, links, and Floer cohomologies
Authors: Konno Hokuto , Miyazawa Jin , Taniguchi Masaki
Published: June 2024

We develop a version of Seiberg–Witten Floer cohomology/homotopy type for a 4‐manifold with boundary and with an involution that reverses the structure, as well as a version of Floer cohomology/homotopy type for oriented links with nonzero determinant. This framework generalizes the previous work of the authors regarding Floer homotopy type for spin 3‐manifolds with involutions and for knots. Based on this Floer cohomological setting, we prove Frøyshov‐type inequalities that relate topological quantities of 4‐manifolds with certain equivariant homology cobordism invariants. The inequalities and homology cobordism invariants have applications to the topology of unoriented surfaces, the Nielsen realization problem for nonspin 4‐manifolds, and nonsmoothable unoriented surfaces in 4‐manifolds.
Core-level spectra of metallic lanthanides: Lanthanum (La)
Authors: Morgan David J.
Published: June 2024

The core-level aluminum excited spectra for lanthanum, the eponymous parent lanthanide metal, are presented together with exemplar spectra highlighting the metals reactivity from reaction with background chamber gases. Recommendations are given for the background integrations limits and form, together with comments on sensitivity factors.
Single Session Intermittent Heat Exposure With More Frequent and Shorter Cooling Breaks Facilitates Greater Training Intensity and Elicits Physiological Responses Comparable to Continuous Heat Exposure
Authors: Ramos Julian A.P. , Ducker Kagan J. , Riddell Hugh , Landers Grant , Girard Olivier , Brade Carly J.
Published: June 2024

Purpose: To investigate the influence of shorter, more frequent rest breaks with per-cooling as an alternative heat-acclimation session on physiological, perceptual, and self-paced maximal cycling performance, compared with continuous heat exposure. Methods: Thirteen participants completed 1 continuous and 3 intermittent-heat-exposure (IHE) maximal self-paced cycling protocols in a random order in heat (36 °C, 80% relative humidity): 1 × 60-minute exercise (CON), 3 × 20-minute exercise with 7.5-minute rest between sets (IHE-20), 4 × 15-minute exercise with 5-minute rest between sets (IHE-15), and 6 × 10-minute exercise with 3-minute rest between sets (IHE-10). Mixed-method per-cooling (crushed-ice ingestion and cooling vest) was applied during rest periods of all IHE protocols. Results: Total distance completed was greater in IHE-10, IHE-15, and IHE-20 than in CON (+11%, +9%, and +8%, respectively), with no difference observed between IHE protocols. Total time spent above 38.5 °C core temperature was longer in CON compared with IHE-15 and IHE-20 (+62% and +78%, respectively) but similar to IHE-10 (+5%). Furthermore, a longer time above 38.5 °C core temperature occurred in IHE-10 versus IHE-15 and IHE-20 (+54% and +69%, respectively). Sweat loss did not differ between conditions. Conclusion: IHE with per-cooling may be a viable alternative heat-acclimation protocol in situations where training quality takes precedence over thermal stimulus or when both factors hold equal priority.
Polymerase theta is a synthetic lethal target for killing Epstein-Barr virus lymphomas
Authors: Willman Griffin H. , Xu Huanzhou , Zeigler Travis M. , McIntosh Michael T. , Bhaduri-McIntosh Sumita
Published: June 2024

Treatment options for Epstein-Barr virus (EBV)-cancers are limited, underscoring the need for new therapeutic approaches. We have previously shown that EBV-transformed cells and cancers lack homologous recombination (HR) repair, a prominent error-free pathway that repairs double-stranded DNA breaks; instead, EBV-transformed cells demonstrate genome-wide scars of the error-prone microhomology-mediated end joining (MMEJ) repair pathway. This suggests that EBV-cancers are vulnerable to synthetic lethal therapeutic approaches that target MMEJ repair. Indeed, we have previously found that targeting PARP, an enzyme that contributes to MMEJ, results in the death of EBV-lymphoma cells. With the emergence of clinical resistance to PARP inhibitors and the recent discovery of inhibitors of Polymerase theta (POLθ), the polymerase essential for MMEJ, we investigated the role of POLθ in EBV-lymphoma cells. We report that EBV-transformed cell lines, EBV-lymphoma cell lines, and EBV-lymphomas in AIDS patients demonstrate greater abundance of POLθ, driven by the EBV protein EBNA1, compared to EBV-uninfected primary lymphocytes and EBV-negative lymphomas from AIDS patients (a group that also abundantly expresses POLθ). We also find POLθ enriched at cellular DNA replication forks and exposure to the POLθ inhibitor Novobiocin impedes replication fork progress, impairs MMEJ-mediated repair of DNA double-stranded breaks, and kills EBV-lymphoma cells. Notably, cell killing is not due to Novobiocin-induced activation of the lytic/replicative phase of EBV. These findings support a role for POLθ not just in DNA repair but also DNA replication and as a therapeutic target in EBV-lymphomas and potentially other EBV-cancers as EBNA1 is expressed in all EBV-cancers.

IMPORTANCE

Epstein-Barr virus (EBV) contributes to ~2% of the global cancer burden. With a recent estimate of >200,000 deaths a year, identifying molecular vulnerabilities will be key to the management of these frequently aggressive and treatment-resistant cancers. Building on our earlier work demonstrating reliance of EBV-cancers on microhomology-mediated end-joining repair, we now report that EBV lymphomas and transformed B cell lines abundantly express the MMEJ enzyme POLθ that likely protects cellular replication forks and repairs replication-related cellular DNA breaks. Importantly also, we show that a newly identified POLθ inhibitor kills EBV-cancer cells, revealing a novel strategy to block DNA replication and repair of these aggressive cancers.
Draft genome sequences of
Streptomyces virginiae
strain CMAA1738,
Paenibacillus ottowii
strain CMAA1739 and
Pseudomonas inefficax
strain CMAA1741, isolated from rhizosphere of wheat landraces
Authors: Nishisaka Caroline Sayuri , Ventura João Paulo , Quevedo Hélio Danilo , Godoy Fernanda de Almeida , Rossmann Maike , Mendes Rodrigo
Published: June 2024

In this study, we have identified and characterized three genomes from bacteria isolated from the rhizosphere of
Triticum aestivum. Streptomyces virginiae
CMAA1738 and
Paenibacillus ottowii
CMAA1739 were obtained from the wheat landrace Iran 1-29-11334, and
Pseudomonas inefficax
CMAA1741 was isolated from the wheat landrace Karakilcik.
Complete genome sequence of
Rhodococcus
sp. strain PD04, a pyridine-degrading bacterium under hypersaline condition
Authors: Huo Donghui , Hu Yangfan , Li Lanpeng , Gao Huipeng , Wang Meng , Guan Hao , Zhang Quan , Yu Bo
Published: June 2024

We report the complete genome sequence of a pyridine-degrading
Rhodococcus
sp. strain PD04 under 4% salinity environment, isolated from wastewater of coking plant. The genome is 6.07 Mb with 5,767 annotated gene coding sequences.
Complete genome sequence of
Staphylococcus hominis
FSEL1 isolated from chicken skin in South Korea
Authors: Ban Ga-Hee
Published: June 2024

Staphylococcus hominis
FSEL1 has been isolated from chicken skin. The complete genome sequence of the bacterium comprised one chromosome and two plasmids of 2.44 Mbp. A total of 2,273 CDS, 2,473 genes, 19 rRNAs, 62 tRNAs, and 1 tmRNA were predicted to be present within the genome.
Draft genome sequence of
Xanthomonas arboricola
pv. pruni PVCT 262.1 isolated from
Prunus dulcis
in italy
Authors: Dimaria Giulio , Mosca Alexandros , Russo Marcella , Cubero Jaime , Pothier Joël F. , Koebnik Ralf , Catara Vittoria
Published: June 2024

Here, we report the draft genome sequence of
Xanthomonas arboricola
pv. pruni strain PVCT 262.1, isolated from almond (
Prunus dulcis
) leaves affected by bacterial spots in Italy in 2020. Genome size is 5,076,418 bp and G+C content is 65.44%. A total of 4,096 protein-coding genes and 92 RNAs are predicted.
Complete genome sequence of
Parvimonas micra
strain JM503A, a genetically tractable dental abscess clinical isolate
Authors: Higashi Dustin L. , Nguyen Anh , Qin Hua , Borland Christina , Palmer Elizabeth A. , Biais Nicolas , Kreth Jens , Merritt Justin
Published: June 2024

Parvimonas micra
is a pathobiont of humans that is often found in abundance at sites of mucosal inflammation as well as within malignant tumors. Here, we report the complete genome sequence of
P. micra
strain JM503A, which is a genetically tractable clinical isolate derived from a human odontogenic abscess specimen.
The complete genome of “
Candidatus
Phytoplasma fraxini” AshY1 from the ash yellows group
Authors: Böhm Jan W. , Huettel Bruno , Schneider Bernd , Kube Michael
Published: June 2024

The complete genome of “
Candidatus
Phytoplasma fraxini” AshY1, originating from
Fraxinus americana
in North America, was assembled using long reads from single-molecule real-time sequencing technology. The chromosome of 598 kb provides insights into the effector repertoire of a phytopathogenic bacterium from the 16SrVII phytoplasma group.
Mycobacteriophage maravista: a cluster F1 phage discovered on Cape Cod, Massachusetts
Authors: Pelagalli Charles , Sera Debbie-Jacobs , DeGiorgis Joseph A. , Cornely Kathleen
Published: June 2024

Mycobacterium virus Maravista
, a member of the family
Gracegardnervirianae
and species
Cheoctovirus
, is an F1 cluster phage that infects
Mycobacterium smegmatis
mc²155. The Maravista genome has 61.3% GC content, is 60,140 bp in length, and encodes 104 putative genes. Maravista encodes two putative glycosyltransferases, suggesting glycosylation of its capsid protein.
Global emergence of double and multi-carbapenemase producing organisms: epidemiology, clinical significance, and evolutionary benefits on antimicrobial resistance and virulence
Authors: Yuan Pei-Bo , Dai Li-Ting , Zhang Qi-Ke , Zhong Yu-Xia , Liu Wan-Ting , Yang Ling , Chen Ding-Qiang
Published: June 2024

Redundant carbapenemase-producing (RCP) bacteria, which carry double or multiple carbapenemases, represent a new and concerning phenomenon. The objective of this study is to conduct a comprehensive analysis of the epidemiology and genetic mechanisms of RCP strains to support targeted surveillance and control measures. A retrospective analysis was conducted using surveillance data from 277 articles. Statistical analysis was performed to determine and evaluate species prevalence, proportions of carbapenemases, antibiotic susceptibility profiles, sample information, and patient outcomes. Complete plasmid sequencing data were utilized to investigate potential antimicrobial resistance or virulence advantages that strains may gain from acquiring redundant carbapenemases. RCP bacteria are widely distributed globally, and their prevalence is increasing over time. Several countries, including China, India, Iran, Turkey, and South Korea, have reported more than 100 RCP strains. The most commonly reported RCP species are
Klebsiella pneumoniae
and
Acinetobacter baumannii
, which exhibit varying proportions of carbapenemase combinations. Certain species-carbapenemase combinations, such as
K. pneumoniae
carrying New Delhi metallo-β-lactamase (NDM) + oxacillinase (OXA) (56.76%) and
K. pneumoniae
carbapenemase (KPC) + Verona integron-encoded metallo-β-lactamase (VIM) (50.00%) carbapenemases, are associated with high mortality rates. In patients with RCP strains isolated from the bloodstream and respiratory system, the mortality rates are 58.70% and 69.23%, respectively. Analysis of plasmids from RCP strains suggests that they may acquire additional antibiotic resistance phenotypes and virulence factors. Carbapenem-resistant bacteria carrying redundant carbapenemases pose a significant global health threat. This study provides valuable insights into the epidemiology and genetic mechanisms of these bacteria, supporting the development of effective control and prevention strategies to mitigate their transmission.

IMPORTANCE

This study examined the global distribution patterns of 1,780 bacteria with double or multiple carbapenemases from 277 articles and assessed their clinical impact. The presence of multiple carbapenemases increases the chances of co-resistance to other classes of antibiotics and more virulence factors, further complicating the clinical management of infections.
Impact of extended-spectrum chromosomal AmpC (ESAC) of
Escherichia coli
on susceptibility to cefiderocol
Authors: Raro Otávio Hallal Ferreira , Le Terrier Christophe , Nordmann Patrice , Poirel Laurent
Published: June 2024

The impact of chromosomally encoded wild-type or extended-spectrum (ESAC) AmpC β-lactamases of
Escherichia coli
on susceptibility to ceftazidime, cefepime, and cefiderocol was evaluated in different genetic backgrounds, including wild-type, PBP3-modified, and porin-deficient
E. coli
strains. Recombinant
E. coli
strains possessing the different backgrounds and producing variable ESACs were evaluated. Although ESAC enzymes conferred resistance to ceftazidime and decreased susceptibility to cefepime as expected, we showed here that cefiderocol was also a substrate of ESAC enzymes.

IMPORTANCE

We showed here that chromosomally encoded intrinsic extended-spectrum cephalosporinases of
Escherichia coli
may impact susceptibility not only to ceftazidime and cefepime but also to cefiderocol.
Supplemental Material: Updating the Upper Cretaceous (Campanian) Two Medicine Formation of Montana (USA): Lithostratigraphic revisions, new CA-ID-TIMS U-Pb ages, and a calibrated framework for dinosaur occurrences
Authors: Rogers Raymond R. , et al.
Published: June 2024

Table S1: U-Pb isotopic data for zircon analyses from Campanian bentonites of the Two Medicine Formation, Montana, USA. Table S2: GPS coordinates for measured columns in Two Medicine Formation.
Implementation barriers and facilitators of remote monitoring, remote consultation and digital care platforms through the eyes of healthcare professionals: a review of reviews
Authors: Oudbier Susan J , Souget-Ruff Sylvie P , Chen Britney S J , Ziesemer Kirsten A , Meij Hans J , Smets Ellen M A
Published: June 2024

Objectives

Digital transformation in healthcare is a necessity considering the steady increase in healthcare costs, the growing ageing population and rising number of people living with chronic diseases. The implementation of digital health technologies in patient care is a potential solution to these issues, however, some challenges remain. In order to navigate such complexities, the perceptions of healthcare professionals (HCPs) must be considered. The objective of this umbrella review is to identify key barriers and facilitators involved in digital health technology implementation, from the perspective of HCPs.

Design

Systematic umbrella review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Data sources

Embase.com, PubMed and Web of Science Core Collection were searched for existing reviews dated up to 17 June 2022. Search terms included digital health technology, combined with terms related to implementation, and variations in terms encompassing HCP, such as physician, doctor and the medical discipline.

Eligibility criteria

Quantitative and qualitative reviews evaluating digital technologies that included patient interaction were considered eligible. Three reviewers independently synthesised and assessed eligible reviews and conducted a critical appraisal.

Data extraction and synthesis

Regarding the data collection, two reviewers independently synthesised and interpreted data on barriers and facilitators.

Results

Thirty-three reviews met the inclusion criteria. Barriers and facilitators were categorised into four levels: (1) the organisation, (2) the HCP, (3) the patient and (4) technical aspects. The main barriers and facilitators identified were (lack of) training (n=22/33), (un)familiarity with technology (n=17/33), (loss of) communication (n=13/33) and security and confidentiality issues (n=17/33). Barriers of key importance included increased workload (n=16/33), the technology undermining aspects of professional identity (n=11/33), HCP uncertainty about patients’ aptitude with the technology (n=9/33), and technical issues (n=12/33).

Conclusions

The implementation strategy should address the key barriers highlighted by HCPs, for instance, by providing adequate training to familiarise HCPs with the technology, adapting the technology to the patient preferences and addressing technical issues. Barriers on both HCP and patient levels can be overcome by investigating the needs of the end-users. As we shift from traditional face-to-face care models towards new modes of care delivery, further research is needed to better understand the role of digital technology in the HCP-patient relationship.
Effects of peer-education training on cardiopulmonary resuscitation knowledge and skill retention of secondary school students: a feasibility study
Authors: Spartinou Anastasia , Karageorgos Vlasios , Sorokos Konstantinos , Darivianaki Panagiota , Petrakis Emmanouil C , Papapanagiotou Michalis , Fraidakis Othon , Nyktari Vasileia , Papaioannou Alexandra
Published: June 2024

Objectives

The need for cardiopulmonary resuscitation (CPR) training dissemination in the community could be resolved by mass school training programmes. However, the availability of instructors remains an unsolved problem. Our purpose was to investigate the effects of three different instructor types: healthcare professionals, schoolteachers and peer students, on CPR skills retention of secondary school students 6 months after training.

Design

The study was designed as a prospective randomised single-blinded controlled trial. The study ended before reaching the target sample size for the schoolteacher arm.

Setting and participants

Students from three different secondary schools in Heraklion, Greece, were recruited to attend CPR training.

Interventions

All participants received a manual and a digital video disc demonstrating the CPR/automated external defibrillator (AED) algorithm, followed by hands-on training. They were randomly assigned to receive training by either healthcare professionals, schoolteachers or peer students, who had previously been trained appropriately.

Outcome measures

CPR knowledge and skill retention were evaluated immediately (secondary outcome) and 6 months after training (primary outcome), using a knowledge questionnaire, skill checklists and feedback device.

Results

408 students (199 girls – two non-binary) were enrolled in the study with a median age of 13 (IQR 12–14) years. A total of 255 students (125 girls) were reassessed at 6 months. Preliminary analysis of the data revealed no statistically significant differences between the three groups regarding factual knowledge immediately after training (p=0.226) and at 6 months (p=0.867). Immediately after training, more students trained by healthcare professionals or teachers performed safe defibrillation (p<0.000); however, this finding was dissipated at 6-month reassessment (p=0.202). Compliance with the CPR algorithm and the quality of hands-only CPR were not different (p>0.05) among the groups.

Conclusions

The type of instructor did not affect the CPR knowledge and skill retention of students 6 months after training. Schoolchildren acting as peer instructors could be an effective alternative to healthcare professionals and schoolteachers, although further studies are needed.
ERAS for Ambulatory TURBT: Enhancing Bladder Cancer Care (EMBRACE) randomised controlled trial protocol
Authors: Rezaee Michael E , Mahon Katherine M , Trock Bruce J , Nguyen The-Hung Edward , Smith Armine K , Hahn Noah M , Patel Sunil H , Kates Max
Published: June 2024

Introduction

Transurethral resection of bladder tumour (TURBT) is one of the more common procedures performed by urologists. It is often described as an ‘incision-free’ and ‘well-tolerated’ operation. However, many patients experience distress and discomfort with the procedure. Substantial opportunity exists to improve the TURBT experience. An enhanced recovery after surgery (ERAS) protocol designed by patients with bladder cancer and their providers has been developed.

Methods and analysis

This is a single-centre, randomised controlled trial to investigate the effectiveness of an ERAS protocol compared with usual care in patients with bladder cancer undergoing ambulatory TURBT. The ERAS protocol is composed of preoperative, intraoperative and postoperative components designed to optimise each phase of perioperative care. 100 patients with suspected or known bladder cancer aged ≥18 years undergoing initial or repeat ambulatory TURBT will be enrolled. The change in Quality of Recovery 15 score, a measure of the quality of recovery, between the day of surgery and postoperative day 1 will be compared between the ERAS and control groups.

Ethics and dissemination

The trial has been approved by the Johns Hopkins Institutional Review Board #00392063. Participants will provide informed consent to participate before taking part in the study. Results will be reported in a separate publication.

Trial registration number

NCT05905276
Head Injury Evaluation and Ambulance Diagnosis (HOME) Study protocol: a feasibility study assessing the implementation of the Canadian CT Head Rule in the prehospital setting
Authors: Alqurashi Naif , Bell Steve , Carley Simon D , Lecky Fiona , Body Richard
Published: June 2024

Introduction

Traumatic brain injury (TBI) is a common presentation in the prehospital environment. At present, paramedics do not routinely use tools to identify low-risk patients who could be left at scene or taken to a local hospital rather than a major trauma centre. The Canadian CT Head Rule (CCHR) was developed to guide the use of CT imaging in hospital. It has not been evaluated in the prehospital setting. We aim to address this gap by evaluating the feasibility and acceptability of implementing the CCHR to patients and paramedics, and the feasibility of conducting a full-scale clinical trial of its use.

Methods and analysis

We will recruit adult patients who are being transported to an emergency department (ED) by ambulance after suffering a mild TBI. Paramedics will prospectively collect data for the CCHR. All patients will be transported to the ED, where deferred consent will be taken and the treating clinician will reassess the CCHR, blinded to paramedic interpretation. The primary clinical outcome will be neurosurgically significant TBI. Feasibility outcomes include recruitment and attrition rates. We will assess acceptability of the CCHR to paramedics using the Ottawa Acceptability of Decision Rules Instrument. Interobserver reliability of the CCHR will be assessed between paramedics and the treating clinician in the ED. Participating paramedics and patients will be invited to participate in semistructured interviews to explore the acceptability of trial processes and facilitators and barriers to the use of the CCHR in practice. Data will be analysed thematically. We anticipate recruiting approximately 100 patients over 6 months.

Ethics and dissemination

This study was approved by the Health Research Authority and the Research Ethics Committee (REC reference: 22/NW/0358). The results will be published in a peer-reviewed journal, presented at conferences and will be incorporated into a doctoral thesis.

Trial registration number

ISRCTN92566288.
High-resolution mapping of essential maternal and child health service coverage in Nigeria: a machine learning approach
Authors: Kawakatsu Yoshito , Mosser Jonathan F , Adolph Christopher , Baffoe Peter , Cheshi Fatima , Aiga Hirotsugu , Watkins D A , Sherr Kenneth H
Published: June 2024

Background

National-level coverage estimates of maternal and child health (MCH) services mask district-level and community-level geographical inequities. The purpose of this study is to estimate grid-level coverage of essential MCH services in Nigeria using machine learning techniques.

Methods

Essential MCH services in this study included antenatal care, facility-based delivery, childhood vaccinations and treatments of childhood illnesses. We estimated generalised additive models (GAMs) and gradient boosting regressions (GB) for each essential MCH service using data from five national representative cross-sectional surveys in Nigeria from 2003 to 2018 and geospatial socioeconomic, environmental and physical characteristics. Using the best-performed model for each service, we map predicted coverage at 1 km2and 5 km2spatial resolutions in urban and rural areas, respectively.

Results

GAMs consistently outperformed GB models across a range of essential MCH services, demonstrating low systematic prediction errors. High-resolution maps revealed stark geographic disparities in MCH service coverage, especially between rural and urban areas and among different states and service types. Temporal trends indicated an overall increase in MCH service coverage from 2003 to 2018, although with variations by service type and location. Priority areas with lower coverage of both maternal and vaccination services were identified, mostly located in the northern parts of Nigeria.

Conclusion

High-resolution spatial estimates can guide geographic prioritisation and help develop better strategies for implementation plans, allowing limited resources to be targeted to areas with lower coverage of essential MCH services.
Patient and proxy perspectives in decision-making for geriatric hip fracture management in the Netherlands: a qualitative study
Authors: Laane Duco , Kroes Thamar , van den Berg Arda , de Jongh Mariska , The Regina , Van der Velde Detlef , Nijdam Thomas
Published: June 2024

Objective

The objective of this study was to explore the perspectives with the decision-making process between surgery and palliative, non-operative management of geriatric hip fracture patients and their proxies.

Design

Aqualitative interview study was performed. Patients and proxies were asked to participate in semi-structured interviews. Data were analysed using reflexive thematic analysis according to Braun and Clarke’s six-step guide.

Setting and participants

Hip fracture patients in the Netherlands were eligible for inclusion. For hip fracture patients with a pre-existing diagnosis of dementia and for patients who opted for palliative, non-operative management, proxies were included.

Results

A total of 16 interviews were conducted, consisting of 4 patient interviews and 12 proxy interviews. Five themes were identified during thematic analysis: (1) underlying patient values, (2) the provision of information, (3) reasons to consider either palliative, non-operative management or surgery, (4) involvement in decision and (5) realisation of expectations. Information provided by the physician varied in terms of desired level of detail but involved discussing the advantages and disadvantages of surgery and palliative, non-operative management. Patients and proxies underscored the importance of achieving optimal quality of life, and the disparity between expected and actual treatment outcomes was unpleasant and negatively influenced the overall experience.

Conclusions

In-depth analysis provided a unique insight into the patient and proxy perspectives in shared decision-making for geriatric hip fracture management in the acute setting. Overall, there were differences between reported experiences and preferences of participants. This heterogeneity stresses the importance of keeping a person-centred approach during shared decision-making. Other key considerations during shared decision-making include physicians informing patients from professional experience and communicating sensitively about both treatment options and prognosis. Physicians should aim to provide realistic, sensitive and timely information to both patients and proxies during the choice between curation and palliation for their hip fracture.
Can the 128-Hz tuning fork be an alternative to the biothesiometer for diabetic peripheral neuropathy screening? A cross-sectional study in a tertiary hospital in East India
Authors: Chattopadhyay Sujaya , Goswami Soumik , Sengupta Nilanjan , Baidya Arjun
Published: June 2024

Introduction

Diabetic neuropathy is frequently underdiagnosed and undertreated. Logistic problems accompany the routine use of the biothesiometer. Hence, we attempted to find a more easily available alternative.

Research design and methods

149 patients with diabetes visiting the outpatient endocrinology clinic were assessed for vibration sense using a 128-Hz tuning fork (absolute timing method) and a biothesiometer. A reading of >25 V on the biothesiometer (known as vibration perception threshold or VPT) was taken as the diagnostic criterion for severe neuropathy while >15 V was used as an indicator of the mild form. The sensitivity and specificity were calculated by constructing the receiver operating characteristic curve (ROC). A p value of <0.05 was considered as statistically significant.

Results

The timed tuning fork (TTF) test showed a statistically significant correlation with the VPT measurements (r=−0.5, p=0.000). Using the VPT findings as a reference, a timed tuning fork cut-off of 4.8 s was 76% sensitive and 77% specific in diagnosing mild neuropathy while absent tuning fork sensation demonstrated 70% sensitivity and 90% specificity in detecting severe neuropathy.

Conclusions

The tuning fork test demonstrated significant sensitivity and specificity in diagnosing diabetic peripheral neuropathy when compared against the biothesiometer. A cut-off of 4.8 s can be a useful indicator of the early stages of onset of the condition.
Global prevalence ofBorrelia burgdorferiandAnaplasma phagocytophilumcoinfection inIxodestick populations: protocol for a systematic review and meta-analysis
Authors: Luo Suyi , Bao Fukai , Wu Hanxin , Ma Weijie , Zhu Liangyu , Huang Xun , Yang Rui , Peng Li , Gao Li , Wu Xinya , Zhong Lei , Dong Yan , Li Bingxue , Ma Weijiang , Liu Aihua
Published: June 2024

Introduction

Ixodesticks are pivotal in transmitting diseases like Lyme disease and human granulocytic anaplasmosis, caused byBorrelia burgdorferiandAnaplasma phagocytophilum, respectively. These pathogens not only affect humans through single or multiple tick bites but also pose risks to animal hosts, leading to potential coinfections. Despite regional studies indicating significant prevalence, their global coinfection data remain sparse. This study aims to bridge this gap through a systematic review and meta-analysis ofB. burgdorferiandA. phagocytophilumcoinfections inIxodesticks worldwide. Addressing data limitations and study variability, it seeks to provide a nuanced understanding of coinfection patterns, their epidemiological implications and inform targeted prevention strategies.

Methods and analysis

Following Preferred Reporting Items for Systematic Review and Meta-analysis Protocols 2015 guidelines and PROSPERO registration, this study will undertake a thorough database search without constraints on language or publication date, using standardised screening and data extraction protocols. The quality and bias of studies will be evaluated using Joanna Briggs Institute tools. In the statistical analysis phase, conducted in R, we will initially determine the use of fixed or random-effects models based on the assessment of data heterogeneity. This choice will guide the framework for subsequent analyses. Within the selected model’s framework, we will perform subgroup analyses and meta-regression to investigate the effects of various factors, ensuring that each step is tailored to the initial model selection to maintain analytical consistency.

Ethics and dissemination

As this study does not involve clinical research or data collection from subjects, ethical approval is not required. We will uphold ethical standards in synthesising and reporting data. Study outcomes will be published in peer-reviewed journals, communicating findings to the scientific community and contributing to the understanding ofIxodestickborne diseases.

PROSPERO registration number

CRD42023449735.
Career choice motivation and professionalism in medical students in China: a gender-stratified analysis
Authors: Shi Yan , Gao Hunmin , Yan Yumeng , Li Xue , Ping Weiwei , Yang Hui , Du Yiqian
Published: June 2024

Objective

To examine the associations between career choice motivation and professionalism among medical students based on gender in the context of COVID-19.

Design

Cross-sectional study.

Setting

The study was conducted at a medical school in China.

Methods

A total of 1421 second-year to fourth-year medical students participated in the survey using cluster sampling. They were asked to complete questionnaires on demographic information, career choice motivation and professionalism. Linear regression models were used to analyse the relationship between career choice motivations and professionalism based on gender differences.

Results

Female medical students outperformed males in professionalism (p<0.001). Third-year medical students have the lowest level of professionalism irrespective of gender. In addition, females have more intrinsic career choice motivation than males. Students motivated bypersonal interesthad the highest level of professionalism, while those whogo with the flowhad the lowest. According to the linear regression analysis, the motivationadvice from parentswas the factor of professionalism in male medical students (p<0.05). However, the motivationgo with the flownegatively influenced the professionalism of female medical students (p<0.05).

Conclusion

The level of professionalism differed between genders based on different career choice motivations. Career choice motivation can be used as an entry point for professionalism education among medical students. Targeted interventions should be implemented to improve professionalism, especially for male medical students and unmotivated students.
Feasibility and acceptability of a telerehabilitation intervention on patients undergoing total knee arthroplasty in Iran: randomised controlled trial protocol
Authors: Farrokhi Navvab , Sarzaeem Mohammad Mahdi , Feizi Davood
Published: June 2024

Introduction

Telerehabilitation is a promising avenue to enhance post-total knee arthroplasty (TKA) rehabilitation by improving accessibility, convenience and cost-effectiveness. Despite its potential benefits, its application in the context of TKA in Iran is in its early stages, lacking comprehensive studies on feasibility, acceptance and programme adherence. This article outlines a protocol for an open-label, parallel-group, randomised controlled trial investigating the impact of a 4 week telerehabilitation programme alongside usual care.

Methods

Thirty patients (aged 50–90) undergoing TKA for severe Knee Osteoarthritis at Atiyeh Hospital in Tehran, Iran, will be recruited using block randomisation. Participants will be assigned to either the intervention group, receiving telerehabilitation or the control group without telerehabilitation. The intervention will include virtual physiotherapy sessions thrice weekly, lasting 30–45 min each, over 4 weeks. The primary objective is to assess the feasibility and acceptability of telerehabilitation, measured through recruitment and attrition rates, questionnaire completion rates, patient satisfaction using appropriate questionnaire and adherence to the intervention. Secondary outcomes encompass four Knee Injury and Osteoarthritis Outcome Score questionnaire subscales (function in Activities of Daily Living, Pain, Symptoms, Quality of Life). Patient global assessment will use a standardised question. An online survey will evaluate walking assistant device usage, exercise adherence and adverse events. The number of individuals receiving in-person rehabilitation will be documented after the first postoperative surgeon visit. Assessments occur at baseline and 4 weeks postsurgery.

Analysis

Statistical analysis, including independent samples t-test, paired samples t-test, χ2 test, Fisher’s exact test, analysis of covariance and multiple linear regression, will use SPSS software version 16, with significance set at p<0.05.

Ethics and dissemination

Approved by AJA University of Medical Sciences Ethics Committee (IR.AJAUMS.REC.1402.126), trial results will be presented to relevant groups and published in peer-reviewed journals.

Trial registration number

TCTR20231020004.
Validation of the Seizure-Related Impact Assessment Scale (SERIAS): a study protocol
Authors: Foster Emma , Conquest Alison , Ewart Chris , Nicolo John-Paul , Rayner Genevieve , Winton-Brown Toby , O'Brien Terence J , Kwan Patrick , Malpas Charles , French Jacqueline A
Published: June 2024

Introduction

This study aims to validate the Seizure-Related Impact Assessment Scale (SERIAS). This novel patient-reported outcome measure (PROM) compares the ‘trade-off’ between seizures and treatment-related adverse effects, and measures epilepsy disability qualitatively and quantitively. It fills an important gap in PROMs for epilepsy clinical trials and practice.

Methods and analysis

Adults with epileptologist-confirmed epilepsy from two Australian Epilepsy Centres are being recruited. People with functional seizures, or who are unable to self-complete English-language validated instruments are excluded. Participants providing informed consent are invited to complete questionnaires at baseline, 3 and 6 months later. SERIAS includes five questions that ask about the number of days per month that seizures or treatment-related adverse effects partially or fully impact work/home/school and family/social/non-work activities, as well as a visual analogue scale regarding epilepsy-related disability. SERIAS is completed alongside seven internationally validated instruments measuring treatment-related adverse effects, mood disorders and quality of life. Target recruitment is n=100, ensuring>50 people complete all questionnaires at all timepoints. Comprehensive psychometric analysis will be performed. Convergent validity will be investigated using bivariate correlations with relevant measures. Reliability will be investigated using Cronbach’s alpha, McDonald’s omega and test–retest correlation coefficients. SERIAS will be a novel PROM for epilepsy clinical trials and practice.

Ethics and dissemination

Multisite ethics approval was granted by the Alfred Health Ethics Committee (HREC 17/23). Results of this study will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences.

Trial registration number

ACTRN12623000599673.
Weekly iron-folic acid supplementation and its impact on children and adolescents iron status, mental health and school performance: a systematic review and meta-analysis in sub-Saharan Africa
Authors: Kedir Shemsu , Hassen Abate Kalkidan , Mohammed Bekri , Ademe Beyene Wondafrash
Published: June 2024

Objective

This systematic review and meta-analysis aimed to comprehensively assess the impact of weekly iron-folic acid supplementation (WIFAS) on the nutrition, health and educational outcomes of children and adolescents in sub-Saharan Africa.

Design

A systematic review and meta-analysis was used.

Data sources

Five databases, namely, MEDLINE, Scopus, Web of Science, Cochrane Library and Google Scholar, were systematically searched for relevant articles up to 23 August 2023.

Eligibility criteria

It was focused on randomised controlled trials involving children and adolescents in sub-Saharan Africa, exploring the effects of iron supplementation on various outcomes, such as serum ferritin and haemoglobin levels, anaemia, mental health and school performance.

Data extraction and synthesis

The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with two independent reviewers thoroughly evaluating each paper. Using the Cochrane risk of bias tool, we evaluated the certainty of evidence such as the risk of bias, inconsistency, indirectness, imprecision and publication bias.

Results

A systematic review of 10 articles revealed that WIFAS significantly increased serum ferritin levels in adolescent girls (Hedge’s g=0.53, 95% CI 0.28 to 0.78; heterogeneity I2=41.21%, p<0.001) and haemoglobin levels in school-aged children (Hedge’s g=0.37, 95% CI 0.01 to 0.73; heterogeneity I2=91.62%, p<0.001). The analysis further demonstrated a substantial reduction in the risk of anaemia by 20% (risk ratio=0.8, 95% CI 0.69 to 0.93; heterogeneity I2=28.12%, p<0.001).

Conclusion

WIFAS proved effective in enhancing serum ferritin and haemoglobin concentrations and lowering the risk of anaemia in school-aged children and adolescents compared with a placebo. Similarly, there are not enough studies to examine the effects of WIFAS on school performance. However, information regarding mental health problems, mortality and potential side effects remains insufficient.

PROSPERO registration number

CRD42023397898.
Comparing the diagnostic efficacy of optical coherence tomography and frozen section for margin assessment in breast-conserving surgery: a meta-analysis
Authors: Fan Shishun , Zhang Huirui , Meng Zhenyu , Li Ang , Luo Yuqing , Liu Yueping
Published: June 2024

Aims

This meta-analysis assessed the relative diagnostic accuracy of optical coherence tomography (OCT) versus frozen section (FS) in evaluating surgical margins during breast-conserving procedures.

Methods

PubMed and Embase were searched for relevant studies published up to October 2023. The inclusion criteria encompassed studies evaluating the diagnostic accuracy of OCT or FS in patients undergoing breast-conserving surgery. Sensitivity and specificity were analysed using the DerSimonian and Laird method and subsequently transformed through the Freeman-Tukey double inverse sine method.

Results

The meta-analysis encompassed 36 articles, comprising 16 studies on OCT and 20 on FS, involving 10 289 specimens from 8058 patients. The overall sensitivity of OCT was 0.93 (95% CI: 0.90 to 0.96), surpassing that of FS, which was 0.82 (95% CI: 0.71 to 0.92), indicating a significantly higher sensitivity for OCT (p=0.04). Conversely, the overall specificity of OCT was 0.89 (95% CI: 0.83 to 0.94), while FS exhibited a higher specificity at 0.97 (95% CI: 0.95 to 0.99), suggesting a superior specificity for FS (p＜0.01).

Conclusions

Our meta-analysis reveals that OCT offers superior sensitivity but inferior specificity compared with FS in assessing surgical margins in breast-conserving surgery patients. Further larger well-designed prospective studies are needed, especially those employing a head-to-head comparison design.

PROSPERO registration number

CRD42023483751.
Creating elastase aneurysms in rabbits: a video primer
Authors: Cortese Jonathan , Bayraktar Esref Alperen , Oliver Alexander A , Bilgin Cem , Ding Yong-Hong , Ueki Yasuhito , Lortscher Sarah , Brinjikji Waleed , Kadirvel Ramanathan , Kallmes David F
Published: June 2024

The New Zealand rabbit elastase-induced arterial aneurysm of the right common carotid artery remains a widely used model for assessing the effectiveness and safety of new neuroendovascular devices.1 This model offers a simple and reliable platform for pre-clinicalin vivoinvestigations, crucial for comprehending the biological processes underlying aneurysm healing after endovascular treatment.2 Notably, the induced aneurysm exhibits morphological, hemodynamic, and histological characteristics similar to human intracranial aneurysms. The creation of the aneurysm is performed using open and endovascular techniques. Each step of the procedure requires a meticulous and controlled gesture to ensure reproducibility of the aneurysm and minimize animal misuse. In video 1 we present a step-by-step procedural guide for aneurysm creation and follow-up. We hope this resource will help in promoting this model and provide useful guidance for researchers in the field.

Video 1

Surgical procedure of creating elastase-induced aneurysms in rabbits.
Anatomical pattern of entheseal and synovial fibroblast activation in patients with psoriasis and its risk of developing psoriatic arthritis
Authors: Corte Giulia , Atzinger Armin , Temiz Selahattin Alp , Noversa de Sousa Rita , Mutlu Melek Yalcin , Schoenau Verena , Raimondo Maria Gabriella , Kleyer Arnd , Kuwert Torsten , Ramming Andreas , Simon David , Sticherling Michael , Schmidkonz Christian , Schett Georg , Fagni Filippo
Published: June 2024

Objectives

To assess the presence and anatomical distribution of activated fibroblasts in the joints and entheses of patients with psoriasis with arthralgia and to test how fibroblast activation visualised by68gallium-labelled fibroblast activation protein inhibitor-04 (68Ga-FAPI-04)-positron emission tomography (PET)/CT correlates with clinical tenderness, musculoskeletal ultrasound findings and progression to psoriatic arthritis (PsA).

Methods

We conducted a prospective cohort study in patients with psoriasis and arthralgia who underwent clinical and ultrasound evaluation and whole-body PET/CT imaging with68Ga-FAPI-04.68Ga-FAPI-04 uptake at synovial and entheseal sites was assessed by maximal standardised uptake values (SUVmax) and PET/CT Joint Index (JI); logistic regression models were used to investigate its correlation with clinical and ultrasound findings. Survival analyses were performed on patients with at least 6 months of follow-up.

Results

36 patients with psoriasis were enrolled.68Ga-FAPI-04 uptake was found in 318 (7.9%) joints and 369 (7.3%) entheses in 29 (80.6%) participants, with a mean SUVmax (SD) of 3.2 (1.8) for joints and 2.9 (1.6) for entheses. Large joints and the lower limbs were predominantly affected. A significant positive relationship was found between68Ga-FAPI-04-PET/CT signal intensity and the 68 tender joint count (SUVmax: p<0.001; PET/CT-JI: p<0.001) and tender entheses count (SUVmax: p<0.001; PET/CT-JI: p=0.002). No correlations were found with ultrasound findings (SUVmax: p=0.969; PET/CT-JI: p=0.720). Patients with relevant synovio-entheseal68Ga-FAPI-04 uptake showed a statistically significant higher risk of developing PsA (p=0.02), independent of ultrasound findings.

Conclusions

Patients with psoriasis presenting with arthralgia show localised signs of resident tissue activation in joints and entheses, which are associated with higher risk of developing PsA.